Auto Insurance; Apparent Conflict Between Mandatory IME Requirement and Section 1796(a) of the MVFRL

Sayles v. Allstate Ins. Co., 260 F.Supp.3d 427 (M.D.Pa. 2017); Scott v. Travelers Commercial Ins. Co., 2017 WL 6403010 (M.D. Pa. 2017), Petition of Third Circuit Court of Appeals, Nos. 17- 3463 and 16–4034, for Certification of Question of State Law granted Oct. 15, 2018, appeal dockets 58 and 59 MAP 2018 

The Pennsylvania Supreme Court granted the Third Circuit’s petition for certification of a question of state law concerning Section 1796(a) of the Pennsylvania Motor Vehicle Financial Responsibility Law (MVFRL) in two appeals pending from the Middle District of Pennsylvania. The auto insurance policies in question contain a requirement common to many policies that a person seeking coverage or benefits must submit to medical examinations when and as often as the insurer may reasonably require, as a condition precedent to the payment of first-party medical benefits.  Section 1796(a) of the MVFRL, however, provides that “[w]henever the mental or physical condition of a person is material to any claim for medical, income loss or catastrophic loss benefits, a court of competent jurisdiction . . . may order the person to submit to a mental or physical examination by a physician” but only if there is “good cause shown.”

In Sayles, the court predicted that the Pennsylvania Supreme Court would find the insurer’s medical examination provision in direct conflict with Section 1796(a). In Scott, the court made the same prediction.

The Supreme Court will resolve the question, having stated it as follows:

Whether, under Pennsylvania law, a contractual provision in a motor vehicle insurance policy that requires an insured to submit to an independent medical examination by a physician selected by the insurer, when and as often as the insurer may reasonably require, as a condition precedent to the payment of first -party medical benefits under that policy, conflicts with the Motor Vehicle Financial Responsibility Law, 75 Pa.C.S. §1796(a), and is therefore void as against public policy.


For more information, contact Kevin McKeon or Dennis Whitaker.