top of page

PTSD May Be Considered a Bodily Injury Under Insurance Policy (PA)


December 19, 2019 at 11:57:40 PM

<p style="text-align: justify;">The Superior Court of Pennsylvania recently reversed an order granting summary judgment to an insurer after the insurer claimed that the plaintiff failed to produce evidence essential to her cause of action. In <em><a href="">Carol Evans v. Travelers Insurance Company</a>,</em> the insurance company moved for summary judgment claiming that the plaintiff failed to show that her Post-Traumatic Stress Disorder (“PTSD”) resulted from bodily harm she sustained in a motor vehicle accident.</p>
<p style="text-align: justify;">The underlying incident involved a car accident in which Carol Evans (“Evans”) was driving in the left passing lane when a tractor-trailer merged into her direction and collided with her vehicle.  The accident caused a crack in Evans’ windshield, broke the passenger side mirror off her vehicle, smashed her passenger side windows, caused broken glass to enter inside of the vehicle, and pushed her vehicle to the left toward the concrete barrier.  Evans was able to regain control of her car and pull over to the right side of the road.  As a result of the accident, Evans did not initially seek medical care.  Instead, Evans relied on generic pain medications at first.  Later, the pain in her head and neck escalated and she began to experience dizziness in the week following the accident.</p>
<p style="text-align: justify;">Several months after the accident, Evans began treating with a psychiatrist for PTSD.  Initially, Evans’ insurer, Travelers Insurance Company (“Travelers”) paid for her PTSD treatment but later denied coverage for future treatment.  Travels determined that Evans’ PTSD did not constitute “bodily injury” as defined by the endorsement because it was not caused by a physical injury.  As a result, Evans filed a breach of contract lawsuit against Travelers in the Court of Common Pleas in Wayne County.</p>
<p style="text-align: justify;">In response, Travelers filed a Motion for Summary Judgment claiming that Evans was not entitled to receive coverage for her PTSD treatment.  The trial court found that Evans failed to provide evidence that her mental injuries resulted from her physical injuries, which was essential to her cause of action.  As a result, Evans appealed to the Superior Court.</p>
<p style="text-align: justify;">First, Evans concluded that the trail court erred in determining that her PTSD was not covered under the Travelers’ policy.  Specifically, she argued that PTSD, sustained with concomitant physical injuries, constitutes “bodily injury” under the policy.  In response, Travelers’ relied on Superior Court case law denying coverage in an instance in which the plaintiff solely experienced PTSD but was not actually involved in a physical accident.  The Court distinguished that case from the instant matter as Evans suffered both physical and emotional injuries as a result of her accident.  As such, the Court concluded that Evans was entitled to benefits under her policy if the physical harm she sustained in the accident resulted in an illness.  The Court determined that Evans produced evidence to support her claim that her PTSD resulted from her physical injuries and caused her continuous pain, affected her emotion and physical well-being, and required extensive medical testing, treatment, and rehabilitation.  Furthermore, the Court found that Evans’ PTSD could have been caused in part by her physical injuries which are closely related and seemingly intertwined.  As a result, the Court found there was a genuine issue of material fact to deem summary judgment inappropriate.</p>
<p style="text-align: justify;">Evans also argued that the trial court’s interpretation of the policy conflicts with the Motor Vehicle Financial Responsibility Law (“MVFRL”) and violates public policy.  Specifically, Evans concluded that she was denied coverage even though she paid additional premiums for Added Party Benefits.  She argued that she paid these additional premiums to receive “Increased Medical Expenses,” at a limit of $100,000.00.  The Court was not persuaded with Evans’ position regarding the Added Party Benefits.  Rather, the Court found it inconsequential that Evans chose to pay for the Added Party Benefits, as it did not relieve Evans of the requirement that she show that she sustained “bodily injury” in her motor vehicle accident.  The Court was unpersuaded that Evans’ payment of additional premiums allowed her access to coverage for psychiatric treatment that was otherwise unavailable.</p>
<p style="text-align: justify;">Thanks to Zhanna Dubinsky for her contribution to this post.  Please contact <a href="">Vincent F. Terrasi</a> with any comments.<strong>

bottom of page