Automobile Insurance Policy Exclusions

Weatherford insurance lawyers and those in Mineral Wells, Springtown, Aledo, Azle, Willow Park, Hudson Oaks, Peaster, Poolville, Cool, Millsap, Brock, and other places in Parker County would want to know about the opinion in this case.
The case is from the Eastland Court of Appeals and was decided in 1965. The style of the case is, Hilliard Gonzales et al. v. Farmers Insurance Exchange.
Hilliard Gonzales and Noe Mata filed suit against Farmers for benefits under a family automobile policy written for Ramon Gonzales, the father of Hilliard. The case was tried to the Judge without a jury and judgment was rendered against Gonzales.
The facts were stipulated and are substantially as follows:
Farmers issued a Texas Standard Family automobile policy to Ramon Gonzales covering a 1961 Dart with bodily injury, property damage, and $2,000.00 medical payment coverage. The policy also covered a 1949 Pontiac with bodily injury and property coverage only, no medical payment coverage. During the policy period the 1949 Pontiac was exchanged for a 1954 Olds. by the named insured. Plaintiffs here were passengers in the 1954 Olds. during the policy period, when it was involved in a collision and they were injured and received medical treatment. Hilliard Gonzales was the son of Ramon Gonzales and resident of his household. Noe Mata was neither a relative not a member of Ramon’s household. The policy was introduced in evidence by stipulation. The pertinent parts of the policy are as follows:
PART II – EXPENSE FOR MEDICAL SERVICES Coverage C – Medical Payments. To pay all reasonable expenses incurred within one year from the date of accident for necessary medical, surgical, X-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services:
Division 1. To or for the named insured and each relative who sustains bodily injury, sickness or disease, including death resulting therefrom, hereinafter called ‘bodily injury’, caused by accident while occupying or through being struck by an automobile.
Division 2. To or for any other person who sustains bodily injury, caused by accident, while occupying (a) the owned automobile, while being used by the named insured, by any resident of the same household or by any other person with the permission of the named insured; or (b) a nonowned automobile, if the bodily injury results from (1) its operation or occupancy by the named insured or its operation on his behalf by his private chauffeur or domestic servant or (2) its operation or occupancy by a relative and it is a private passenger automobile or trailer not regularly furnished for the use of such relative.
Definitions. The definitions under Part I apply to Part II, and under Part II:
‘occupying’ means in or upon or entering into or alighting from; ‘an automobile’ includes a trailer of any type.’
‘owned automobile’ means (a) a private passenger, farm or utility automobile described in the policy, (b) a trailer owned by the named insured, (c) a private passenger, farm or utility automobile ownership of any of which is acquired by the named insured during the policy period, provided (1) it replaces a described automobile, ***.’
‘When two or more automobiles are insured hereunder, the terms of this policy shall apply separately to each ***’.
Exclusions. This policy does not apply under Part II to bodily injury: (a) sustained while occupying (1) an owned automobile while used as a public or livery conveyance, or (2) any vehicle while located for use as a residence or premises; (b) sustained by the named insured or a relative (1) while occupying an automobile owned or furnished for the regular use of either the named or any relative, other than an automobile defined herein as an ‘owned automobile’ ***.
In making it’s decision on this appeal, the appeals court said, “The record shows conclusively that the named insured did not apply for medical payment coverage on the Pontiac or the Olds.; that he was not charged a premium not did he pay a premium for such coverage, and there was no intention on the part of the named insured to obtain such coverage nor on the part of the insurance company to furnish such coverage.”
Under the ‘two or more automobiles’ provision of the policy, the court was compelled to view the policy as a separate policy on the 1961 Dart and a separate policy on the 1954 Olds. Plaintiffs cannot recover under the Dart policy because the car in which they were injured is not described in the Dart policy. When the claim is considered under the 1954 Olds., there is no medical payments coverage.
This is yet another case an experienced Insurance Law Attorney would want to know about in order to properly advise clients about the merits of their claim.

Contact Information