State Farm Mutual Automobile Insurance v. Allen

544 A.2d 491, 375 Pa. Super. 319, 1988 Pa. Super. LEXIS 1937
CourtSuperior Court of Pennsylvania
DecidedJune 30, 1988
Docket03206
StatusPublished
Cited by31 cases

This text of 544 A.2d 491 (State Farm Mutual Automobile Insurance v. Allen) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Farm Mutual Automobile Insurance v. Allen, 544 A.2d 491, 375 Pa. Super. 319, 1988 Pa. Super. LEXIS 1937 (Pa. Ct. App. 1988).

Opinions

MONTEMURO, Judge:

Appellant, State Farm Mutual Insurance Company, appeals from an order denying its petition to compel appellee, Philip Allen, to submit to a medical examination pursuant to the provisions of the Motor Vehicle Financial Responsibility Law.1

The pertinent facts leading up to this appeal are as follows. While insured by appellant, appellee was involved in an automobile accident in which he sustained various injuries, including an acute lumbo sacral strain and sprain and acute lumbo sacral radiculopathy. On September 23, 1986, appellant filed a petition seeking to compel appellee to submit to a medical examination pursuant to Section 1796 of the Vehicle Financial Responsibility Law. 75 Pa.C.S.A. § 1796. Appellee filed preliminary objections to this petition on October 1, 1986. However, the trial court was unaware that such preliminary objections had been filed. As a result, the petition was treated as an uncontested motion and the trial court granted the petition by order dated October 17, 1986. Because the trial court’s order made no mention of the disposition of appellee’s preliminary objections, appellee contacted the trial judge’s administrative staff and inquired about the status of his preliminary objections. Upon investigation, the trial court recognized that it had inadvertently overlooked appellee’s preliminary objections. The court then vacated its October 17, 1986 order and addressed on the merits the petition and answer thereto, which had been filed on October 30, 1986. Upon consideration of both the petition and answer the court denied appellant’s petition for a medical examination. In denying the petition the court concluded that appellant had failed to demonstrate the requisite “good cause” for compelling such an examination. In addition, the court found [322]*322that appellant’s petition was “replete with lies and falsehoods” and awarded appellee attorney’s fees and costs incurred in presenting the petition. This timely appeal followed. We affirm in part and reverse in part.

An action to compel an insured to submit to an independent medical examination may be commenced under the Pennsylvania Motor Vehicle Financial Responsibility Law under the following circumstances:

(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.C.S.A. § 1796 (emphasis supplied).

Appellant claims that the trial court erred in finding that it had failed to satisfy its burden of showing “good cause” for requiring appellee to submit to a medical examination. The standard for determining whether “good cause” exists for requiring an insured to submit to an independent medical examination under the Motor Vehicle Financial Responsibility Law was recently set forth by a panel of this court in State Farm Mutual Automobile Insurance Company v. Zachary, 370 Pa.Super. 386, 536 A.2d 800 (1987).2 In Zach[323]*323ary, we stated that in order to demonstrate “good cause”, “it is mandatory that the averments contained within the petition to compel a medical examination must rise to a level of specificity so as to ensure that the claimant will not be forced to submit to unnecessary examinations sought in bad faith.” Id., 370 Pa.Superior Ct. at 389-90, 536 A.2d at 801. We also adopted the analysis employed by the Allegheny Court of Common Pleas in Nationwide Insurance Co. v. Fandray, 12 Pa.D. & C.3d 65, 128 P.L.J. 63 (1979), as the yardstick by which to measure whether a petition has set forth sufficient reasons to justify an independent medical examination:

In Nationwide Insurance Co. v. Fandray, 12 [Pa.] D. & C.3d 65, 70, 128 P.L.J. 63 (1979), the Honorable R. Stanton Wettick of the Court of Common Pleas of Allegheny County commented on the requirements of “good cause shown”:
[t]o establish ‘good cause shown’, an insurer’s petition, at minimum, must contain facts showing that the proofs supplied in support of the claim are inadequate, that the proposed physical examination will substantially assist the insurer in evaluating the claim and that the amount of the claim justifies a court order compelling the claimant to submit to a physical examination.
Later, in Erie Insurance Exchange v. Dzandony [Dzadonyl [39] D. & C.3d. [33], 134 P.L.J. 166 (1986), Judge Wettick further opined that the petition must show that ‘the information supplied by the insured in support of his or her claim does not eliminate reasonable doubt as to the validity of the claim.’

