Court Opinion

ID: 9732240
Source: CourtListenerOpinion
Date Created: 2023-08-26 16:12:33.076816+00
Date Added: 2024-06-11T15:23:14.890457
License: Public Domain

WIEAND, Judge,
concurring and dissenting:
Although I agree with my colleagues of the majority that the award of counsel fees and costs must be reversed, I would also hold that it was an abuse of discretion for the trial court to deny the insurer’s petition to require the claimant to submit to a physical examination. With respect to this aspect of the case, I find that I am specifically in disagreement with the majority’s approval of the unnecessarily stringent, three-element test for determining “good cause” which was adopted by a prior panel of this Court in State Farm Mutual Automobile Ins. Co. v. Zachary, 370 Pa.Super. 386, 536 A.2d 800 (1987).
*327The statutory provision authorizing a court to require a claimant to submit to a mental or physical examination by a physician appears at 75 Pa.C.S. § 1796 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. (Emphasis added.)
This statutory requirement is not merely a formality, but must be deemed a limitation on the right of an insurer to require a claimant to submit to a mental or physical examination by a physician of the insurer’s choice. The requirement of good cause entails more than relevancy. This requirement, therefore, cannot be met by mere conclusory allegations that the examination will provide relevant information.
It should be obvious that what may be good cause will vary from case to case according to the nature of the alleged injury and the type of examination requested. The ability of the petitioning insurer to obtain the desired information by other means is also a relevant consideration. Of necessity, therefore, much must be left to the sound discretion of the trial judge, who is called upon to apply with discriminating judgment the good cause requirement. The phrase “good cause” depends upon the circumstances of each individual case, and a finding of its existence lies largely in the discretion of the court to which the decision is *328committed. Wilson v. Morris, 369 S.W.2d 402, 407 (Mo. 19.63).
This does not mean that the petitioner must prove a defense on the merits in order to obtain a mental or physical examination of the claimant. It also does not mean that an evidentiary hearing is necessary in all cases. Although a hearing may be necessary in some cases, in others a showing of probable cause can be made by depositions or affidavits. In still others, it can be determined solely from the petition and answer. The requirement does mean, however, that the petitioning insurance company must produce sufficient information so that the trial court can fulfill the function imposed upon it by statute.
These observations are not novel. They are the same observations made by the Supreme Court of the United States when it was called upon in Schlagenhauf v. Holder, 379 U.S. 104, 85 S.Ct. 234, 13 L.Ed.2d 152 (1964), to interpret Federal Rule of Civil Procedure No. 35. The Supreme Court’s reasoning is equally applicable to an interpretation of the statutory good cause requirement now before this Court for interpretation.
The majority approves the minimum requirements adopted in State Farm Mutual Automobile Ins. Co. v. Zachary, supra, as follows: (1) that the proofs submitted in support of the claim are inadequate, i.e., that the information supplied by the claimant in support of his or her claim does not eliminate reasonable doubt as to the validity of the claim; (2) that the proposed examination will substantially assist the insurer in evaluating the claim; and (3) that the amount of the claim justifies a court order compelling the claimant to submit to a physical examination.
I am unable to accept this test. I find particularly objectionable the suggestion that a claim must be of a sufficient amount — the precise amount has not been suggested — to justify an examination. This is based upon the misguided belief that an insurer should accept and not resist a false claim so long as it does not involve a substantial amount. Moreover, a requirement that the claim must *329be of a “sufficient amount” is a virtual guarantee of additional litigation intended to define a claim of “sufficient amount.” I would find this requirement wholly unacceptable.
I would also reject the majority’s suggestion that a claimant should not be required to submit to an examination if his proof of injury is adequate. The issue should not be the strength of the claimant’s proofs but whether there is an actual controversy. If there is a bona fide controversy about the nature and/or extent of the claimant’s injuries and a physical examination will substantially assist the insurer in evaluating the claim, an examination should be allowed. In such cases, the requirement of good cause has been met.
I would hold that the requirement of good cause contains only two components. These include (1) a bona fide controversy regarding the nature of the claimant’s injuries; and (2) a showing that the requested mental or physical examination will substantially aid the petitioning insurer in its evaluation of the claim. These requirements are adequate to protect the claimant against harassment by the insurer. They will also preserve for the insurer the right to make an independent evaluation of a questionable claim.
In the instant case, I would hold that the petition and answer, with the medical reports and bills attached thereto, are sufficient to establish good cause for requiring the claimant to submit to a physical examination. The claimant has applied to the insurer for continuing reimbursement for physical therapy, muscle relaxants, and other treatment allegedly needed to alleviate a soft-tissue injury of the back which has been diagnosed as “lumbosacral strain and sprain.” The physician’s report, however, contains a suggestion that the claimant’s disability ended approximately nine months prior to the filing of the insurer’s petition for examination. In the meantime, claims for treatment have continued. It is the claimant who has asserted a claim for continuing disability, and he has thereby placed his physical condition in controversy. The nature of the claim and the *330uncertainty regarding the need for continued treatment, moreover, establish good cause for an examination which will aid the insurer in determining the existence and extent of the injury for which the claimant requests reimbursement.
I would reverse and remand with directions to the trial court to allow the requested physical examination. I would also reverse the order awarding counsel fees and costs.