The Fine Lines of Insurance Coverage

In Wilson Puente v. Progressive Northwestern Insurance Company, 181 Conn.App. 852 (2018), the Connecticut Appellate Court found that a pedestrian who was struck near the vehicle he had just exited, as he was intending to walk across a parking lot, was not entitled to underinsured motorist benefits coverage under the policy issued to cover his vehicle.  The accident occurred when a motor vehicle operated by the underinsured third party, Christian Zuna, struck Wilson Puente after he had walked passed the rear of his vehicle, which was parked facing forward.  When he saw Mr. Zuna’s Honda Civic approaching, Mr. Puente was forced to jump onto the front end of the Zuna automobile, and he suffered injuries when his left foot was caught under the front end of the vehicle. The Plaintiff’s claim in this litigation was for underinsured motorist benefits under an insurance policy issued by the Defendant, Progressive Northwestern Insurance Company, to his company of four or five employees, Wilson Roofing and Siding, LLC.

The Trial Court had granted summary judgment in favor of the insurance company, finding that there was no genuine issue of material fact regarding its obligation to the Plaintiff under the policy. Thereafter, the Plaintiff appealed, raising two issues.  First, Mr. Puente claimed that he was a “named insured” within the meaning of the policy issued to Wilson Roofing, LLC.  Second, even if he was not the named insured, Mr. Puente claimed that he was entitled to recover on the grounds that he was “occupying” the insured vehicle when he was injured.

The Appellate Court rejected both arguments.  As an initial matter, the policy described those who qualify for coverage under the uninsured/underinsured motorist part by distinguishing when the “named insured” is a natural person on the one hand or a corporation, partnership, organization or other entity on the other.   In either case, people “occupying” the named insured’s auto are covered.  However, only when the named insured is a natural person are that person and his/her relatives also covered.  In this case, the policy’s “named insured” on the Declarations Page was “Wilson Roofing, LLC.”

In these circumstances, the Court found that this policy language was unambiguous, and that Wilson Roofing, LLC, not Mr. Puente, was the named insured. Because the named insured was not a natural person, the Court found Mr. Wilson had to be “occupying” the insured vehicle to be entitled to coverage.  In so finding, the Court distinguished the case of Ceci v. National Ind. Co., 225 Conn. 165, 622 A.2d 545 (1993).  As in the present case, the policy in Ceci was issued to a business.  However, the policy in that case further provided that individuals entitled to underinsured motorist benefits included the named insured, family members, and occupants of the insured auto.  Family members were defined as those who are related to the named insured by blood, marriage or adoption and are residents of the named insured’s household.  The Ceci Court had found that this policy language was ambiguous, as it included family members as insureds in a policy issued to a business.  By contrast, the policy in Puente clearly distinguished between covered persons when the named insured was a natural person or a business, and afforded coverage in the latter circumstance only to occupants of the insured vehicle.  Thus, unlike in Ceci, the policy in Puente was unambiguous and did not provide coverage for the Plaintiff personally. 

Regarding the second issue, the Appellate Court affirmed the Trial Court’s finding that the Plaintiff failed to raise any issue of material fact as to whether he was “occupying” an insured vehicle when he was injured.  The policy had defined “occupying” as “in, on, entering or exiting” the insured vehicle and did not define the term “exiting.”  To resolve this issue, the Court looked to Connecticut’s underinsured motorist statute, § 38a-363(c), which defines ‘‘occupying’’ a vehicle as ‘‘to be in or upon entering into or alighting from the vehicle.’’  Connecticut courts had previously construed the term “occupying” to require physical contact with the insured vehicle for coverage to apply.  Testone v. Allstate Ins. Co., 165 Conn. 126, 328 A.2d 686 (1973); Allstate Ins. Co. v. Howe, 31 Conn. App. 132, 623 A.2d 1031, cert. denied, 226 Conn. 911, 628 A.2d 983 (1993).

In Testone, supra, 165 Conn. 128–129, a tow truck operator was injured when an uninsured vehicle struck a disabled car he was attaching to the tow truck. The insurances policies covering the tow truck and the disabled car required the tow truck operator to be ‘‘occupying’’ the vehicle, which was defined in the policies as ‘‘in or upon or entering into or alighting from’’ the vehicle. Id., 130–31. The Court found he was neither in physical contact with nor upon the disabled vehicle.  Therefore, coverage did not apply.

In Howe, supra, 31 Conn. App. 133–134, an insured sought underinsured motorist coverage for injuries she sustained when she was hit by a vehicle as she was returning to her friend’s automobile after stopping due to an accident. This Court found that there was physical contact with the vehicle and that the claimant had taken steps to reenter the vehicle.  Thus, the Court found that it would “appear” that coverage was afford in those circumstances.

In Puente, the insurance policy did not define the term “exiting,” and the Plaintiff tried to distinguish Testone on the basis that the policy in that case had instead used the term “alighting from” the insured vehicle.  The Court recognized that the definition of “occupying” in the subject policy was consistent with, but not identical to, the language of § 38a-363(c) and prior cases. Nevertheless, the Court found that the word ‘‘occupying” in each case required physical contact with the insured vehicle in order to trigger coverage. Because Mr. Puente had stepped out of the insured vehicle and walked past the rear of the vehicle before he was struck, he was not in physical contact with the vehicle when he was injured. Thus, his claim was properly denied.

The takeaway with this case is that there are many unfortunate and unpredictable motor vehicle incidents. However, there are many fine lines within an insurance policy that are essential in deciding whether coverage is afforded in certain situations. As noted above, the difference in the definition of an “insured” for purposes of underinsured motorist coverage caused the result in Puente to be different from Ceci.  By contrast, the slightly different definition of the word “occupying” did not change the result from prior cases.  Please do not hesitate to reach out to us if you have any questions about handling any similar underinsured motorist issues or any other insurance coverage claims. We would be pleased and prepared to help!

 

Photo Credit: C&L Auto Body Shop