United States District Court, M.D. Pennsylvania
SAMANTHA SAYLES, individually and on behalf of all others similarly situated, Plaintiffs,
ALLSTATE INSURANCE COMPANY, Defendant.
RICHARD CAPUTO, UNITED STATES DISTRICT JUDGE
before the Court is a Motion to Dismiss filed by Defendant
Allstate Insurance Company (“Allstate”). (Doc.
10.) For the reasons that follow, Allstate's Motion will
be granted in part and denied in part.
well-pleaded facts as set forth in Plaintiff's Complaint
(Doc. 1-1) are as follows:
Samantha Sayles (“Sayles”) was insured under an
auto insurance policy issued by Defendant Allstate (the
“Policy”). (Compl. ¶ 13.) The Policy
provided for, inter alia, first-party medical
expense benefits up to $5000 per person. (Ex. A, Doc. 11-1.)
Relevant to the instant dispute, the Policy states under a
subheading labeled “Proof of Claim; Medical
As soon as possible, you [claimant] or any other person
making claim must give us [Allstate] written proof of claim
including all details reasonably required by us to determine
the amounts payable.
The injured person may be required to take physical
examinations by physicians selected by us, as often as we
reasonably require. The injured person or his representative
must authorize us to obtain medical reports and copies of
(Ex. A, Doc. 11-1) (the “examination
requirement”). On December 11, 2015, Sayles was
involved in a motor vehicle accident within the Commonwealth
of Pennsylvania in which she sustained numerous physical
injuries. (Compl. ¶ 14.) Sayles was treated by medical
providers for these injuries. (Id. ¶ 15.) On
May 20, 2016, Allstate sent a letter to Sayles's counsel,
Charles Kannebecker, concerning Sayles's medical benefits
under the Policy. (Id. ¶ 17.) The letter states
in pertinent part:
Please be advised that we [Allstate] are requesting MES
Solutions to perform an Independent Medical Exam (IME) on
your client, Samantha Sayles.
Pursuant to our contract (policy) Section Proof of Claim:
Medical Reports, an insured must submit to mental and
physical examinations by physicians selected by Allstate when
and as often as we may reasonably require.
During the time all pending bills won't be paid until the
Independent Medical Exam is completed. Once the review comes
back, all bills will be processed per the results of the
Independent Medical Exam review. This process will take
approximately 60 days.
(Doc. 11-1 Ex. B.) In accordance with the letter, Allstate
refused to pay Sayles's medical benefits until the
physical examination was completed. (Compl. ¶¶ 16,
18, 26.) At no point did Allstate petition a court to compel
the physical examination of Sayles that it sought.
(Id. ¶ 21.) Sayles alleges that Allstate's
examination requirement is a company-wide policy.
(Id. ¶ 27.)
claims that the Policy's examination requirement violates
the Pennsylvania Motor Vehicle Financial Responsibility Law
(“MVFRL”), 75 Pa. Cons. Stat. Ann. § 1701,
et seq. (Compl. ¶ 41.) Section 1796 of the
MVFRL entitled “Mental or Physical Examination of
Person” states in relevant part:
(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 . . . 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.
Allstate did not petition a court to compel Sayles to submit
to a physical examination, and consequently because there was
no court order based upon a showing of “good
cause” directing Sayles to submit to such an
examination in accordance with the statutory specifications,
Sayles claims that Allstate's refusal to pay her medical
benefits until she completed the physical examination that it
requested violated the statute. (Compl. ¶¶ 41-42;
see Count II.)
putative class action was originally filed in the Court of
Common Pleas of Pike County on June 20, 2016. (See
Doc. 1.) On July 25, 2016, Allstate removed the action to
federal court. (See Doc. 16.)
Rule of Civil Procedure 12(b)(6) provides for the dismissal
of a complaint, in whole or in part, for failure to state a
claim upon which relief can be granted. See Fed. R.
Civ. P. 12(b)(6). When considering a Rule 12(b)(6) motion,
the Court's role is limited to determining if a plaintiff
is entitled to offer evidence in support of her claims.
See Semerenko v. Cendant Corp., 223 F.3d 165, 173
(3d Cir. 2000). The Court does not consider whether a
plaintiff will ultimately prevail. Id. A defendant
bears the burden of establishing that a plaintiff's
complaint fails to state a claim. See Gould Elecs. v.
United States, 220 F.3d 169, 178 (3d Cir. 2000).
pleading that states a claim for relief must contain “a
short and plain statement of the claim showing that the
pleader is entitled to relief.” Fed.R.Civ.P. 8(a)(2).
The statement required by Rule 8(a)(2) must
“‘give the defendant fair notice of what the . .
. claim is and the grounds upon which it rests.'”
