C-III.A · Insurance on Residence (Casualty)
Medical payments to others: who is and is not covered
Medical payments to others pays necessary medical expenses of people injured in covered situations, regardless of fault, up to a per-person limit. Anything beyond that must come from personal liability, which requires that the insured be legally liable. Example: a friend falls at Hana's home, Hana was not negligent, the bills are $7,000 and the limit is $5,000 per person: $5,000 is paid and the other $2,000 is not owed.
Who is not covered: the insured and regular residents. Medical payments to others does not apply to a person, other than a residence employee, who regularly resides on any part of the insured location. Example: Omar owns a two-family house and rents the other unit to Jill. Jill is not in his household, but she regularly resides on the insured location, so medical payments do not pay her. If Omar were negligent, she could still claim under personal liability.
Where: on the insured location, or off it only when the injury comes from: - a condition on the insured location or the ways next to it (a branch from the insured's tree hits a passerby) - the activities of an insured (a ball the insured throws hits a player in a park) - a residence employee at work - an animal owned by or in the care of an insured (the insured's dog bites a jogger) A friend who slips on a store's wet floor while out with the insured is none of these.
Employees: medical payments do not pay a person eligible for workers' compensation benefits. In California, a household employee such as a nanny is protected instead by the workers' compensation coverage that Ins. Code §11590 requires in a comprehensive personal liability policy, for an employee described in Labor Code §3351(d). She does not have to prove fault.
Remember
· Pays regardless of fault, up to the per-person limit.
· Not for insureds or anyone who regularly resides on the insured location (except residence employees).
· Off premises: condition of the premises, insured's activities, residence employee, insured's animal.
CA
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