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PIP benefits for bus accident?

PIP benefits for bus accident?

June 26
08:16 2018

PIP benefits for bus accident?

Svetlana Koren’s minor son Eric was injured as a result of a collision involving two school buses. Koren filed a claim for personal injury protection (PIP) benefits on behalf of Eric with her insurer, State Farm Fire & Casualty Company.

The PIP portion of Koren’s policy provided benefits “for bodily injury sustained by [the] insured and caused by an automobile accident.” The provisions further defined an “automobile” as a “motor vehicle registered or designed for carrying ten passengers or less …” The terms “accident” and “automobile accident” were not defined in the policy.

State Farm denied Koren’s claim on the grounds that Eric’s injuries were not sustained during an “automobile accident” as contemplated by the policy. Specifically, because each of the two buses involved was designed to carry more than 10 passengers, neither vehicle met the policy definition of an “automobile.”

Koren filed suit against State Farm on behalf of Eric, and the parties filed cross motions for summary judgment on issues related to insurance coverage. The court sided with State Farm. It found that the policy’s definition of “automobile” was not ambiguous and the buses did not qualify as automobiles. The court also found that the policy definition of “automobile” tracked with the language of relevant state statutes and therefore did not contravene public policy. Because the court found that the school bus collision did not qualify as an insurable event, it did not reach State Farm’s other coverage arguments for summary judgment. Koren appealed.

On appeal, Koren argued that her policy defined the term “automobile” but not “automobile accident.” According to Koren, “automobile accident” is a term of art that has a special meaning and extends coverage to all motor vehicle collisions.

The court stated that the modifier “automobile” attached to the word “accident” in Koren’s policy compelled it to conclude that Eric’s injuries did not qualify for PIP coverage. “It is not enough that Eric’s injuries were sustained in an accident. For PIP coverage to apply, Eric’s injuries must have been sustained in an accident that was causally connected to an automobile.”

The trial court’s order of summary judgment in favor of State Farm was affirmed.

Koren vs. State Farm Fire & Casualty Company-Court of Appeals of Washington, District 3-January 9, 2018-No. 34723-1-III.

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