One of the best arguments one can make for securing uninsured/underinsured motorist (UM/UIM) coverage is that it will provide coverage even if you aren’t actually driving or in a motor vehicle. For example, if you are a pedestrian or bicyclist struck by an uninsured or underinsured driver, you can seek coverage from your UM/UIM carrier to make up the difference.
However, insurance companies are free to write the terms of their coverage, so this isn’t a guaranteed benefit. In the recent case of Spiller v. Travelers Property Casualty Co. of America, the U.S. District Court in the Western District of Kentucky ruled that a worker who was not in his employer’s truck when he was struck by a negligent driver was not entitled to collect UIM benefits.
The underlying facts of this work injury lawsuit were that the plaintiff, employed by a contractor, was tasked with making certain repairs along a four-lane expressway. In the course of doing this work, he was trailed by a large truck equipped with an arrow that flashed. This was supposed to alert rear traffic to move left because there was construction on the right. A few hours into his shift, a motorist slammed into that arrow board attached to the truck, pushing the truck into the plaintiff and causing him to suffer injuries.
For this, the plaintiff was entitled to workers’ compensation coverage. However, he also had the option of a third-party claim against the negligent driver, which he pursued. He settled that case for the policy limits of that driver’s liability insurance, which were $100,000.
After that, the plaintiff presented an underinsured motorist claim to his employer’s auto insurance carrier, Travelers. However, the company rejected the claim, arguing the plaintiff wasn’t an insured under the policy because he hadn’t been occupying the truck.
Although employees cannot sue their employers for work-related injuries, this was a claim for additional insurance benefits from a liability carrier. Such claims do not violate the exclusivity rules of workers’ compensation law.
The plaintiff sued the company in state court, although the matter was later removed to federal court. The key question was whether the plaintiff was in fact an insured per the terms of the UIM contract. The endorsement for UIM coverage stipulated that an insured was anyone who was “occupying a covered auto.” The term “occupying” was defined as in, upon, getting in, on, out, or off. Both the plaintiff and the defendant agreed the plaintiff would only be considered an insured if he fit this definition of occupying the truck.
The injured worker argued that he was occupying the truck – even though he was a full car-length away – because he was “upon” the truck at the time of the accident. Therefore, he argued, he was occupying it.
The trial court granted summary judgment to the defense, finding that the term “occupying” is not ambiguous, and applying the precedent set in Missouri and other jurisdictions, the court determined the plaintiff wasn’t occupying the truck. Relying on a four-part test, the court asked whether the plaintiff was in close proximity to the insured vehicle, whether there was a causal link between the injury and the vehicle, whether the plaintiff was oriented toward the vehicle or the sidewalk or highway, and whether the plaintiff was engaged in some essential use of the vehicle.
Since the plaintiff didn’t meet these criteria, the court ruled, his injuries were not covered.
Contact the Carolina workers’ compensation lawyers at the Lee Law Offices by calling 800-887-1965.
Spiller v. Travelers Property Casualty Co. of America, Oct. 5, 2016, U.S. District Court in the Western District of Kentucky
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OSHA Clarifies Its Stance on Anti-Retaliation Regulations, Post-Work Accident Drug Testing, Nov. 2, 2016, Asheville Worker Injury Lawyer Blog