Recently, the Pennsylvania Superior Court found, in Evans v. Travelers, 2019 Pa. Super. 353, decided on December 4, 2019, that treatment for post-traumatic stress disorder could be covered by first party benefits as a policy-defined bodily injury.
This case arose in 2014, when the Plaintiff was driving on I-476 in Carbon County, when her passenger vehicle was struck by a tractor-trailer, attempting to change lanes, with the Plaintiff not initially seeking medical treatment for symptoms reported to include headaches, neck pain, dizziness, nightmares, and panic attacks.
Although the Plaintiff did treat for a cervical spine injury, receiving cervical spine injections, and then undergoing physical therapy, the Plaintiff was also independently evaluated and treated by a psychiatrist for post-traumatic stress disorder.
Submitting an application to her insurance carrier, Travelers, for first party benefits, to pay for medical expenses that she incurred as a result of “bodily injuries” caused by the motor vehicle accident, the Plaintiff’s submission of medical expenses for her psychiatric treatment for the post-traumatic stress disorder was initially denied by Travelers, as well as denying coverage for future treatment for the same condition, in reliance upon a 1995 Pennsylvania Superior Court Decision in Zerr v. Erie Insurance Exchange, 667 A.2d 237, a Decision that involved the Superior Court determining that emotional and mental injuries were not covered under the insurance policy’s definition of bodily injury, and the same policy language was used in the Plaintiff’s personal automobile insurance policy with Travelers in the Evans v. Travelers matter.
The predicate for treatment being covered, under both the Erie and Travelers’ policies required the medical treatment to be caused by a “physical” injury.
Traumatized by Travelers’ denial of her post-traumatic stress disorder treatment, the Plaintiff filed suit against Travelers in the Wayne County Court of Common Pleas, with the Trial Court initially granting Summary Judgment to Travelers, finding that the Plaintiff had failed to produce evidence that her mental injuries, again the post-traumatic stress disorder, had resulted from her physical injuries, which the Trial Court determined to be an essential component for coverage under the first party provisions of the Plaintiff’s personal automobile insurance policy.
An Appeal followed.
Before the Superior Court, the Court reviewed the Zerr Decision, which had found that the Plaintiff had not sustained a bodily injury as defined by other Zerr’s policy, or by the Pennsylvania Motor Vehicle Financial Responsibility Law, as the “injury” did not result in illness, but rather the illness resulted in a bodily injury.
In the Evans case, the Superior Court observed that the Plaintiff had reported and treated for physical manifestations, e.g., headaches, dizziness, balance issues, exhaustion, flashbacks, and panic attacks, in addition to treatment for post-traumatic stress disorder diagnoses.
Conceding that the Court was bound by the Zerr Decision, that physical manifestations of emotional distress do not constitute “bodily injury”, the Court distinguished Zerr, as the claim for coverage in that case was based solely on an emotional injury, without any accompanying physical injury and/or physical manifestations of injury.
Relying upon that distinction, the Superior Court in Evans concluded that the Plaintiff was entitled to benefits under her policy as the physical injuries that she sustained in the motor vehicle accident had resulted in the Plaintiff developing an “illness”, i.e., post-traumatic stress disorder.
Concluding that a genuine issue of material fact existed as to whether the Plaintiff’s post-traumatic stress disorder had resulted from the bodily injuries that she sustained in the motor vehicle accident, the Pennsylvania Superior Court reversed the Trial Court’s Summary Judgment ruling, and remanded the case back to the Trial Court, to reconsider the coverage issue raised by the Plaintiff, seeking to secure payment for medical expenses that she incurred for treatment of post-traumatic stress disorder.
The takeaway is be careful what you wish for, as the Evans Decision could become a predicate for Plaintiffs reporting physical manifestations as a result of motor vehicle accidents, with the manifestations then being the stepping stone to coverage for psychiatric treatment, with the question being what needs to be proven and/or disproven in terms of history, accident, manifestations, diagnoses, and treatment, for coverage to apply, or to apply.
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