Covering bodily injuries with home, business or auto policies
Coverage Q&A: When are someone else's medical expenses covered by an insured's policy?
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Question: We insure a homeowner under a standard HO 03 04/91 policy.
The insured’s daughter owns a horse. The horse is kept in a stable located away from the insured premises. The insured and horse were visiting the off-premise stable when the horse injured another person. Would liability coverage exist for the homeowner and (household member) daughter?
— Massachusetts Subscriber
Answer: Under Section II in the HO 04 91, medical payments to others are provided if injury is off the insured location and is caused by an animal owned by or in the care of an “insured.” There is no exclusion for animals under this section. As long as the injury was unintentional, there is coverage.
Related: Critter-related property damage requires an eagle eye
Medical payments for preventive care?
Question: Our insured operates a small retail store, and she always kept her pet dog on the premises. The dog had the run of the store, was friendly and would always interact with the customers.
Recently, the dog died, and it was suspected that the animal may have had rabies. Tests were to be done on the dog, but they were delayed due to bad weather, which effectively closed down the area. The insured notified her recent customers about the dog and some of them went to receive anti-rabies vaccinations. The customers received two or three of the vaccinations in the series before the tests on the dog showed that it did not have rabies.
The insured wants to pay for the vaccinations under the medical payments section of her CGL policy, but the insurer denied coverage, saying that there was no bodily injury suffered here. We think there ought to be coverage because the vaccinations were taken to prevent bodily injury and perhaps even death, and med pay coverage is supposed to be for goodwill purposes. What is your opinion?
— Wisconsin Subscriber
Answer: The costs incurred in this case are not covered by the medical payments section of the CGL form. The policy states that medical payments are covered if they result from an accident causing bodily injury.
Bodily injury is a defined term, and bodily injury did not occur here. Although preventive vaccinations were thought by some customers to be necessary, and may have even been medically justifiable, the insuring agreement of the medical payments section of the CGL form was not met.
Unless the dog actually bit one of the customers, there was no bodily injury and that is what med pay covers. Med pay can be used as a goodwill tool for a business, but the insuring agreement still has to be met for medical payments to be made.
Related: Top 10 states for dog bite claims in 2016
Insured passes out, crashes car after bee sting
Question: Our insured is allergic to bee stings and was recently stung by a bee. He was driving himself to the doctor’s office for treatment when he passed out. He crashed his car into a tree and injured himself.
This brought up the question in our office as to whether his injuries would be covered by the medical payments part of his auto policy. Some of us think the med pay only applies to injuries caused by an auto and that the ultimate cause of the insured’s injuries was the bee sting. What is your opinion?
— Nebraska Subscriber
Answer: The personal auto policy’s medical pay coverage is for reasonable expenses incurred for necessary medical and funeral services because of bodily injury caused by an accident and sustained by an insured. The named insured is an insured while occupying a motor vehicle and he was injured due to an accident. His medical expenses from the accident should be covered unless there is some exclusion on the policy that applies.
Now, the insurer is entitled to try to separate the injuries the insured suffered due to the auto accident from the injuries due to the bee sting. The med pay insuring agreement does not specifically require bodily injury caused by an auto accident, but it does require the covered insured to be occupying a motor vehicle or to be a pedestrian struck by a motor vehicle. In this case, the insured was apparently stung by a bee before he got into his car and the medical results from that sting would not be covered by auto med pay. It may be impossible to separate the sting injuries from the crash injuries, or perhaps the difference in cost is negligible, but the insurer would be entitled to limit its payment under the auto med pay to the crash injuries if it chose.
Is walking the same as horseback riding?
Question: The personal auto medical payments coverage extends to the named insured while a pedestrian when struck by an auto. Would riding a horse make the insured a pedestrian? Black’s law includes someone on roller skates or skateboard under its definition.
— Michigan Subscriber
Answer: We are of the opinion that the answer is no. Riding a horse is using the horse to get around since it moves on its own. A person on roller skates or a skateboard, like a pedestrian, has to use his own power to move and this makes such things different from riding a horse.
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