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Evans v. Travelers Insurance Co.

Superior Court of Pennsylvania

December 4, 2019

CAROL EVANS Appellant
v.
TRAVELERS INSURANCE COMPANY

          Appeal from the Order Entered August 14, 2018 In the Court of Common Pleas of Wayne County Civil Division at No(s): 531-Civil-2016

          BEFORE: PANELLA, P.J., KUNSELMAN, J., and STEVENS [*] , P.J.E.

          OPINION

          STEVENS, P.J.E.

         Appellant Carol Evans appeals the order of the Court of Common Pleas of Wayne County entering summary judgment in favor of Appellee Travelers Insurance Company ("Travelers"). The trial court concluded that summary judgment was warranted as it found that Evans failed to produce evidence of a fact essential to her cause of action: whether her Post-Traumatic Stress Disorder (PTSD) resulted from bodily harm sustained in the motor vehicle accident at issue. We reverse and remand for further proceedings.

         On September 17, 2014, Evans was traveling southbound in her Chrysler PT Cruiser in the left passing lane of Interstate 476 (I-476 or the Pennsylvania Turnpike) near Kidder Township, Carbon County.[1] At that time, Rodolfo Hudson was traveling southbound in a tractor-trailer in the right lane of I-476. At some point, Hudson attempted to move his tractor-trailer to the left passing lane and violently collided with Evans' vehicle. Compl. at ¶ 1-5; Evans Deposition ("Dep."), December 14, 2017, at 15.

         This forceful impact cracked Evans' windshield, broke the passenger side mirror off her vehicle, smashed her passenger side windows, caused broken glass to fly into the vehicle, and pushed Evans' entire vehicle to the left towards the concrete barrier. Evans regained control of her vehicle and pulled over to the right side of the interstate. Hudson pulled over his tractor-trailer, and both parties waited for emergency personnel to arrive. Dep. at 14-17.

         While Evans felt pain in her head and neck immediately after the accident, she did not initially seek medical care but instead took generic pain medications. Id. at 19. Evans' pain in her head and neck escalated, and she began to experience dizziness in the week following the accident. Id. at 19-22. Her husband insisted that she get treatment at a local hospital. Id. at 22. Evans subsequently reported various symptoms including persistent headaches and neck pain, dizziness, balance issues, fogginess of her mental processes, extreme exhaustion, nightmares, flashbacks, and panic attacks. Id. at 23-25, 34-37, 40-46, 56-69, 73-75.

         Thereafter, Evans submitted to extensive medical testing, received injections into her cervical spine to alleviate pain, underwent physical therapy and rehabilitation to regain balance and address issues with cognition, and was prescribed multiple medications for pain, dizziness, and emotional distress. Dep. at 23-28, 32-34, 52-69. Several months after the collision, beginning in February 2015, Evans was evaluated and treated by psychiatrist Dr. Matthew Berger for PTSD. Id. at 34-37.

         It is undisputed that Evans was treated for "injuries to her neck and thoracic spine with radiculopathy," and head injuries that included "concussion, closed head injury, post-concussion syndrome, vertigo, post-traumatic vascular headac[h]es, post-traumatic vestibuloneuronitis, and/or post-traumatic stress disorder (PTSD)." Compl. at ¶ 8. Evans indicated that she was advised that her injuries "may be permanent in nature." Id.

         Evans submitted an application to her insurer, Travelers, for first party benefits coverage under her automobile policy.[2] The first party benefits endorsement requires Travelers to pay "medical expenses" of an "insured who sustains 'bodily injury' caused by an accident arising out of the maintenance or use of a motor vehicle." Endorsement, at 2 (some quotation marks omitted). The endorsement defined "medical expenses" in part as "reasonable and necessary charges incurred for … medical and rehabilitative services, including but not limited to … psychiatric, and psychological services." Id. at 1. The endorsement defined "bodily injury" as "accidental bodily harm to a person and that person's resulting illness, disease, or death." Id.

         While Travelers initially paid for Dr. Berger's treatment of Evans' PTSD, Travelers subsequently denied coverage for future treatment. Evans' counsel sent Travelers a letter from Dr. Berger, who indicated he was treating Evans for PTSD related to the motor vehicle accident and that continued treatment of Evans' PTSD was "medically necessary." Berger Letter, 8/26/15, at 1.

         On October 7, 2015, Travelers' claims representative, Kami Hause, indicated that, while Travelers did not dispute that Evans sustained physical injuries in the accident, Travelers claimed Evans' PTSD does not constitute "bodily injury" as defined by the endorsement. Hause Letter, 10/7/15, at 1. Hause asserted that the endorsement's definition of bodily injury was identical to the policy language in Zerr v. Erie Ins. Exchange, 667 A.2d 237 (Pa.Super. 1995), in which this Court determined that emotional or mental injuries were not covered under that definition of bodily injury, unless they were caused by a physical injury. Hause Letter, 10/7/15, at 1.

         Evans filed this cause of action in the Court of Common Pleas of Wayne County, arguing that Travelers breached the parties' insurance contract.[3], [4] Evans' complaint alleges that "Travelers acted with no reasonable foundation in refusing to pay first party benefits when due, with respect to the unilateral denial of payment for treatment of head and neck injuries and sequelae of same, including psychological, neuropsychological, and/or emotional manifestations." Compl. at ¶ 36 (emphasis added). In its answer and new matter, Travelers asserted that "[t]he subject Travelers Policy and Pennsylvania case law bar coverage for emotional and mental injuries which are not caused by physical injury." Answer at ¶ 47.

         On May 30, 2018, Evans filed a Motion for Partial Summary Judgment, arguing that she was entitled to receive first party benefits for the treatment of her PTSD, which she sustained in the accident with concomitant physical injuries. Evans also argued that Travelers' strict interpretation of the policy conflicted with the Motor Vehicle Financial Responsibility Law (MVFRL) and violated public policy. On the same day, Travelers filed a Motion for Summary Judgment, claiming Evans was not entitled to receive coverage for treatment for PTSD, which did not result from the physical injuries she sustained in the collision as required by policy language.

         In an opinion and order entered August 14, 2018, the trial court granted summary judgment in favor of Travelers, denied Evans' motion for summary judgment, and dismissed Evans' complaint with prejudice. Specifically, the trial court found that Travelers was entitled to summary judgment as Evans "failed to produce evidence that her mental injuries resulted from her physical injuries, which is essential to the cause of action." Trial Court Opinion (T.C.O.), 8/14/18, at 5. This timely appeal followed.

         Evans raises the following issues for our review on appeal:

I. Did the trial court err in granting [Travelers'] Motion for Summary Judgment, denying [Evans'] Motion for Partial Summary Judgment, and dismissing [Evans'] Complaint when there was no genuine issue or dispute of material fact that [Evans] suffered concomitant physical injuries, in addition to her psychiatric injuries, as a result of the motor vehicle collision at issue; psychiatric services were a covered first party medical expense pursuant to her policy with [Travelers]; and [Travelers] based their ...

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