What is the Definition of a “Motor Vehicle Accident”?

On August 27, 2004, the Texas Supreme Court in a 5-4 decision issued an opinion in Texas Farm Bureau Mutual Insurance Company v. Sturrock, 2004 WL 1908330, *7 (Tex. 2004) holding that under the Personal Injury Protection (“PIP”) coverage of a Texas Personal Auto Policy, a “motor vehicle accident” occurs “when 1) one or more vehicles are involved with another vehicle, an object, or a person, 2) the vehicle is being used, including exit or entry, as a motor vehicle, and 3) a causal connection exists between the vehicle’s use and the injury-producing event.” The Court’s opinion attempts to resolves what it termed as a “grammatically confusing” definition of “auto accident” created in Mid-Century Insurance Co. of Texas v. Lindsey, 997 S.W.2d 153 (Tex. 1999).

Sturrock was involved in an “accident” when he injured himself while exiting his vehicle. His foot became tangled in the door panel and as he was attempting to prevent his fall he suffered injuries to his neck and shoulder. He filed a claim for PIP benefits under his Texas Personal Auto Policy with Texas Farm Bureau. Sturrock’s policy provided that, in order to receive benefits under the PIP clause, he must be a “covered person” that sustained an injury “resulting from a motor vehicle accident.” (Emphasis added).

Relying on the holding in Mid-Century and conventional wisdom, Texas Farm Bureau concluded that falling from one’s vehicle while exiting is not a “motor vehicle accident,” and denied his claim for PIP benefits. The court rejected Texas Farm Bureau’s argument that the vehicle was no more than the situs of the accident, and bore no causal relationship to the injury.

The court also revisited Mid-Century’s holding that the term “auto accident” meant “where one or more vehicles are involved with another vehicle, object or person” and concluded it grammatically confusing, in that it implied the necessity of a plurality of persons or objects when it was meant to emphasize a plurality of vehicles. The court then announced its new definition stating that motor vehicle accident occurs where one is involved with “another vehicle, an object or a person.”

The court also suggested that Texas Farm Bureau’s argument, if accepted, would result in “greater coverage for passengers than for actual premium-paying insureds.” The court speculated that, under Texas Farm Bureau’s interpretation, the following would result:

A passenger who fell from Sturrock’s truck in the same way would be covered but Sturrock would not. Sturrock would be covered if he had fallen out of his car onto another person, but not if he had fallen directly onto the ground. He would be covered if a tire dislodged from another vehicle and hit his car, but not if his own tire blew out and caused his vehicle to roll over. Sturrock would be covered if he were run over by a vehicle with a faulty parking brake, but not if his own vehicle ran over him because of the same defect.

As the nature of PIP coverage is to be one in which fault is immaterial, the court could not rationalize a reasoning for denying no-fault benefits “to insureds who suffer injuries by their own covered vehicle.”

However, the court recognized the danger in allowing no-fault coverage on an unlimited basis, and thus, limited its holding. In order to file for PIP benefits the vehicle must still be “more than the mere situs of the accident or injury producing event.” The vehicle must be involved in the accident in some manner, thus suggesting that the vehicle must play some causative role rather than be a mere location. The court cited jurisdictions around the country that applied a similar interpretation in slip-and-fall accidents while “entering into or alighting from the covered vehicle” in support of its rationale.

The court held that since Sturrock was injured when he became entangled in a portion of his vehicle, the vehicle played the necessary causative role in producing his injures, thereby entitling him to PIP coverage.

The court went on to reason that its holding complied with the language of Sturrock’s policy: that the policy mandated that a “covered person” is one that is entering or exiting a covered vehicle; as such, a reading of the policy that would exclude accidents like Sturrock’s would “render the definition of ‘covered person’ meaningless.”

The majority concluded that Sturrock should be afforded coverage under his auto policy’s PIP benefits because “a ‘motor vehicle accident” occurs when 1) one or more vehicles are involved with another vehicle, an object or a person, 2) the vehicle is being used, including exit or entry, as a motor vehicle, and 3) a causal connection exists between the vehicle’s use and the injury-producing event.”

Justice Owen authored the dissent, joined by Justices Hecht, Wainwright, and Brister. The dissent argued that the holding in Mid-Century should have been applied, and Sturrock’s claims denied.

The dissent points out that none of the out-of-state authorities relied upon by the majority contains even substantially similar policy language to what is at issue in the Texas policy. The dissent instead pointed to a number of out of state cases that dealt with policies that required an automobile or motor vehicle accident for coverage to apply. In those out-of-state authorities, the courts consistently held, in similar factual situations, no automobile or motor vehicle accident occurred. However, they agreed that the policy language in other states differed substantially from the policy language involved in this case. The majority also collapsed the policy language of the PIP coverage with that of the uninsured motorist coverage to arrive at their opinion.

The court’s opinion contains numerous references to an amicus brief filed by the Texas Department of Insurance. Great deference is paid to the Department’s interpretation of the policy language and prior case law. Though historically, TDI bulletins have been of no persuasive or precedential value to the Texas Supreme Court, it is apparent that the Supreme Court in this case was greatly influenced by the brief.