Today, the Pennsylvania Supreme Court ruled in favor of our client in a case that will have significant ramifications for insured individuals throughout the state. In May 2019, Attorney Adam G. Reedy had the privilege of arguing the case of William H. Scott v. Travelers’ Commercial Insurance Company before the Pennsylvania Supreme Court. The case concerned whether Travelers had the right to deny Mr. Scott’s medical benefits under his policy because he did not submit to an Independent Medical Exam (IME), which the company requested without showing good cause.
Our position was that because the insurer did not make a showing of good cause, which would have included petitioning the court and allowing it to choose a neutral doctor, they did not have a right to unilaterally deny our client the medical benefits to which he was entitled under his policy. Instead, the insurer attempted to bypass the court by forcing our client to submit to a one-sided IME conducted by a doctor of the insurance company’s choosing.
In the end, the Supreme Court ruled that policy clauses requiring insureds to submit to medical exams without good cause or a court petition are void.
The Implications of the Supreme Court’s Decision on IMEs
The implications of this case are enormous. Currently, most car insurance policies require accident victims to submit to IMEs to the insurance company’s doctor as often as the company requests, without requiring any reason for why the IME is necessary. These clauses essentially put insureds at the company’s mercy, and the practice of using insurer-employed doctors has long been criticized by experts for being unfair.
Mr. Reedy argued that these clauses included in most auto insurance policies are actually in direct conflict with public policy, specifically the protections under the Motor Vehicle Act. Our firm made the same argument before the United States District Court and the Honorable Judge Schwab, who also ruled in favor of our client.
By rendering these clauses void, insured individuals now have far more power and protection than they did before. If an insurance company wants to have an insured submit to a medical exam, insureds have the right to demand, in court, a showing of good cause and the right to receive a neutral doctor chosen by the court. If an insurance company fails to meet these requirements, it does not have the power to deny medical benefits.
In response to the Supreme Court ruling, Mr. Reedy said, “This is a huge win for all Pennsylvanians. The Supreme Court’s ruling has thwarted the auto insurance industry’s efforts to limit the rights of innocent people injured in motor vehicle crashes. No longer can an insurance company dictate an injured person’s treatment. They must now follow the law as prescribed by the State’s legislature.”