To Recover PIP Cover There Must be an Auto Accident
When a person becomes ill, parks his car, and falls out of it onto the pavement, is he operating the vehicle for personal injury protection (PIP) no fault insurance coverage purposes? In Kelly Ramm and Lisa Ramm v. Farmers Insurance Company Of Washington, Court of Appeals of Washington, 2017 WL 2451502,No. 34542-4-III (6/6/17) the Washington Court of Appeals was asked to resolve the issue.
Kelly Ramm was driving with his son on Trent Avenue in Spokane, Washington when he began to feel nauseous. Believing he was going to be sick, Mr. Ramm turned his vehicle from Trent to a side street and then pulled over toward the side of the road. The vehicle was placed in park but the keys remained in the ignition with the engine running. Mr. Ramm then unbuckled his seatbelt and leaned out the driver’s door to vomit onto the road. He passed out and fell forward onto the pavement, striking his head and suffering significant injuries. After falling and while still unconscious, Mr. Ramm began bleeding profusely. His head and upper body fell outside the vehicle but his legs and feet remained inside near the pedals for the accelerator and brakes. Mr. Ramm’s son provided some basic first aid and drove his father to the emergency room.
The Ramms accumulated medical bills in excess of $10,000 for treatment of Mr. Ramm’s injuries. Mr. Ramm submitted a PIP claim under his personal automobile policy with Farmers. The insurance policy agreement affords that Farmers “will provide the benefits described [in the policy] for bodily injury to each Insured person caused by a motor vehicle accident.” (emphasis in original).
Farmers responded to Mr. Ramm’s PIP claim by denying coverage for the incident. It took the position that a motor vehicle accident only occurs when the covered motor vehicle is being operated as a motor vehicle and a motor vehicle is not being operated as a motor vehicle when parked. Farmers reasoned that since Mr. Ramm sustained his injuries by falling from a parked vehicle, the events leading to those injuries could not be considered a motor vehicle accident and he was not entitled to PIP coverage.
The Ramms sued Farmers alleging breach of contract for failure to pay PIP benefits and moved for partial summary judgment on the breach of contract claim. Farmers filed a cross motion for summary judgment, and the trial judge granted Farmers’ cross motion, denied the Ramms’ motion, and dismissed the breach of contract claim.
At issue here is whether Mr. Ramm’s injuries were caused by a “motor vehicle accident,” as contemplated by the insurance policy. The term motor vehicle accident unambiguously refers to an incident where one or more vehicles come in forceful contact with another vehicle or a person, causing physical injury. A motor vehicle accident occurs when a motor vehicle is being operated as a motor vehicle.
In Washington, a motor vehicle is being operated as a motor vehicle when it is being driven or when it is stopped while being driven. For example, if a tree limb were to fall on the motor vehicle while a person was driving or had stopped while driving, that would constitute a ‘motor vehicle accident.’ On the other hand, a motor vehicle is not being operated as a motor vehicle when parked.
Mr. Ramm’s injuries were not caused by forceful contact with a vehicle. The forceful contact was with the pavement. A reasonable construction of the term “motor vehicle accident” simply does not encompass this unfortunate incident.
Mr. Ramm’s car was not stopped at a traffic signal. He was not taking any action to ensure the car remained motionless. Instead, Mr. Ramm’s vehicle was pulled to a side road and the transmission was placed in park.
It is irrelevant that Mr. Ramm did not intend to have his vehicle remain in park for very long. That is not the test. The test is what was happening at the moment of the incident. Because Mr. Ramm was in no sense operating his vehicle at the time the injuries were sustained, the incident did not qualify for PIP coverage.
There is no question Mr. Ramm was injured. However, it is also clear, that Mr. Ramm was not involved in a motor vehicle accident. He got sick and fell to the pavement. To recover on a PIP policy there must be a motor vehicle accident. Since there was none the court agreed appropriately with Farmers and rejected the claim of Mr. Ramm.
This article and all of the blog posts on this site digests and summarize cases published by courts of the various states and the United States. The court decisions have been modified from the actual language of the court decisions, were condensed for ease of reading, and convey the opinions of the author regarding each case.
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant and expert witness specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 49 years in the insurance business.
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
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