Accident - What Is It?
Published: Mar 23, 2015
If one of your insurance companies denies an auto claim because the adjuster says the injury didn't result from an "auto accident" or a "motor vehicle accident," or the accident didn't result from the "use" of an auto, there is hope for a reversal of that decision. The Texas Supreme Court has interpreted those phrases.
The phrases are used in various sections of auto insurance policies, as summarized below:
TDI and ISO Business Auto Policies
Section II - Liability Coverage
We will pay all sums an "insured" legally must pay as damages because of bodily injury or property damage to which this insurance applies, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto".
Personal Injury Protection - Endorsement CA 22 64 or TE 04 01
We will pay Personal Injury Protection benefits because of "bodily injury" resulting from a motor vehicle accident and sustained by a person "insured".
TDI and ISO Personal Auto Policies
Part A - Liability Coverage
A. We will pay damages for "bodily injury" or "property damage" for which any "covered person" becomes legally responsible because of an auto accident.
Part B2 - Personal Injury Protection Coverage
A. We will pay Personal Injury Pretection benefits because of bodily injury:
1. Resulting from a motor vehicle accident; and
2. Sustained by a "covered person".
Resulting From Use of an Auto
Texas courts have generally held that "use" is broader than "operation" and includes putting or bringing a thing into action or service and employing a thing for or applying a thing to a given purpose.
The Texas Supreme Court ruled in MidCentury vs. Lindsey (1999) that "use" within the context of the auto policy means:
(1) The accident must have arisen out of the inherent nature of the automobile, as such,
(2) The accident must have arisen within the natural territorial limits of an automobile, and the actual use must not have terminated, and
(3) The automobile must not merely contribute to cause the condition which produces the injury, but must itself produce the injury.
Auto Accident or Motor Vehicle Accident
In its 2004 decision in the case Texas Farm Bureau v. Sturrock, the Texas Supreme Court ruled that an “auto accident” or a “motor vehicle accident” occurs when:
(1) One or more vehicles are involved with another vehicle, an object, or a person,
(2) The vehicle is being used, including exit or entry, as a motor vehicle, and
(3) A causal connection exists between the vehicle’s use and the injury-producing event.
This case involved a PIP claim resulting when the vehicle’s driver entangled his foot in the door facing and fell out of the vehicle. The court’s decision allowed the driver to collect PIP benefits previously denied by the company.
Other types of liability and medical claims that may be affected by the Supreme Court decisions include:
- No coverage for a case involving a dog bite to a passenger riding in the auto.
- No coverage for a case involving a drive-by shooting.
- Coverage for a case involving accidental discharge of a weapon while resting in a gun rack in the back window of a pickup.
- No coverage for a case involving transmission of tuberculosis by a bus driver to the passengers of the bus (Texas Supreme Court, 2011, Lancer Ins. Co. vs Garcia Holiday Tours).
- Coverage for bodily injury incurred in an explosion of cleaning solvents used on a mobile catering truck (Employers Mutual vs. Bonilla, Federal 5th Circuit, 2010).
- Coverage for injury incurred when someone slams a car door on their fingers or hand.
- Coverage for injury incurred when someone falls out of a parked pickup truck.
- Coverage for injury incurred by a person working under a vehicle when the vehicle falls off the jack.