Harper v. Wausau Ins. Co

In Harper v. Wausau Ins. Co., 56 Cal. App. 4th 1079, 66 Cal. Rptr. 2d 64 (1997), the injured party fell on the insured's property and then brought suit against the insurer for medical expenses under a commercial general liability policy. The medical expense portion of that policy read the same as the one in the instant case including the Provision that the insurer would pay up to $ 5,000 for medical expenses for bodily injury regardless of fault. The issue was whether the injured party was a third party beneficiary under the terms of the insurance policy and in light of California Civil Code 1559. That provision, like SDCL 53-2-6, stated that "'a contract made expressly for the benefit of a third person, may be enforced by him at any time before the parties thereto rescind it.'" Harper, 56 Cal. App. 4th at 1086, 66 Cal. Rptr. 2d at 68. In speaking of 1559, the California court noted that it "excludes enforcement of a contract by persons who are only incidentally or remotely benefited by the agreement." Id. In finding that the injured party in Harper was a third party beneficiary, the Harper court reasoned: "Here, the insurance policy contained a liability provision based on fault ("Coverage A") and a medical payment provision, based on injury on the property ("Coverage C"). The express language of "Coverage C" plainly indicates it is meant to directly confer a benefit upon third parties who are injured on the owner's property. The payment is premised on the happening of the event and is not premised on fault. Thus, the insurer undertook a separate and direct obligation to pay to the medical expenses of any persons injured on the owner's property regardless of its insured's negligence. Accordingly, the payments were plainly intended to directly benefit plaintiff and were not incidental or remote." (Harper, 56 Cal. App. 4th at 1090, 66 Cal. Rptr. 2d at 70.)The Harper court also quoted from Appleman on Insurance Law and Practice. The quotation merits repetition since it analyzes medical payment provisions in commercial and homeowner liability policies. "Medical provisions of liability, or homeowner's, policies are a form of minimal group accident insurance provided at minimal cost with a named insured as the entity through whom the coverage is issued. . . . Generally, medical payment clauses are considered to constitute separate accident insurance coverage. Such coverage is divisible from the remainder of the policy, and creates a direct liability to the contemplated beneficiaries. The purpose is to grant peace of mind and create a fund for the payment of medical services so that those injured will not necessarily be contemplating how to impose liability upon the insured. And, with this in mind, a broad and liberal interpretation will be given. Such provision is the separate obligation of the insurer, independent of its obligation to pay sums of money as damages under the liability features of the contract. It has no relevance to the financial responsibility law. Nor is liability for such payment in any way dependent upon negligence of the insured. . . ." (Harper 56 Cal. App. 4th at 1089-1090, 66 Cal. Rptr. 2d at 70.)