PAP Coverage Question over a Trip and Fall
September 9, 2016
Our insured was getting off a bus. He stepped off the platform the bus driver provided the passengers and then tripped over a telephone pole lying on the ground as a parking lot divider, falling onto his car that was parked there. He broke his arm. The insurer denied coverage under both the New York no-fault policy and the personal auto med pay section. Is the insurer correct to deny coverage?
New York Subscriber
Coverage for med pay under the PAP could be extended to the insured since the insured is covered for bodily injury under the standard PAP while occupying a motor vehicle designed for use on public roads. The key point is whether the insured was occupying the vehicle when the injury occurred. "Occupying" is defined in the PAP as "in or upon or getting in, on out, or off." A case can be made that the insured was upon or even getting in or on the car when the injury occurred since he was injured falling onto the car. Since the words "upon" and "getting on" are not defined in the policy, the insured should get the benefit of a reasonable doubt. Besides, since med pay is sort of a good will coverage, the insurer should offer to pay the medical costs, especially since coverage is in a gray area and is not explicitly excluded.
The New York no fault coverage is not applicable in this instance based on the definition in the policy of an "eligible injured person."
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