Case Summary: Denial of coverage for insured’s failure to attend a medical examination upheld
Automobile insurer’s denial of coverage on the basis that the insured failed to attend a medical examination was upheld on appeal.
Insurance law – Automobile insurance – Independent medical examination – Terms of policy – Breach of policy – Practice – Leave to appeal
Greenidge v. Allstate Insurance Co.,  A.J. No. 151, 2019 ABCA 52, Alberta Court of Appeal, February 8, 2019, P.T. Costigan, F.L. Schutz and M.G. Crighton JJ.A.
The insured appealed the lower court’s finding that the respondent insurer did not breach the terms of its automobile insurance policy when it declined coverage to the insured after the insured refused to attend a medical examination unless it was video-recorded. The insurer requested the medical examination pursuant to Special Provision 4 of the policy which provided that “the Insurer has the right and the claimant shall afford to a duly qualified medical practitioner named by the Insurer an opportunity to examine … the Insured’s person when and as often as it reasonably requires while the claim is pending”.
The Court of Appeal found that Special Provision 4 was clear and unambiguous and thus dismissed the appeal. The policy provision does not give the insured the right to decline the examination, select the practitioner, or dictate the manner in which the examination will take place. An insurer does not breach the duty of utmost good faith by relying on a term of the policy nor is there anything unfair in the insurer insisting that the insured comply with a term of the policy.
This case was digested by Kora V. Paciorek, and first published in the LexisNexis® Harper Grey Insurance Law Netletter and the Harper Grey Insurance Law Newsletter. If you would like to discuss this case further, please contact Kora V. Paciorek at email@example.com.