Medical Payments Coverage and Personal Auto

Our personal auto insured was recently involved in an accident. While sitting still in a parking lot, he was hit in the rear by a truck. He got out of his car to check the damage. He became dizzy and fainted while talking to the truck driver, and struck his head on the ground. His wife took him to the closest emergency room.

His personal auto insurer is denying payment for the emergency room expenses. They contend that there is not enough proximity between the accident and his injuries. He's never suffered dizziness or seizures previously. We believe that it was being struck by the truck that brought on his fainting and, thus, the ER expenses should be covered.

May we have your opinion?

Illinois Subscriber

The personal auto policy promises to pay for medical expenses incurred by an insured as the result of an accident. It also states that the insured must be occupying a motor vehicle. The policy defines "occupying" as "in, upon, getting in, on, out or off."

We believe that enough proximity exists between the accident and the fall that auto medical payments should apply to his emergency room visit. There are no intervening events between the accident and his passing out. If he had no previous history of seizures or dizziness, the logical conclusion is that the accident brought on the dizziness. Remember, it's not up to the insured to prove that the accident caused his dizziness; it's up to the insurer to prove that the accident didn't cause it.