QuestionMy Mom has New York State car insurance including PIP for her own vehicle, she was injured as a passenger in my vehicle in Florida on vacation -- our assumption is that her own vehicle PIP should follow her even if a passenger in another state in another vehicle - to help pay for her bills beyond my PIP in FL -- the insurance agent in NY is saying no, that she needed to be driving my vehicle. Are they shaking us around ?
AnswerHi Tom,
This question is beyond my expertise, for the reasons explained below. Hence, I almost checked the box to make you go to another expert. But without giving you some guidance, that would do you no good.
I am going to give just general information, and you will have to one of our experienced and helpful insurance adjusters here at allexperts. I am also going to give you a link below to find the state insurance commissioner and ask for clarification.
The reason is: Dr. Settlement is a personal injury trial attorney. So our work is usually simply trying cases on issues of liability and damages and we are not working day-to-day in the field of insurance coverages, as the adjusters are.
Hence, my quick answer is to get the adjuster to state (in an e-mail preferably, so you get the story down in writing) the legal reasons for denying the claim. Then go to the state insurance commissioner and ask for clarification or for help.
That is the total sum of my answer, but since attorneys like to talk, I am going to ramble on about a few background topics that I want you to have in mind when you speak with your Mother’s adjuster. I thought I had best try to give you your price of admission, so if you want to go through the analysis with me, I hope I can shed a bit of light on how the policy might be read by the adjuster.
There are some guiding principles at work here, and the first two are:
a) the insurance contract controls the relationship with the insured, NOT some office procedure; and
b) state law trumps the insurance contract in terms of defining the rights of the PIP claimants.
In working those here, we also run across a third principle: when an injured passenger makes a first party claim (i.e. for medical expenses or lost wages under PIP), the first policy to be tapped will be the policy that insures the vehicle. Hence, that would be your policy in this case. It is your policy that will most often be looked to first, and only when your limits are exhausted will the passenger’s policy be used.
So, for starters, most companies, even if they are going to honor their PIP, will require a passenger to exhaust the PIP of the car in which their insured was riding. Note that this pertains ONLY to first party coverage (i.e. the insurance covering the car) and NOT to the third party coverage (the insurance of the one who caused the accident.
Hence, that is our first possibility: the adjuster will require your Mother to open a claim against your PIP. Once your PIP is exhausted, then your Mother can claim under her PIP.
If you and your Mother do not wish to do this, then you can do as I used to do and that is to point out that irrespective of what the “practice” OR the “procedure” is for the company, she paid her premiums to be covered as a driver and a passenger, and they MUST honor the obligation.
If that argument does not work, ask the adjuster for her legal authority. Try to get her to put it in an e-mail. That way you can present it to the state insurance commissioner for review. This procedure may be written in the contract that PIP is effective only after your insurance is exhausted.
The more interesting topic is her statement that your Mother’s insurance will not cover her AT ALL as a passenger in an out-of-state accident. Forgive my inexperience Tom, but that concept would be a first for me in nearly 30 years in this business. But then again, I am only familiar with the laws of maybe fifteen states, so maybe NY does allow such a policy provision. I did try to look it up for you, but the morass of NY law did not yield a ready answer.
This is where we see that the state law trumps the policy. Most states specifically define the rights of the PIP policy. And so the statutes will control over the policy if there is a conflict.
The best way to find out what the rights are is to contact your Mother’s state insurance commissioner http://www.settlementcentral.com/links.php (third line down).
I hope I did not waste your time, and that my effort here has produced some information that has been of value to you, Tom, and thus I would respectfully request that you take the time to locate the FEEDBACK FORM on this site and leave some feedback for me.
Best Wishes,
Dr. Settlement, J.D. (Juris Doctor)
http://www.SettlementCentral.Com
