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Section II – General Liability Coverages

Coverage C – Locations and Operations Medical Payments 

CA 00 25

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II. General Liability Coverages

C. Locations and Operations Medical Payments

            1. Coverage (Insuring Agreement)

            2. Exclusions

 

Actual Policy Language

Explanation

SECTION II – GENERAL LIABILITY COVERAGES

II. General Liability

The General Liability section of the Auto Dealers Coverage Form closely tracks the Commercial General Liability Coverage Form (04 13 edition). 

C.  Locations And Operations Medical Payments

C.  Locations And Operations Medical Payments

1. Coverage

a. We will pay medical expenses as described below to or for each person who sustains "bodily injury" to which this coverage applies, caused by an "accident" and resulting from your "auto dealer operations".

b. We will pay only those expenses incurred for services rendered within one year from the date of the "accident".

c. We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance. We will pay reasonable expenses for:

(1) First aid administered at the time of an "accident";

(2) Necessary medical, surgical, diagnostic imaging and dental services, including prosthetic devices; and

(3) Necessary ambulance, hospital, professional nursing and funeral services. 

1. Coverage

Medical payments coverage is triggered by "bodily injury," subject to the definition in the policy. It is paid without regard to negligence, and is usually seen as a means of avoiding larger liability suits. See CGL technical report Medical Payments--Automatic?

The term "accident" eliminates medical payments coverage for intentional injury by an insured, but intentional injury by others on the insured's premises would be covered.

Notice that the accident must arise out of the insured's auto dealer operations, defined as locations used for an auto dealership and operations necessary or incidental to a dealership. Accidents involving autos are excluded by virtue of the Auto exclusion in the General Liability section, which is incorporated into the Medical Payments exclusions.

Although the accident must occur during the policy period, the expenses can be turned in (incurred and reported) within one year after the date of the accident, even if the policy has expired.

The expenses payable under medical payments coverage are specified in the insuring agreement. "First aid" usually involves the insured's out-of-pocket expenses for rendering aid at the time of the accident, including emergency transportation to a medical facility.

There is a separate limit of insurance for Coverage C - see F. Limits of Insurance – General Liability Coverages.

Endorsement CA 25 52 (Exclusion - Locations and Operations Medical Payments) eliminates this coverage.

2. Exclusions

This insurance does not apply to “bodily injury”:
2. Exclusions

a. Workers' Compensation

To a person, whether or not an "employee" of any "insured", if benefits for the "bodily injury" are payable or must be provided under a workers' compensation or disability benefits law or a similar law. 

a. Persons Covered by Workers' Compensation

This exclusion eliminates medical payments coverage for any person, even members of the public, if they have workers' compensation benefits available to cover the injury. An employee of another business injured on the insured's premises could not collect, unless his employer did not provide workers' compensation benefits.

b. Insured

To any "insured". 

b. Insured

This exclusion applies to additional insureds on the policy, as well as the named insured, employees, and others qualifying as insureds. 

d. Injury On Normally Occupied Premises

To a person injured on that part of the premises you own or rent that the person normally occupies.

d. Residents

Residential tenants of the insured are excluded. The lease usually holds the landlord harmless for all injuries occurring on the premises, so the liability exposure from tenants is minimal.

c. Hired Person

To a person hired to do work for or on behalf of any "insured" or a tenant of any "insured".

c. Employees and Independent Contractors

Persons performing work for the insured (or a tenant of the insured's property) are not covered, whether they are employees or independent contractors.

e. Athletic Activities

To a person injured while practicing, instructing or participating in any physical exercises or games, sports, or athletic contests.

e. Athletic Participants

This exclusion is found only in medical payments, and not in liability Coverage A. The exclusion is broad enough to apply to the insured's sponsorship of athletic events, as well as those organized by the insured, such as company "teams."

f. Injury Away From Auto Dealer Locations

Sustained by a person away from locations owned, maintained or used for your "auto dealer operations".

f. Off-Premises Injuries

Medical payments coverage is not available for injuries arising out of products or completed work, since such injuries would normally occur away from the dealership premises.

Also excluded, however, are injuries that arise out of a dealer's operations but sustained off-premises. This is a key distinction from the medical payments coverage provided by the CGL, which applies to an off-premises injury if it arises out of the insured's operations. 

g. Bodily Injury And Property Damage Liability

Excluded under Paragraph A. Bodily Injury And Property Damage Liability.

g. All "Coverage A" Exclusions Apply

This exclusion incorporates all of the bodily injury exclusions in Coverage A. Key exclusions include pollution, autos, aircraft and watercraft.