Sayles v. Allstate Insurance Company

CourtDistrict Court, M.D. Pennsylvania
DecidedSeptember 15, 2023
Docket3:16-cv-01534
StatusUnknown

This text of Sayles v. Allstate Insurance Company (Sayles v. Allstate Insurance Company) is published on Counsel Stack Legal Research, covering District Court, M.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sayles v. Allstate Insurance Company, (M.D. Pa. 2023).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA

SAMANTHA SAYLES, : Civil No. 3:16-CV-1534 : Plaintiff, : : (Judge Mannion) v. : : (Magistrate Judge Carlson) ALLSTATE INSURANCE CO., : : Defendant. :

MEMORANDUM OPINION

I. Factual Background and Procedural History We are now called upon, once again, to consider a longstanding legal saga. In this case, we most assuredly do not write upon a tabula rasa. Quite the contrary, over the past seven years, this litigation has commanded the attention of at least five judges of this court, as well as the Third Circuit Court of Appeals and the Pennsylvania Supreme Court. As a result of this litigation, the issues before us have been substantially narrowed and focused. This lawsuit began its way in federal court on July 26, 2016, when Allstate removed Ms. Sayles’ complaint from the Court of Common Pleas of Pike County. (Doc. 1). Ms. Sayles’ state court complaint was cast as a class action brought against Allstate on behalf of the plaintiff and other similarly situated Allstate insureds. (Doc. 1-1). In her complaint, Ms. Sayles alleged that she had been injured in a 2015 motor vehicle accident at a time when she was insured through Allstate. (Id., ¶¶ 13-15). According to the complaint, Allstate had refused to accord benefits to Sayles.

Instead, citing to provisions of its policy, Allstate ordered Ms. Sayles to submit to an independent medical examination (“IME”) by a doctor of its choosing as a condition for consideration of her claim. (Id., ¶¶ 16-37). Notably, Ms. Sayles alleged

that Allstate sought to compel her and others to undergo these examinations without first obtaining a court order directing the examination or making a showing of good cause. (Id.) According to Sayles, this insurance company practice violated Section

1796(a) of the PMVFRL, which provides that: (a) General rule.--Whenever 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 or the administrator of the Catastrophic Loss Trust Fund for catastrophic loss claims may order the person to submit to a mental or physical examination by a physician. The order may only be made upon motion for good cause shown. The order shall give the person to be examined adequate notice of the time and date of the examination and shall state the manner, conditions and scope of the examination and the physician by whom it is to be performed. If a person fails to comply with an order to be examined, the court or the administrator may order that the person be denied benefits until compliance.

75 Pa. Cons. Stat. § 1796(a). Sayles’ complaint construed this statutory text as prescribing the sole and exclusive path for obtaining an IME from an insurance policy claimant in Pennsylvania. Since Allstate’s alleged practice of unilaterally requiring IMEs without the benefit of a court order, or finding of good cause, did not satisfy these statutory requirements, Sayles asserted that with respect to herself and other class members Allstate violated the PMVFRL when it conditioned

consideration of a claim upon completion of an IME. Based upon these averments, Sayles brought individual and class claims seeking a declaratory judgment that Allstate must follow the court order

requirements of § 1796(a) when seeking to compel a claimant to submit to an IME. (Id., Count I). Sayles’ complaint also asserted individual and class claims for damages based upon this alleged violation of the requirements of § 1796(a). (Id., Count II).1 With the issues in this lawsuit framed in this fashion, the threshold

question presented by Sayles’ complaint was the issue of whether Allstate’s alleged practice of unilaterally requiring IMEs without the benefit of a court order, or finding of good cause, violated § 1796(a).

As to this issue the courts were divided, a fact which was recognized by the district court in 2017 when it ruled upon a motion to dismiss filed by Allstate. (Doc. 35). Because of the legal uncertainty surrounding this threshold question, Allstate

1 In addition, Sayles’ original complaint brought a series of additional claims under the Pennsylvania Unfair Trade Practices Act, Pennsylvania’s Insurance Bad Faith Act, as well as common law claims of breach of the duty of fair dealing, unjust enrichment, and intentional misrepresentation. (Id., Counts III-VIII). These claims were dismissed. (Docs. 35, 36). Sayles subsequently filed an amended complaint, (Doc. 54), which only pursues her PMVFRL claims and a companion breach of contract claim. (Doc. 54). Thus, currently the gravamen of this litigation is the allegation that Allstate’s practices violated the PMVFRL. sought, and obtained, leave to appeal this question to the United States Court of Appeals for the Third Circuit. (Docs. 37, 41, 42). The Court of Appeals, in turn,

certified this state law question regarding the interplay between § 1796(a) and the terms of the Allstate policy to the Pennsylvania Supreme Court for its determination. On November 20, 2019, more than three years after this lawsuit commenced, the

Pennsylvania Supreme Court definitely resolved this issue, holding that: [I]nsurers are required to follow Section 1796(a) when seeking to compel an insured to submit to an IME, when the insured has refused to voluntarily comply with such a request, and any insurance policy which purports to set requirements by which an insurer may compel an insured to undergo an IME is required to comport with that section.

Sayles, 219 A.3d at 1124. Accordingly, the State Supreme Court concluded that: “these IME policy provisions manifestly conflict with, and are repugnant to, the statutory protections for individuals insured under automobile insurance policies regarding the conduct of IMEs as established by the General Assembly in Section 1796(a); consequently, they are void as against the public policy of this Commonwealth.” Id. at 1126–27. Given this definitive ruling by the state’s highest court, the Third Circuit remanded this case to the district court for further proceedings. Sayles v. Allstate Ins. Co., No. 17-3463, 2019 WL 11317938 (3d Cir. Dec. 27, 2019). With this merits issue definitively resolved, the parties then turned to the

question of whether Sayles could maintain a class action lawsuit for damages in light of the determination that Allstate’s policy provisions were void as against public policy. What then ensued was a protracted period of pretrial class certification

discovery, which spanned some two years and culminated on March 17, 2022. (Doc. 85). As part of this discovery on July 8, 2020, Plaintiff served her first Demand for Production of Documents upon Allstate which sought the following documents:

9. For each year from February 12, 1984 , to the present, please provide a list of all of insureds, including names and addresses, insured by a Pennsylvania automobile insurance policy, that Allstate denied PIP benefits to based on the result of the mental or physical exam of the insured, as well as the amount of benefits that Allstate denied as to each insured based on the result of the mental or physical exam and any documents related to Allstate ' s denial of said benefits.

(Doc. 114-1, at 12).

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Sayles v. Allstate Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sayles-v-allstate-insurance-company-pamd-2023.