Nationwide Insurance v. Hoch

36 Pa. D. & C.4th 256, 1997 Pa. Dist. & Cnty. Dec. LEXIS 88
CourtPennsylvania Court of Common Pleas, Alleghany County
DecidedJanuary 28, 1997
Docketno. GD96-18851
StatusPublished
Cited by6 cases

This text of 36 Pa. D. & C.4th 256 (Nationwide Insurance v. Hoch) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Alleghany County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nationwide Insurance v. Hoch, 36 Pa. D. & C.4th 256, 1997 Pa. Dist. & Cnty. Dec. LEXIS 88 (Pa. Super. Ct. 1997).

Opinion

WETTICK, J.,

Respondent was involved in an automobile accident in November 1995. At the time of the accident, respondent was insured under a policy of motor vehicle liability insurance issued by Nationwide Insurance Company. Respondent contends that she continues to be disabled as a result of [258]*258injuries sustained in the accident. Nationwide continues to make payments for her wage losses.

The subject of this opinion and order of court is Nationwide’s petition to compel an independent medical examination. Under section 1796(a) of the Motor Vehicle Financial Responsibility Law, 75 Pa.C.S. §1796, insurance companies may file a petition to compel an insured to submit to a physical examination by a physician selected by the insurance company whenever the physical condition of a person is material to any claim for income loss benefits. This legislation provides that a court may order such an examination only “for good cause shown.”

Under the good cause standard, an insurance company’s petition must contain factual allegations showing that a medical examination is warranted. Allegations showing only a desire of the insurance company for a physical examination are insufficient. The insurance company is not entitled to a medical examination until it has pursued non-intrusive means to obtain reliable information concerning the insured’s physical condition such as providing the insured with the opportunity to submit medical records from her treating physician addressing any questions of the insurance company. At the minimum, the petition should explain why the medical records which the treating physicians have supplied have not eliminated reasonable doubt as to the validity of the claim and why the proposed physical examination will substantially assist the insurance company in evaluating the claim. State Farm Insurance Companies v. Swantner, 406 Pa. Super. 235, 594 A.2d 316 (1991), alloc. denied, 530 Pa. 633, 606 A.2d 903 (1992).

In the present case, the petition on its face fails to set forth good cause for the examination. The petition contains only conclusory allegations that the insured’s [259]*259physical condition is in controversy and that without the physical examination which the insurance company seeks, the insurance company will be without sufficient information to properly evaluate the insured’s continuing claims.

Nationwide contends that I should issue a court order compelling the physical examination pursuant to a provision within the insurance agreement which provides for the insured, if injured, to “submit to examinations by company-selected physicians as often as the company reasonably requires.”

In Erie Insurance Exchange v. Dzandony, 39 D.&C.3rd 33 (1986), I rejected Erie Insurance’s request for an examination based on a similar policy provision. I concluded that the policy provision upon which Erie relied could not be enforced through the filing of a petition to compel a medical examination: “even if the clause upon which Erie relies could be included in an insurance policy subject to the provisions of the Motor Vehicle Financial Responsibility Law, the clause cannot be enforced through a petition. In the absence of legislation or rule of court providing for proceedings to be instituted by a petition, a lawsuit must be commenced by writ or complaint. Cohen v. Government Employees Insurance Company, 289 Pa. Super. 319, 433 A.2d 86 (1981). While section 1796 of the Motor Vehicle Financial Responsibility Law permits a court to act upon a petition where a physical examination is sought for good cause shown, this law does not authorize proceedings to be instituted by a petition if the relief requested is based upon an insurance company’s alleged rights under an insurance policy.” Erie Insurance Exchange v. Dzandony, supra.

I also concluded that under principles of contract law, Erie would not be entitled to specific performance of this contractual provision in its insurance policy.

[260]*260“Finally, the relief which Erie seeks in this action is a court order compelling specific performance of the contractual provision requiring the insureds to submit to a physical examination at Erie’s request. But an action for specific performance is available only if there is no adequate remedy at law. Cimina v. Bronich, [349] Pa. Super. [399, 405], 503 A.2d 427, 430 (1985) [rev’d, 517 Pa. 378, 537 A.2d 1355 (1988)]. Erie has an adequate remedy at law. If the insureds have materially breached their duties under the insurance agreement, thereby harming Erie, Erie may refuse to honor their claims. We recognize that it is questionable whether Erie would be entitled to this relief. Because section 1796 of the Motor Vehicle Financial Responsibility Law permits Erie to obtain a physical examination for good cause shown and further provides that a court may order that the insured be denied benefits until compliance with its order, as a matter of law Erie appears to have suffered no harm from the alleged breach of their insurance agreement. Paxton National Insurance Company v. Brickajlik, [342] Pa. Super. [621], 493 A.2d 764 (1985) [rev’d, 513 Pa. 627, 522 A.2d 531 (1987)]. But a showing of harm is also a prerequisite for a court order compelling specific performance.” Id. at 168. Also see, Paxton National Insurance Company v. Brickajlik, 513 Pa. 627, 522 A.2d 531 (1987); compare Hill v. Nationwide Insurance Company, 391 Pa. Super. 184, 570 A.2d 574 (1990); Vanderveen v. Erie Indemnity Company, 417 Pa. 607, 208 A.2d 838 (1965); Foster v. Colonial Assurance Company, 668 A.2d 174 (Pa. Commw. 1995).

In addition, I concluded that the policy provision cannot be enforced because it is inconsistent with the insurance company’s obligations under the Motor Vehicle Financial Responsibility Law.

[261]*261“The Motor Vehicle Financial Responsibility Law is comprehensive legislation governing the rights and obligations of the insurance company and the insured under liability insurance policies covering motor vehicles. This legislation specifies the benefits that must be provided and the benefits that must be made available (75 Pa.C.S. §§ 1711, 1712, 1715, 1731); it requires various exclusions (section 1718); and it provides for payment of benefits within 30 days after the insurance company receives reasonable proof of the amount of the benefits (section 1716). Provisions within an insurance contract which impose additional burdens on an insured before the insured may recover these benefits to which the insured is statutorily entitled are inconsistent with this legislative scheme.

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Cite This Page — Counsel Stack

Bluebook (online)
36 Pa. D. & C.4th 256, 1997 Pa. Dist. & Cnty. Dec. LEXIS 88, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nationwide-insurance-v-hoch-pactcomplallegh-1997.