The significance of this ruling for your practice is that once an IME is performed indicating the patient/insured has recovered, the carrier can cut off payments to you for any further care. (

William vs. Allstate Insurance Co

, U.S. District Court for the Eastern District of Pennsylvania, 2:08 – CV – 03031 – RB.).

A federal judge has predicted that the Pennsylvania Supreme Court will eventually rule that an insurance carrier can discontinue medical payments if the insured does not submit to a reasonable medical exam.  By way of background, this case involved an insured with Allstate who refused to undergo an independent medical exam when requested to do so by Allstate.  The insured refused to go to the IME because Allstate had not obtained a Court Order requiring the insured to do so, even though there was a provision in the Allstate policy allowing Allstate to require the insured to submit to an IME or face discontinuance of coverage.  The federal judge relied on a Pennsylvania Superior Court case that stated when a policy for car insurance contains language which explicitly states the carrier can compel an insured to attend an IME, such a provision is enforceable without the need for the carrier to obtain a court order.  Many carriers, e.g. Nationwide, are performing a peer review and buttressing their position to discontinue payments with an IME.