Erickson v. Pardus, 551 U.S. 89, 93 (2007) (per
curiam) (quoting Bell Atl. Corp. v. Twombly, 550
U.S. 544, 555 (2007)). Detailed factual allegations are not
required. Twombly, 550 U.S. at 555. However, mere
conclusory statements will not do; “a complaint must do
more than allege the plaintiff's entitlement to
relief.” Fowler v. UPMC Shadyside, 578 F.3d
203, 210 (3d Cir. 2009). Instead, a complaint must
“show” this entitlement by alleging sufficient
facts. Id. While legal conclusions can provide the
framework of a complaint, they must be supported by factual
allegations. Ashcroft v. Iqbal, 556 U.S. 662, 664
(2009). As such, “[t]he touchstone of the pleading
standard is plausibility.” Bistrian v. Levi,
696 F.3d 352, 365 (3d Cir. 2012).
inquiry at the motion to dismiss stage is “normally
broken into three parts: (1) identifying the elements of the
claim, (2) reviewing the complaint to strike conclusory
allegations, and then (3) looking at the well-pleaded
components of the complaint and evaluating whether all of the
elements identified in part one of the inquiry are
sufficiently alleged.” Malleus v. George, 641
F.3d 560, 563 (3d Cir. 2011).
is appropriate only if, accepting as true all the facts
alleged in the complaint, a plaintiff has not pleaded
“enough facts to state a claim to relief that is
plausible on its face, ” Twombly, 550 U.S. at
570, meaning enough factual allegations “‘to
raise a reasonable expectation that discovery will reveal
evidence of'” each necessary element. Phillips
v. Cty. of Allegheny, 515 F.3d 224, 234 (3d Cir. 2008)
(quoting Twombly, 550 U.S. at 556). “The
plausibility standard is not akin to a ‘probability
requirement, ' but it asks for more than a sheer
possibility that a defendant has acted unlawfully.”
Iqbal, 556 U.S. at 678. “When there are
well-pleaded factual allegations, a court should assume their
veracity and then determine whether they plausibly give rise
to an entitlement to relief.” Id. at 679.
deciding a motion to dismiss, the Court should consider the
complaint, exhibits attached to the complaint, and matters of
public record. Mayer v. Belichick, 605 F.3d 223, 230
(3d Cir. 2010) (citing Pension Benefit Guar. Corp. v.
White Consol. Indus., Inc., 998 F.2d 1192, 1196 (3d Cir.
1993)). The Court may also consider “undisputedly
authentic” documents when the plaintiff's claims
are based on the documents and the defendant has attached
copies of the documents to the motion to dismiss.
Pension Benefit Guar. Corp., 998 F.2d at
1196. The Court need not assume that the plaintiff can prove
facts that were not alleged in the complaint, see City of
Pittsburgh v. W. Penn Power Co., 147 F.3d 256, 263 &
n.13 (3d Cir. 1998), or credit a complaint's
“‘bald assertions'” or
“‘legal conclusions, '” Morse v.
Lower Merion Sch. Dist., 132 F.3d 902, 906 (3d Cir.
1997) (quoting In re Burlington Coat Factory Sec.
Litig., 114 F.3d 1410, 1429-30 (3d Cir. 1997)).
Complaint seeks to bring claims on behalf of a class, which
Sayles generally defines as:
All persons injured in motor vehicle accidents and insured
under Pennsylvania auto insurance polices issued by
[D]efendant which provided for medical benefits coverage whom
[D]efendant required or directed to submit to insurance
physical exams without Court order directing insured to
submit to physical exams.
(Compl. ¶ 43.) The Complaint raises eight (8) counts
seeking relief: (1) a request for a declaratory judgment
declaring Allstate in violation of § 1796 of the MVFRL
and that it must hereafter comply with the statute
(id. ¶¶ 59, 128(B)); (2) claims for a
violation of § 1796 of the MVFRL (id. ¶
62); (3) claims for violations of the Pennsylvania Unfair
Trade Practices and Consumer Protection Law
(“UTPCPL”), 73 Pa. Cons. Stat. Ann. § 201-1,
et seq. (id. ¶ 71); (4) claims for
violations of Pennsylvania's Insurance Bad Faith Act, 42
Pa. Cons. Stat. Ann. § 8371 (id. ¶ 83);
(5) claims for breach of the duty of good faith and fair
dealing (id. ¶ 99); (6) claims for unjust
enrichment (id. ¶ 108); (7) claims of
intentional misrepresentation (id. ¶ 117); and
(8) alternative claims for medical benefits (id.
¶ 124). Allstate filed the instant Motion to Dismiss on
August 26, 2016. (Doc. 10.) Allstate's Motion is premised
chiefly upon the argument that Pennsylvania law permits
parties to enter into an insurance contract like the one
presently at issue, which contains a provision that requires
the insured to submit to an IME as often as the insurer
“reasonably requires.” (See Doc. 11, at
7-11.) Because Sayles did not attend the IME which Allstate
required, Allstate contends that she breached the insurance
contract. (Id. at 11.) Sayles filed her Brief in
Opposition on September 20, 2016. (Doc. 23.) Allstate filed
its Reply Brief on October 11, 2016. (Doc. 24.)