While Zachary sets forth the standard for determining whether “good cause” exists, we have also recognized that where the petition and answer demonstrate that factual disputes exist, the case should proceed pursuant to Pa.R. C.P. 209. Keystone Insurance Company v. Caputo, 365 Pa.Super. 431, 435-36, 529 A.2d 1134, 1136 (1987). Under Rule 209, where a party denies material allegations in the petition, the petitioner must either take depositions on dis[324]*324puted factual issues or order the cause for argument on the petition and answer, thereby conceding the existence of all facts properly pleaded in the answer. In order to expedite the proceedings, the respondent may, after fifteen (15) days, obtain a rule to show cause why the petitioner should not take depositions or order the cause for argument on the petition and answer. Id.; See also Pa.R.C.P. 209. In Caputo, we further opined:

We have stated elsewhere that Rule 209 places no time limits on either party to proceed, and until either party takes action that would enable the court to make a factual determination or until some other force spurs matters along, the court cannot properly act on the petition. We do not mean by this that the court must sit and wait for the parties to bestir themselves. The court itself may set the time for the argument, so long as the parties are given notice.

Id. (citations omitted).

In the instant case, appellee filed an answer which denied most of the conclusory allegations contained in the petition. Accompanying the answer, appellee attached copies of the medical reports which had been provided to appellant. Appellant’s reply to the answer did not deny that these medical reports had been provided nor did appellant supply the trial court with an affidavit pointing to factual inconsistencies which would justify the taking of depositions or listing the case for argument pursuant to Rule 209.

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

Related

Estate of: Simpson, W.Appeal of: Colecchia, D.
2023 Pa. Super. 221 (Superior Court of Pennsylvania, 2023)
Estate of: Tomcik, C. Appeal of: Tomcik, J.
2022 Pa. Super. 192 (Superior Court of Pennsylvania, 2022)
Moyer, T. v. Leone, A.
2021 Pa. Super. 154 (Superior Court of Pennsylvania, 2021)
Wallace, R. v. State Farm Mutual Auto Ins.
Superior Court of Pennsylvania, 2020
A.F. and S.M. v. R.F. and S.F.
Superior Court of Pennsylvania, 2014
Scalia v. Erie Insurance Exchange
878 A.2d 114 (Superior Court of Pennsylvania, 2005)
Wood v. Geisenhemer-Shaulis
827 A.2d 1204 (Superior Court of Pennsylvania, 2003)
Kulp Ex Rel. Kulp v. Hrivnak
765 A.2d 796 (Superior Court of Pennsylvania, 2000)
Township of South Strabane v. Piecknick
686 A.2d 1297 (Supreme Court of Pennsylvania, 1996)
In Re Estate of Liscio
638 A.2d 1019 (Superior Court of Pennsylvania, 1994)
Whitmore v. Kenney
626 A.2d 1180 (Superior Court of Pennsylvania, 1993)
Kwasnik v. Hahn
615 A.2d 84 (Superior Court of Pennsylvania, 1992)
Gill v. Tax Claim Bureau
616 A.2d 198 (Commonwealth Court of Pennsylvania, 1992)
Township of Kennedy v. Kenvue Development, Inc.
603 A.2d 257 (Commonwealth Court of Pennsylvania, 1992)
COM., DEPT. OF TRANSP. v. Smith
602 A.2d 499 (Commonwealth Court of Pennsylvania, 1992)
Murphy v. Murphy
599 A.2d 647 (Superior Court of Pennsylvania, 1991)
State Farm Insurance Companies v. Swantner
594 A.2d 316 (Superior Court of Pennsylvania, 1991)
Fleming v. CNA Insurance
10 Pa. D. & C.4th 423 (Montgomery County Court of Common Pleas, 1991)
Horne v. Sentry Insurance
588 A.2d 546 (Superior Court of Pennsylvania, 1991)

Cite This Page — Counsel Stack

Bluebook (online)
544 A.2d 491, 375 Pa. Super. 319, 1988 Pa. Super. LEXIS 1937, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mutual-automobile-insurance-v-allen-pasuperct-1988.