Nationwide Mutual Insurance Co. v. Moore, G.
329 WDA 2017
| Pa. Super. Ct. | Oct 6, 2017Background
- On March 23, 2016 Gene Moore, riding a bicycle, was struck by a car driven by Amy Shiock, who was insured by Nationwide. Moore was not otherwise insured.
- Moore submitted medical bills to Nationwide; Nationwide paid $90,580.84 in medical expenses as first‑party benefits under 75 Pa.C.S. § 1713(4).
- After initial treatment and discharge from physical therapy, Moore sought later ER treatment for back pain he told providers was caused by moving furniture, then submitted those bills to Nationwide as related to the accident.
- Nationwide requested an independent medical examination (IME); Moore refused, and Nationwide petitioned the trial court to compel the IME based on the insurer’s policy clause requiring examinations "as often as the company reasonably requires."
- The trial court found good cause under 75 Pa.C.S. § 1796 based on the lapse in treatment and an intervening, self‑reported furniture‑lifting incident, and ordered the IME.
- The Superior Court affirmed, concluding the order rested on statutory authority and good cause rather than solely on the insurance policy or Fleming.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a person who is not a party to the insurer’s policy can be compelled to submit to an IME | Moore: He is not a party to the insurance contract, so policy provisions cannot be used to compel him. | Nationwide: § 1796 applies to claimants generally; a claimant seeking benefits can be compelled upon good cause. | Held: § 1796 applies to all claimants; non‑party status to the policy does not preclude an IME order when good cause is shown. |
| Whether the trial court erred by ordering an IME without insurer showing “good cause” | Moore: The policy purportedly allows examinations without statutory "good cause" and thus the court erred if it relied on policy language instead of the statute. | Nationwide: The trial court relied on § 1796 and did find good cause on the petition’s face (lapse in care and intervening event). | Held: Court properly relied on § 1796 and found good cause; order affirmed. |
| Whether the insurer’s policy provision requiring company‑selected exams is void as against public policy for not requiring "good cause" | Moore: The policy provision is contrary to statute/public policy because it does not require "good cause." | Nationwide: Statute controls; the court need only apply § 1796 and assess good cause. | Held: Court did not decide the policy‑validity question because it based its order on § 1796; Moore’s public‑policy challenge was unnecessary and not reached. |
| Whether an IME would "substantially aid" the insurer's evaluation (separate requirement) | Moore: Nationwide did not demonstrate how the IME would substantially aid evaluation. | Nationwide: The lapse in treatment and intervening cause raise legitimate questions an IME would address. | Held: Superior Court noted "substantially aid" requirement is no longer an independent restriction after Swantner; in any event, the IME would be helpful given the facts, so the order stands. |
Key Cases Cited
- Fleming v. CNA Insurance Companies, 597 A.2d 1206 (Pa. Super. 1991) (addressed insurer policy clauses on IMEs)
- McGratton v. Burke, 674 A.2d 1095 (Pa. Super. 1996) (standard of review and trial court discretion on IME orders)
- State Farm Ins. Companies v. Swantner, 594 A.2d 316 (Pa. Super. 1991) (en banc) (abrogated judicially imposed additional restrictions and confirmed statute‑based good cause standard for IMEs)
- State Farm Mutual Automobile Ins. Co. v. Zachary, 569 A.2d 365 (Pa. Super. 1990) (earlier panel decision requiring showing that an IME would substantially aid insurer)