Allstate's Motion is now ripe for disposition.
Counts I and II: Section 1796 of Pennsylvania's MVFRL
Allstate moves to dismiss Counts I and II of Sayles's
Complaint on the ground that its examination requirement in
the Policy, which purportedly allows Allstate to require its
insureds to submit to an IME by a physician of Allstate's
choosing as a condition precedent to payment of medical
expenses, is enforceable notwithstanding § 1796 of the
MVFRL. (See Doc. 11, at 7-11.) Based on the
allegations in the Complaint and supporting documents, the
Court predicts that the Pennsylvania Supreme Court would find
Allstate's examination requirement in conflict with
§ 1796 and thus unenforceable. Accordingly,
Allstate's Motion will be denied with respect to Counts I
Pennsylvania Supreme Court has not addressed the predominant
issue presently before the Court: whether a provision in an
automobile insurance policy that requires an insured to
submit to an IME by a physician selected by the insurer as
often as the insurer reasonably requires in order to receive
her first-party medical benefits conflicts with the MVFRL
and, therefore, violates Pennsylvania public policy. Because
the Court is sitting in diversity, and because the
Commonwealth's highest court has not issued an opinion on
point, the Court is “charged with predicting how that
court would resolve the question at issue.”
Colliers Lanard & Axilbund v. Lloyds of London,
458 F.3d 231, 236 (3d Cir. 2006). In making this prediction,
the Court must consider:
(1) what that court has said in related areas; (2) the
decisional law of the state intermediate courts; (3) federal
cases interpreting state law; and (4) decisions from other
jurisdictions that have discussed the issue.
Id. “[L]ower state court decisions are not
controlling on an issue on which the highest court of the
state has not spoken, ” however, “federal courts
must attribute significant weight to these decisions in the
absence of any indication that the highest state court would
rule otherwise.” Wisniewski v. Johns-Manville
Corp., 759 F.2d 271, 273-74 (3d Cir. 1985). That is,
“due deference” must be given to the
well-reasoned decisions of intermediate state courts. See
U.S. Underwriters Ins. Co. v. Liberty Mut. Ins. Co., 80
F.3d 90, 93 (3d Cir. 1996). Of course, a federal
court is free to reach a result that is contrary to an
intermediate appellate court “if, by analyzing other
persuasive data, [the court] predict[s] that the State
Supreme Court would hold otherwise.” Gruber v.
Owens-Ill. Inc., 899 F.2d 1366, 1369 (3d Cir. 1990)
(alterations, internal quotation marks, and citation
omitted). Therefore, “a federal court interpreting
state law may discount state appellate decisions it finds
flawed, if it predicts the state supreme court would reach a
contrary result.” In re Makowka, 754 F.3d 143,
148 (3d Cir. 2014).
case turns largely on how the Pennsylvania Supreme Court
would interpret § 1796 of the MVFRL, the Court is also
guided by the Pennsylvania rules of statutory construction.
See Transguard Ins. Co. of Am., Inc. v. Hinchey, 464
F.Supp.2d 425, 433 (M.D. Pa. 2006). “These rules
provide that where a statute is clear on its face and
unambiguous, it should be interpreted by its plain
meaning.” Id. (citing 1 Pa. Cons. Stat. Ann.
§ 1921(b)); see Warrantech Consumer Prods.
Servs., Inc. v. Reliance Ins. Co. in Liquidation, 96
A.3d 346, 354 (Pa. 2014) (“When the words of a statute
are clear and unambiguous, there is no need to look beyond
the plain meaning of the statute ‘under the pretext of
pursuing its spirit.'” (quoting § 1921(b))).
to the relevant statutory language, § 1796(a) of the
Whenever the mental or physical condition of a person is
material to any claim for medical . . . benefits, a court of
competent jurisdiction . . . 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 . . . may order that the
person be denied benefits until compliance.
to Allstate, the statute does not require Allstate to obtain
a court order based upon a showing of good cause in order to
have its insureds submit to an IME prior to receiving medical
benefits. (Doc. 11, at 7.) Instead, Allstate contends that
the statute merely provides when a court “may”
order a person to submit to an IME, and does not foreclose an
insurer and an insured from entering into an insurance
contract that includes a mandatory IME provision which the
insurer may invoke in its discretion. (Seeid.) In response, Sayles argues that the procedure
prescribed by the statute applies to “any claim”
for medical benefits “whenever” the mental or
physical condition of a person is material to that claim,
without exception. (See Doc. 23, at 3.) Sayles
contends that allowing insurers to insert ...