State Farm Ins. Companies v. Hunt

569 A.2d 365, 390 Pa. Super. 620, 1990 Pa. Super. LEXIS 255

• Court: Supreme Court of Pennsylvania
• Decided: February 2, 1990
• Docket: 552
• Status: Published

Opinions

WIEAND, Judge:

The order which is now before this Court for review directed Donna Hunt, the appellant, to submit to a physical examination pursuant to the Pennsylvania Motor Vehicle Financial Responsibility Act.¹

The statute, at 75 Pa.C.S. § 1796, authorizes a court to require a claimant to submit to a mental or physical examination by a physician upon a showing of good cause whenever the mental or physical condition of the claimant is relevant to the claim.² The requirement of good cause entails more than relevancy. It means that the reasons alleged in a petition must rise to a level of specificity which will insure that a claimant will not be forced to submit to unnecessary examinations in bad faith. State Farm Mutual Auto Insurance Co. v. Allen, 375 Pa.Super. 319, 323, 544 A.2d 491, 492 (1988), quoting State Farm Mutual Auto Insurance Co. v. Zachary, 370 Pa.Super. 386, 389-390, 536 A.2d 800, 801 (1987). “[The] petition must illustrate a need, rather than a mere desire, for an independent medical examination.” State Farm Mutual Auto Insurance Co. v. Zachary, supra. The existence of good cause will vary from case to case according to the nature of the alleged injury and the type of examination requested. Whether good cause has been shown must depend upon the exercise of sound discretion by the trial court, and the exercise of such discretion will not be reversed absent a palpable abuse thereof. Before ordering a party to submit to an examination, however, a trial court should require a showing that a bona fide controversy exists regarding the nature of the claimant’s injuries. It must also be shown that the requested mental or physical examination will substantially aid the insurer in evaluating the claim. State Farm Mutual Auto Insurance Co. v. Allen, supra; State Farm Mutual Auto Insurance Co. v. Zachary, supra. Whether the same information can be obtained by other means is also a proper consideration. State Farm Mutual Auto Insurance Co. v. Zachary, supra.

Donna Hunt was injured as a result of a vehicular accident on January 3, 1988. Following the accident, she did not receive any hospital treatment, either as an in-patient or as an out-patient. On the day following the accident, however, she began a series of treatments with Jack Taylor, a chiropractor. State Farm Insurance Company was the first party insurance carrier for Donna Hunt and paid all of Taylor’s bills up to and including December, 1988.³ In response to an inquiry made by State Farm in March, 1988, Taylor estimated that Hunt would require treatment for “approximately 12 to 24 weeks.” Despite this estimate, Taylor continued to treat the claimant up to and including March, 1989, when a petition to compel a physical examination was filed. In the interim, Hunt had refused State Farm’s requests that she voluntarily present herself for an examination by an orthopedic surgeon to determine whether she required continuing chiropractic treatment. Neither objective evidence nor medical opinion has been submitted to State Farm to support a continuing need for chiropractic treatments. The trial court found that these circumstances constituted good cause for requiring Hunt to submit to a physical examination. We find therein no abuse of discretion.

That there is a bona fide need for a physical examination of Donna Hunt seems clear. Although never hospitalized, she has been receiving continuous chiropractic treatments for a period in excess of fourteen months. This period exceeded by approximately five months the estimated period of treatment submitted to the insurer by Hunt’s own chiropractor. Thus, it seems patently clear that a physical examination by a physician will substantially aid the insurer in evaluating Hunt’s claim, in determining the nature of her injuries, and in assessing the need for continuing treatment. Indeed, it may appear that other, more satisfactory means are available to correct the condition from which she purports to suffer. Because good cause for a physical examination was shown, the learned trial judge did not abuse his discretion when he granted the insurer’s petition and required the claimant to submit to a physical examination.

Appellant argues that the trial court’s order was premature because depositions had not been taken pursuant to Pa.R.C.P. 209. In this case, however, depositions were unnecessary to establish good cause for requiring the claimant to submit to a physical examination. From the petition and answer, it is abundantly clear that the insurer was being asked to pay for continued treatments, that a bona fide dispute existed as to the need for continued treatments, that the insured had not been examined by a medical doctor or, if so, that the results of such an examination had not been made available to the insurer, and that a physical examination of the claimant would substantially assist the insurer in evaluating the claim and in determining the future course of any treatment which the claimant might require. From the pleadings, therefore, the trial court could determine, as it did, that the test for “good cause” had been met as defined in State Farm Mutual Auto Insurance Co. v. Allen, supra, and State Farm Mutual Auto Insurance Co. v. Zachary, supra.

The order of the trial court is affirmed.

TAMILIA, J., files a dissenting Opinion.

1 . This is an appealable order. See: Keystone Insurance Co. v. Caputo, 365 Pa.Super. 431, 529 A.2d 1134 (1987).

2 . Specifically, the statute provides as follows:

(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.

3 . These payments were in the approximate sum of four thousand, five hundred ($4,500) dollars.