Sayles v. Allstate Insurance Company

District Court, M.D. Pennsylvania·Decided October 17, 2024·No. 3:16-cv-01534·Unknown

Opinion

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

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

REPORT AND RECOMMENDATION

I. Introduction We are now called upon to consider the latest strange twist in this longstanding legal saga. In this case, we most assuredly do not write upon a tabula rasa. Quite the contrary, over the past eight years, this litigation has commanded the attention of at least six judges of this court, as well as the Third Circuit Court of Appeals and the Pennsylvania Supreme Court. As a result of this litigation, one would have thought that the issues before us would have been substantially narrowed and focused. However, the motion for injunctive relief filed by Allstate in this case (Doc. 146), suggests that, for the plaintiff, some issues never die—they simply move at the convenience of counsel to a different legal forum. Allstate has filed a motion asking this Court to intervene and enjoin Sayles from relitigating discovery issues that have long been foreclosed in this federal case through the expedient of filing a state court

summons and then propounding extensive discovery demands in state court that plainly relate to issues that have been resolved by this Court in the instant case. Finding that these efforts to circumvent the rulings of this court through the

belated filing of a state case are improper, for the reasons set forth below it is recommended that this motion for injunctive relief (Doc. 146), be granted. II. Factual Background and Procedural History 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). In this removal petition Allstate alleged, inter alia, that Sayles’ proposed state class action complaint was subject to removal since it entailed a potential class

exceeding 100 putative plaintiffs. Sayles immediately endeavored to escape federal court, filing a motion to remand her complaint to state court. (Doc. 5). On September 8, 2016, the district court denied this motion, establishing that jurisdiction over this dispute properly resided in federal court. (Doc. 17).

What then followed were years of merits litigation of Ms. Sayles’ state court complaint, which 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 Title 75 of the Pennsylvania Consolidated Statutes, 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 state law 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.

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 § 1796(a) claims and a companion breach of contract claim. (Doc. 54). 35). Because of the legal uncertainty surrounding this threshold question, Allstate 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).

Free access — add to your briefcase to read the full text and ask questions with AI

Sayles v. Allstate Insurance Company, (M.D. Pa. 2024).

Sayles v. Allstate Insurance Company (Sayles v. Allstate Insurance Company) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Califano v. Yamasaki
442 U.S. 682 (Supreme Court, 1979)
General Telephone Co. of Southwest v. Falcon
457 U.S. 147 (Supreme Court, 1982)
Chick Kam Choo v. Exxon Corp.
486 U.S. 140 (Supreme Court, 1988)
Wal-Mart Stores, Inc. v. Dukes
131 S. Ct. 2541 (Supreme Court, 2011)
Sperry Rand Corporation v. Bernard J. Rothlein
288 F.2d 245 (Second Circuit, 1961)
In Re Hydrogen Peroxide Antitrust Litigation
552 F.3d 305 (Third Circuit, 2009)