Articles & Updates

PA Superior Court Holds that PTSD Could Be Covered as “Bodily Injury” if it Resulted from Physical Injury

Dec 16, 2019 | Articles & Updates

On December 4, 2019, the Pennsylvania Superior Court, in a published opinion, held that post traumatic stress disorder (“PTSD”) could be covered as “bodily injury” – as defined in an auto policy – if the PTSD resulted from physical injuries. Evans v. Travelers Ins. Co., 2019 PA Super 353 (Dec. 4, 2019). The court relied on Zerr v. Erie Insurance Exchange, 667 A.2d 237, 240 (Pa. Super. Ct. 1995), for the proposition that, under most standard insurance policies, coverage is not afforded for mental injury that is not the result of a bodily injury. That is, physical manifestations of emotional distress cannot constitute “bodily harm.” But, the court found that coverage can be afforded for mental injury or emotional distress that results from “bodily harm.”

In Evans, the plaintiff sought first party benefits coverage under her automobile policy for injuries that she sustained as a result of a motor vehicle accident. Specifically, the plaintiff sought benefits for injuries to her head and neck, as well as PTSD. Travelers denied coverage for continued treatment of the plaintiff’s PTSD, based on its conclusion that PTSD does not constitute “bodily injury” as defined by the insurance policy – i.e., “accidental bodily harm to a person and that person’s resulting illness, disease, or death.” As a result, the plaintiff filed suit in the Court of Common Pleas of Wayne County, asserting that Travelers breached the insurance contract. The trial court granted summary judgment in favor of Travelers, finding that the plaintiff “failed to produce evidence that her mental injuries resulted from her physical injuries, which is essential to the cause of action.”

The plaintiff appealed, and the Superior Court reversed the trial court’s decision and remanded the case. In doing so, the Superior Court recognized that “in addition to her diagnosis of PTSD, [the plaintiff] reported numerous physical manifestations of her emotional distress, including: persistent headaches, dizziness, balance issues, fogginess of her mental processes, extreme exhaustion, nightmares, flashbacks, and panic attacks.” The court also pointed to the undisputed evidence of the plaintiff’s physical injuries to her head and neck as a result of the accident. Therefore, distinguishing Zerr, which concerned strictly emotional injury, the court found that the plaintiff could be entitled to benefits under the insurance policy if her physical injuries resulted in her PTSD. Because the plaintiff presented evidence that could suggest that her PTSD resulted from her physical injuries, the Court held that a “genuine issue of material fact exist[ed] as to whether [the plaintiff’s] PTSD resulted from her bodily harm that she sustained in the motor vehicle accident.” As such, summary judgment on the issue was improper.