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INSURANCE COVERAGE: Superior Court holds that insured’s failure to attend IME barred further entitlement to medpay benefits

INSURANCE COVERAGE: Superior Court Holds That Insured’s Failure To Attend IME Barred Further Entitlement To Medpay Benefits

The defendant was involved in a motor vehicle accident on December 6, 2010.  During 2012 and 2013, requests were made for the defendant to submit to a medical examination by a physician selected by the insurer.  The defendant failed to submit to such an examination.

In the insurer’s declaratory judgment action, the court grants summary judgment for the insurer, concluding that it has no obligation to provide additional medpay benefits.  The court noted that the policy required cooperation and required the insurer to submit to exams by physicians selected by the insurer.

The court finds the failure to submit to the IME unjustified and prejudicial to the insurer.  The court notes that the IME was necessary for the insurer to properly evaluate the defendant’s claims for further benefits.  Without the IME, it had been shown that the insurer was unable to determine whether, and to what extent, treatment and expenses incurred were causally related to the motor vehicle accident.

Amica Mutual Ins. Co. v. Levine, 2017 WL 3975450 (7/31/17).

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