Policy Interpretation In Texas

No matter where you live, Weatherford, Aledo, Azle, Lake Worth, Mineral Wells, De Soto, Arlington, Grand Prairie, Dallas, Fort Worth, Mesquite, Garland, or anywhere else in Texas, the insurance companies are always looking for ways to deny a claim.
The Texas Supreme Court, in 2004, decided a case where the insurance company denied a claim for Personal Injury Protection (PIP) benefits under a policy. The style of the case is, Texas Farm Bureau Mutual Insurance Company v. Jeff A. Sturrock. Justice O’Neil delivered the opinion of the Court.
In this case, an insured, Sturrock, was injured when his foot became entangled with his truck’s raised door facing while he was exiting the vehicle. The issue here is whether or not his injury resulted from a “motor vehicle accident” for purposes of PIP coverage under his automobile policy with Texas Farm Bureau Mutual Insurance Company (Farm Bureau). The Court held that 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 and entry, as a motor vehicle, and (3) a casual connection exists between the vehicle’s use and the injury producing event.
The facts here were that Sturrock drove his truck to work, parked, and turned off the engine. While exiting the truck, he entangled his left foot on the raised portion of the truck’s door facing. He injured his neck and shoulder in his attempt to prevent himself from falling from the vehicle.
The Texas Insurance Code, Section 1952.152, requires that every automobile insurance policy issued within Texas provide PIP coverage, unless rejected in writing. Sturrock’s policy provided in pertinent part:
A. We will pay Personal Injury Protection benefits because of bodily injury:
1. resulting from a motor vehicle accident, and 2. sustained by a covered person.
Farm Bureau did not dispute that Sturrock is a “covered person”, but denied that his injuries resulted from a “motor vehicle accident” within the policy’s PIP coverage.
This lawsuit resulted.
Farm Bureau argued that accidents like the one Sturrock experienced do not fit within the plain meaning of “motor vehicle accident” because the term requires some involvement between the covered motor vehicle and another vehicle, person, or object. Conversely, Sturrock claims the incident at hand was a “motor vehicle accident” because the vehicle itself produced the injury.
In the 1995 case, State Farm Mutual Insurance Company v. Peck, the Amarillo Court of Appeals, which involved a drive-by-shooting, held that State Farm had no duty to defend or indemnify its insured because “a drive-by-shooting” could not be transformed into an ‘auto accident’ under the policy.
The Texas Supreme Court more recently had addressed the meaning of “automobile accident” in Mid-Century Insurance Company of Texas v. Lindsey, in 1999. There, Linsey, a passenger in his mother’s car, was shot by a gun that accidently discharged from an adjacent truck when a boy attempted to enter the cab through the rear window. In that case the Court rejected the interpretation that the term “auto accident” required a collision or excluded occurrences like Linsey’s.
The Court went on through an analysis of the meaning of “accident” and “arising out of a motor vehicle’s use” and is a good read for trying to understand how Courts reach their decisions. It also illustrates, by cites to other cases, how difficult decisions can be when interpreting insurance policies. One conclusion that should be obvious is that an experienced Insurance Law Attorney should be consulted in these matters.
In the Sturrock case, the Court ruled in favor of Sturrock by finding that the PIP provision in the policy did provide coverage for Sturrock.