Personal Protection Benefits – Occupying A Vehicle

When it comes to claims dealing with automobile policies, here is a case that needs to be read.  It is a 2019, opinion from the Texarkana Court of Appeals and is styled, Alan Kiely v. Texas Farm Bureau Casualty Insurance Company.

Kiely sued Farm Bureau in an effort to recover Personal Injury Protection (PIP) benefits that had been denied.  Summary Judgement was granted in favor of Farm Bureau and this is Kiely’s appeal from that ruling.  This Court sustained the ruling in favor of Farm Bureau.

The PIP policy at issue provided coverage up to $10,000 per person for each accident.  Texas Insurance Code, Section 1952.151, states PIP requires payment of all reasonable expenses that: (1) arise from an accident; ….

Kiely had sustained storm damage to the roof of his home.  He ordered metal roofing sheets to repair the roof.  A flatbed delivery truck driven by Brian Reeves arrived with the metal roofing sheets in the bed of the truck.  The metal sheets were in three bundles.  Kiely, who uses a cane watched as Reeves manually began unloading the metal roofing.  A bundle of the metal sheets slid off the truck and pinned Reeves to the ground.

Reeves screamed for help and Kiely explained he could not help due to his knee problems.  Kiely attempted to help and heard a loud “pop” in his back.  Kiely continued with his efforts to help Reeves and ended up with two fractured vertebrae in his lower back which resulted in several surgeries.

The parties in this lawsuit stipulated that Kiely did not come in contact with any part of the truck.

Kiely’s claim for PIP benefits was denied and this lawsuit resulted.

Kiely’s policy stated:

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

In Texas, an insurance policy is construed according to the rules governing contract construction.  When a policy has a certain or definite legal meaning or interpretation, then it is not ambiguous.  The Texas Supreme Court has held that the term “auto accident” is not ambiguous.

Kiely maintains this was an auto accident because the injuries resulted from the use of the auto, in that it was being unloaded when the injuries occurred.

Farm Bureau argues that Kiely was not occupying the vehicle and thus, was not a covered person entitled to PIP benefits under the policy.

In this case, the stipulated facts show that Kiely never came into contact with the outside of the truck, including the bed of the truck.  Kiely neither entered the truck nor exited the truck.  Kiely was not struck by the truck.  For these reasons, Kiely was not a “covered person” under the Policy and was therefore not entitled to PIP benefits.

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