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What is a resident relative under PIP coverage?


A

Question: What is a resident relative? Who is considered a resident relative in regards to Personal Injury Protection?

Answer: The definition of a resident relative can differ depending upon state laws as well as the language (terms) of an auto insurance policy.

A typically insurance policy defines a resident as someone who has physical presence in your household with the intention to continue living there. Unmarried dependent children, while temporarily away from home, to attend college for example, are normally still considered residents if they intend to continue to live in the parent's household during breaks, etc.

A relative is someone related to you then by blood, marriage, etc. Thus a relative resident would be someone related to you and that resides in your household.

For instance, Colorado has defined a resident relative as meaning a person who at the time of an accident is related by blood, marriage or adoption to the named insured or resident spouse, and who resides in the named insured's household, even if temporarily living somewhere elsewhere. The state also adds that any ward or foster child, who usually resides within the named insured's household, can be considered a resident relative.

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Another example is from Maryland. The Maryland Appeals court had occasion to consider what constitutes a resident relative for the purposes of an uninsured motorist coverage claim. In this case the plaintiff had been living with his grandmother for almost a year and when he was in an accident he wanted to take use his parent's Uninsured Motorist coverage by saying he was a resident relative. The court, however, found that he could not be a resident relative of his parents who lived in a different town from the grandmother.

The court noted he was not a full-time student, lived with his grandparents for the 11 months preceding the auto accident and during that time only visited his parents' home approximately four to six times. So the court of appeals found he was not a "resident" of his parent's home as defined by their insurance contract with their carrier.

The court reasoned that according to the policy language the plaintiff would be a resident only if he physically lived in his parents' household, is under the age of 24, and attends school full-time. The court thus found that undisputed evidence clearly established that appellant failed to meet either definition of 'resident' because he did not physically live in his parents' home and did not attend college.

Who will be considered a resident relative in regards to your personal injury protection (PIP) coverage will depend upon the definition of a "resident relative" you state has in place as well as the language of your policy regarding this term and your PIP coverages and exclusions.

In general, if you have a child that lives with you than he or she would normally be considered a resident relative and thus covered by your PIP coverages. If you had a child that had moved out and now lives on their own then this child would not usually be covered as a resident relative any longer under your PIP coverage.

If your resident relative has their own insurance policy though, your PIP coverages may not extend to them, depending again on state laws and your policy's terms. For example, in 2007 New Jersey courts decided that a plaintiff in a court case could not recover PIP benefits from both her own auto insurance policy and her mother's policy.

In this New Jersey court case, the plaintiff was involved in a motor vehicle accident in which she sustained extensive injuries. She was operating her privately owned vehicle at the time of the accident and was insured by her own insurance company for $75,000 worth of PIP benefits. Her medical bills exceeded this amount. At the time of the accident the plaintiff resided with her mother who was the named insured on an automobile policy issued by a different insurance carrier and had PIP benefits of up to $250,000. Since the mother's limits were higher she tried to place a claim with her mother's PIP policy for the medical bills in excess of her $75,000 PIP coverages of her own policy.

The mother's auto insurance policy extended coverage and PIP benefits to resident relatives, although subject to exclusions. One such exclusion was the denial of liability coverage and PIP benefits to resident relatives for injuries sustained as a result of an accident involving a vehicle owned by a resident family member. So according to the terms of the mother's policy the daughter was excluded from making her PIP claim since she the accident took place in her own vehicle which had its own coverage on it.

New Jersey law section 39:6A-4.2 authorizes PIP benefits not only to the named insured but also to resident family members of the insured's household, provided the resident family members are not named insureds under their own policies. This section of the statute further provides for recovery of PIP benefits by providing that no person can recover PIP benefits "under more than one insurance policy for injuries sustained in any one accident."

To find out about your state laws with regards to resident relatives, check with your state's insurance regulator. For information on the language of your policy and the exclusions it may have read over the terms of your policy, specifically the PIP portion that you are interested in find out about. If you have any questions about the policy call your agent for explanations and additional help you may need to understand your coverages fully.


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