Consumption and Real Estate
Homeowners insurance claim coverage question for agents or adjusters #5?
Question : Homeowners insurance claim coverage question for agents or adjusters #5?
Opinions?
Insured is driving down the street. There is a passenger in the right front seat and a passenger in the back seat. The back seat passenger warns the inattentive driver about a stopped car ahead. The driver slams on the brakes and does not hit the car in front of them. The back seat passenger flies into the back of the front seat and is injured or claims injury.
Has there been an accident?
homeowners insurance claims
Best answer:
Answer by mbrcatz
There has NOT been an accident, but there HAS been an “occurrence”, which is what you need to trigger coverage on an AUTO policy. You ask about HOMEOWNERS question, but homeowners insurance clearly doesn’t apply here.
Keep in mind, in some states, if the passenger in the rear was not restrained in a seat belt, it could nullify his ability to collect medical payments or pip coverage, depending on what state he lives in.
If rear seat passenger hit the back of the seat in front of him – then he was not wearing a seat belt. Does the state where this happened recognize a seat belt defense? Most states don’t recognize it anymore, but its something I’d look into. So, a lot is going to depend on where the incident happened.
The discussion that follows is very general and the answer may be different based on the laws of the state where the loss happened.
As far as would this be a valid claim? Was the driver negligent? Using the “but for” test- yes. “but for” the drivers slamming on his breaks due to his inattention the rear seat passenger is not injured.
Negligence can also be defined using 4 parts: 1. duty owed, 2 duty breached, 3. injury occurs, 4. injury is proximately related to the breach of the duty owed.
Using this standard- is the driver of the vehicle negligent? yes. He has a duty to pay attention and operate his vehicle in a safe manner. He breached his duty and as a result the rear seat passenger was injured. Is the injury proximately related to the breach of the duty – yes (see the but for rule above). Whether or not the rear seat passengers intervening negligence for not wearing a seat belt affects anything depends on if the state recognizes a seat belt defense. For the sake of discussion, we’ll say it does not.
How does your policy read? Most say they will cover for bodily injury for which an insured is legally liable. Is the insured legally liable? Yes – see discussion above.
The other provision is that it has to arise out of an event that is “sudden and accidental”. Is this sudden and accidental? Yes. The slamming on of brakes did not happen over a period of weeks/months/years. It was a sudden event. The driver did not slam on the brakes with the intention of causing the rear seat passenger injury. Therefore, it is accidental.
So, yes, the rear seat passenger would have a valid claim against any applicable Med Pay and liability coverage.
It does not matter if it is an “accident” or not. The word “accident” never appears in the standard auto policy. All that the insurance company is concerned with is if they had a policy in force on the date of the loss and if the event is a covered loss. It is my opinion, that yes, this would be a covered loss.
This would be covered under the auto policy not the homeowners policy. I’m sure that’s just a typo on your part.