Exclusions In Insurance Policies

Insurance Lawyers in Grand Prairie, Arlington, Fort Worth, Lake Worth, Saginaw, Benbrook, Burleson, and other places in Tarrant County would want to be aware of this older case.
The case was decided in 1967, by the Dallas Court of Appeals. The style of the case is, William A. Cockrum v. Travelers Indemnity Company.
This is an appeal by Cockrum from a take nothing summary judgment in favor of Travelers in a suit to recover medical payments under a family automobile insurance policy.
Here are some facts:
On February 9, 1965, Travelers issued its Family Automobile Policy with William Cockrum as the named insured. The policy contained a schedule of coverage on three separate automobiles owned by Cockrum. Car No. 1 was a 1961 Cadillac and was specifically insured for liability, medical payments in the sum of $1,000, collision and towing. Each separate coverage bore a designated premium charge. Car No. 2 was a 1956 Cadillac with the same coverages with the exception of medical payments. Car No. 3 was a 1961 Pontiac and was specifically insured against all losses except medical payments. It was undisputed that medical payments coverage was not requested on No. 3.
The policy contained the provision that:
“The absence of an entry in any premium space shall mean that such insurance is not afforded with respect to the particular automobile.”
On May 9, 1965, while the policy was in full force and effect, William Cockrum’s daughter, Barbara Jean, was killed while driving the Pontiac and colliding with another car. The amount of the funeral expenses exceeded $1,000. A claim for the benefits was made by Cockrum and denied by Travelers.
Under the terms of the policy, in the “Medical Payments” section, the policy specifically allowed coverage for funeral services, when struck by an another automobile, causing death.
Another portion of the policy read:
“When two or more automobiles are insured hereunder, the terms of this policy shall apply separately to each, …”
Cockrum and Travelers agree that the only question to be resolved by the appeal was one of law, i.e., whether the insurance contract sued upon imposes the legal obligation upon the part of Travelers to pay benefits under the medical payment provision of the policy under the admitted facts presented in the record.
Travelers took the position that the trial court’s judgment was correct since at the time the accident occurred Cockrum’s daughter was driving the Pontiac which was expressly not insured under the medical payment provision of the policy. Travelers argued that since the parties had expressly contracted that no medical payments benefits would be provided on the Pontiac automobile, and no premium charges were made for such coverage on such automobile, there can legally be no liability for the payment of such coverage.
In discussing the case, the court said that the policy must be regarded as being separate and distinct as to each of the three described automobiles. When the policy is thus viewed they said they arrive at the conclusion that there can be liability for medical payment coverage as to the Pontiac for the simple reason that the parties expressly did not contract for such coverage on this particular automobile. But turning to the policy language covering the 1961 Cadillac, Travelers extended medical payment coverage to the extent of $1,000. Under this policy, Travelers expressly agreed that it would pay benefits to him, and “Each relative who sustains bodily injury, Including death resulting therefrom, caused by an accident (a) while occupying the owned automobile … Or (c) Through being struck by an automobile ….”
The court then said, “Obviously the first insuring agreement relating to accidents which occur ‘while occupying the owned automobile’ is not applicable since (Codkrum’s) daughter was not occupying the ‘owned automobile’ which is defined as the passenger automobile described in the policy and for which a specific premium charge indicates that coverage is afforded. Such insuring agreement not being applicable we then proceed to the additional insuring agreement (c) which provides that the insurance company will pay medical payments to the insured, or relative, who sustains bodily injury, or death, caused by accident’ through being struck by an automobile.'”
Following a careful analysis of the undisputed facts and their application to the specific terms and provisions of the insurance contract between the parties, the court was of the opinion and so held that the contract of insurance specifically extended coverage to Cockrum, and his family, for medical payments incurred as a result of an accident “through being struck by an automobile.” Cockrum’s daughter was struck by an automobile and medical expenses were incurred.
The court then stated:
The insurance policy in this case, being contracted between the parties, contains insuring agreements, as well as exclusions, contained in a form prepared by the insurance company. The insurance company is bound by the clearly expressed terms and provisions contained in such contract. While it did not collect a premium on the Pontiac automobile, it did collect a premium for medical payment coverage on the Cadillac automobile which policy extended benefits to the insured, and his family, while being injured as a result of an accident ‘through being struck by an automobile.'”
This appeals court reversed the trial court and ruled in favor of Cockrum.
What this case means to an experienced Insurance Law Attorney is that the insurance policies have to be read carefully and policy language has to be applied to the facts of the claim.