Separation of Insureds Clause and Family Members

We have been informed by one of our companies that there is a potential auto liability BI claim for an insured's wife. The insured, driver of vehicle in an “at-fault” accident in which the wife, passenger, was seriously injured. The wife is also listed as “named insured” on the PAP. We have been informed that there is no exclusion for the wife presenting a BI claim against her husband. Is this possible? Can a “named insured” pursue BI against another “named insured” and it possibly be covered under the PAP?

Pennsylvania Subscriber

The current ISO auto policy PP 00 01 01 05 provides liability coverage for which an insured is legally responsible because of an auto accident. While there are exclusions for intentional injury or intentional property damage, and exclusions of damage to property owned by the insured, there is no exclusion for injuries to named insureds. At first glance this seems to conflict with the medical payments coverage, and it does in that duplicate payments are excluded. An insured can make a claim for injuries under both liability and medical payments as long as the identical losses are not claimed. For example, if an insured is severely injured and incurs $14,000 in medical bills and their med pay coverage limit is $5,000 the remaining $9,000 may be claimed under the liability coverage. However, the amount that was paid under medical payments cannot also be claimed under the liability coverage.

.Medical payments coverage is specifically for the insured; this provides the option of leaving the liability limits available to other parties injured as a result of the accident. If the insured is involved in a large loss, it makes more sense for the insured to leave the liability coverage available for another party who could possibly sue and use the medical payments coverage for himself/family members.

However, if the insured runs into a tree causing severe injuries to a family member and expenses are above the medical payment limits, it makes sense for the claim to be filed under bodily injury. While it is seldom seen the policy does allow it. The insured cannot collect for the identical expenses under both coverages.

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