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The Court of Appeals Clarifies What Constitutes First Party Claims

May 8, 2023

In the case of United Services Automobile Association v. Estep the Court of Appeals upheld what may be considered a circuit court’s expansion of the situations where medical payment benefits may be available.

Mr. Estep was struck by a luggage cart as he was loading his luggage into the rear of his SUV. The wind allegedly blew the cart into him, and his injuries resulted in over $100,000 in medical expenses. He presented a claim to his carrier for first-party benefits, which was denied. The carrier argued that its member was neither using nor occupying the vehicle.

Both the circuit court and the Court of Appeals disagreed. The Court of Appeals held that the use of a vehicle would include loading luggage into it, and, since the plaintiff was bent at the waist and half of his body was inside the SUV at the time he was struck, he was occupying it as well.

The import of the holding in Estep is that courts will be permitted to assess allegations of use of a vehicle and occupancy on a fact-specific basis, which may result in expansions of coverage in first party claims to unusual situations.