Insured's failure to cooperate with No Fault carrier is not permanent bar to provider suing for benefits
Under the No Fault Act, an insurer can require that a claimant submit to an Examination Under Oath (EUO) or an Independent Medical Examination (IME) as often as the insurer "reasonably requests." If the insured fails to cooperate or fulfill these demands, or otherwise refuses to cooperate (for example by executing medical or employment authorizations) the insured's right to collect PIP benefits is suspended.
In two related cases, State Farm refused to pay medical providers for treatments provided after an insured had failed to make himself available to the insurer's agents. The insurer sought summary disposition of the providers' claims, arguing that the lack of cooperation of the injured insureds permanently voided the providers' right to benefits. The trial judge concluded that there was a material factual dispute and refused summary disposition. The insurer appealed.
The higher Court sustained the lower court ruling, holding that since the insureds' benefits were not permanently voided and since State Farm had not sought a court ruling of ineligibility, the providers claims could go forward. The providers will still need to secure the insureds' cooperation, however, in order to prevail in their action for repayment.