Question from an IIABNY member: If you are a pedestrian and get hit by a moving vehicle, where are those injuries and medical bills paid from? And if they are covered under the driver’s No Fault coverage, would the injuries and medical bills also be paid even if the pedestrian ran in front of the moving vehicle trying to cross a road?
Answer: The PIP endorsement to the Personal Auto Policy (ISO endorsement PP 05 87 07 02) states:
Subject to the exclusions and conditions set forth below, an eligible injured person is:
(a) The named insured and any relative who sustains personal injury arising out of the use or operation of any motor vehicle;
(b) The named insured and any relative who sustains personal injury arising out of the use or operation of any motorcycle, while not occupying a motorcycle;…
Therefore, the named insured’s no-fault coverage will pay his medical bills if another car hits him while he’s walking. Of course, if he suffers a serious injury, New York law permits him to sue the car’s driver for non-economic damages.
Regarding your second question, it’s a little murkier. The endorsement states:
This coverage does not apply to personal injury sustained by:…
(e) Any person who intentionally causes his or her own personal injury;…
The key word there is “intentionally”. Since this provision is an exclusion, the carrier bears the burden of proving that the person intentionally caused the injury. There’s a difference between reckless behavior and behaving with intent to cause a self-inflicted injury. A sober person who looks into oncoming traffic and steps in front of a speeding truck would appear to be trying to hurt himself. Someone who staggers drunk out of a bar and crosses the street without looking might not be, nor would someone who thinks he’s faster than he really is and who sprints across the road, trying to beat the car that’s coming. Consequently, I think the answer to your question depends on the circumstances and what the carrier can prove about the person’s state of mind.
Update: An astute IIABNY member called me out on this, saying that the driver's no-fault insurance should cover injuries a pedestrian suffers when the driver hits him. I went back and checked, thinking that an exclusion applies if the injured pedestrian is the owner or a relative of the owner of a vehicle carrying New York no-fault coverage. Turns out I was only partially right -- the exclusion does apply, but only if the injury occurs outside New York State. If one of my IIABNY colleagues succumbs to strong temptation and runs me over in the IIABNY parking lot, that person's no-fault insurance covers my injuries. If the same thing happens when we're in Washington, D.C. for the National Legislative Conference, the coverage will not apply because I have my own New York no-fault insurance and the injury occurs outside of New York.
The moral: Even devoted Insurance Geeks™ get confused by this stuff.
what would happen in this scenerio?
an insured is fleeing a scene where he has the expectation of being harmed by a pedestrian threatening him with a hand gun. In his escape he strikes the pedestrian. Would the insureds New York No-fault benefits be responsible to cover the armed pedestrian?
Posted by: Joe | June 10, 2011 at 12:51 PM
Joe,
Interesting question. In my opinion, the insured's no-fault coverage would not apply to the armed pedestrian's injuries. This is because the PIP endorsement's exclusions state:
"This coverage does not apply to personal injury sustained by:...(g) Any person while: (i) Committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer..."
I'm no expert on the classifications of various crimes under New York law, but I'm assuming that threatening someone with a firearm is a felony. Note that the injured person does not have to be convicted for the exclusion to apply; the act must merely constitute a felony. Therefore, no coverage for the pedestrian in this case.
Posted by: Tim Dodge | June 13, 2011 at 09:25 AM