Vanartsdalen v. Farm Family Casualty Insurance Company, N16C-02-003 FWW

Background

Plaintiff Robert Vanartsdalen (NJ resident) was injured in a motor-vehicle accident on November 3, 2014 while driving his employer’s Delaware-registered vehicle insured by Farm Family (Defendant).
The policy required insureds to submit to independent medical examinations (IMEs) at the insurer’s expense by physicians of the insurer’s choice as often as reasonably required as a condition precedent to PIP benefits.
Defendant scheduled multiple IMEs. Initial proposed exams were outside Plaintiff’s New Jersey municipality; Plaintiff’s counsel objected under N.J.S.A. 39:6A-13(d). Defendant later arranged an IME approximately one mile from Plaintiff’s home.
Plaintiff failed to appear for two scheduled IMEs (August 12 and August 31, 2015) without justification; Defendant twice warned that two or more unexcused failures would cancel PIP benefits and then denied coverage on that basis.
Plaintiff sued for PIP benefits; Defendant moved for summary judgment arguing Plaintiff breached the policy condition precedent by missing two IMEs. Plaintiff opposed, arguing he thought benefits already were cut off and that Defendant was not substantially prejudiced.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Plaintiff’s failure to attend two IMEs breached the policy’s condition precedent and bars coverage	Vanartsdalen asserted confusion about cutoff but did not dispute missing the exams; argued insurer not substantially prejudiced	Farm Family argued attendance at IMEs was an explicit contractual condition and two unexcused no-shows terminated PIP obligations	Court held Plaintiff breached the condition precedent by missing two IMEs; breach bars PIP benefits
Whether insurer waived the right to deny benefits based on missed IMEs	Plaintiff suggested insurer’s conduct or communications created impression benefits already cut off or that insurer waived reliance	Farm Family pointed to explicit warnings that two misses would cancel benefits and that denial specifically cited missed IMEs	Court found no waiver; insurer explicitly warned and identified missed IMEs as the reason for denial
Whether the location of the IME (municipality rule) excused nonattendance	Plaintiff’s counsel objected that initial IMEs violated NJ statute requiring exams within municipality of residence	Farm Family corrected by scheduling an IME within one mile of Plaintiff’s residence	Court treated location issue as resolved because the later IME was within close proximity; location did not excuse Plaintiff’s failures to appear
Whether summary judgment was appropriate	Plaintiff argued material facts (prejudice, understanding of cutoff) precluded summary judgment	Farm Family argued undisputed facts established breach and entitlement to judgment as a matter of law	Court granted summary judgment for Defendant because no genuine issue of material fact on failure to satisfy condition precedent

Key Cases Cited

Merrill v. Crothall-Am., Inc., 606 A.2d 96 (Del. 1992) (summary judgment standard explained)
Moore v. Sizemore, 405 A.2d 679 (Del. 1979) (moving party burden on summary judgment)
Brzoska v. Olson, 668 A.2d 1355 (Del. 1995) (nonmoving party must show material factual disputes)
Casson v. Nationwide Ins. Co., 455 A.2d 361 (Del. Super. 1982) (insured must comply with conditions precedent to compel insurer payment)