A standard homeowners policy provides limited “med-pay” coverage for medical expenses incurred by other persons. Medical payments pay medical expenses incurred by people accidentally injured on your property, regardless of fault, up to policy limits. The med-pay coverage generally has a separate limit of liability from the personal liability coverage.
Medical payments may also apply to medical costs associated with injuries that happen elsewhere arising out of the non-business activities of the insured. Injuries to you or family members living with you are not covered, nor are injuries resulting from activities involved your business.
Injuries Sustained at the Insured’s Home
For injuries sustained at your home, the homeowners policy covers medical expenses for “bodily injury” without regard to the cause of the injury-producing accident. One example is a guest who slips while coming down your stairs and sprains his ankle. Or, a guest who bumps his head on a cabinet requiring stitches.
The med-pay coverage of homeowners policy creates a direct obligation by the insurer to persons injured on the insured premises, regardless of the insured’s negligence. Harper v. Wausau Ins. Co. (1997) 56 CA4th 1079, 1089. Such persons have standing to sue the insurer as intended third party beneficiaries of the insurance contract because such persons were injured on the property and are members of the class of person protected under the policy. Id. at 1091.
An injured person who receives payment from the tortfeasor’s liability insurer in settlement of a personal injury claim is not barred from subsequently suing the insurer to recover under the homeowners policy’s med-pay provision. Such an action does not lead to an impermissible double recovery. Barnes v. Western Heritage Ins. Co. 217 Cal.App.4th 249, 259-261 (noting nationwide split of authority).
For injuries off-premises, the injury must arise out of condition on the insured location, or be caused by the activities of the insured, their employees, or animals in their case. Shaolian v. Safeco Ins. Co., supra, 71 CA4th at 274, 83 CR2d at 706. For instance, your dog wanders into your neighbor’s yard and bites him or your dog accidently bumps into a hiker causing the hiker to fall and suffer a fractured leg.
There is no direct action against the insurer where the policy covers off-premises injuries only if caused by the insured. This means the injured person is not an intended beneficiary with respect to off-premises injuries, and is entitled to medical expense coverage only if the insured was at fault. Since the right to coverage in this situation turns on a finding of actual fault, the claimant must obtain a final judgment before making a claim against the insurer for benefits. Shaolian v. Safeco Ins. Co. (1999) 71 CA4th 268, 275, 83 CR2d 702, 706.
ABOUT THE AUTHOR: Eva Bonelli is a 2007 graduate from Thomas Jefferson School of Law. Ms. Bonelli has been with the firm for many years now and specializes in general liability defense, employment, and business litigation. Contact her at email@example.com
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