Use and Operation: Duty to rescue inures first-party coverage

Key Takeaways

• New York no-fault insurance law is governed by Insurance Law §5102-§5108 and 11 NYCRR 65
• Strict timing and verification rules apply to denials of medical benefits
• Procedural compliance — mailing, verification, EUO/IME scheduling — is often dispositive
• Consult an experienced New York attorney for case-specific guidance

The question of when an injury “arises out of” the use of a motor vehicle has profound implications for insurance coverage under Supplemental Uninsured/Underinsured Motorist (SUM) policies. While most cases involve direct contact between vehicles or pedestrians, some situations present more complex causation questions. The Second Department’s decision in Matter of Encompass Indemnity Co. v Rich addresses a particularly compelling scenario: when first responders are injured while rescuing victims from vehicle accidents caused by another driver’s negligence.

New York courts have long recognized that SUM coverage exists to protect innocent victims from underinsured motorists. However, insurers frequently argue that coverage should be limited to those directly involved in the collision itself, excluding rescuers and other secondary victims. This restrictive interpretation would leave a critical gap in protection for public safety personnel who put themselves at risk responding to accidents. The Rich decision clarifies that New York law takes a broader view of causation when determining what injuries “arise out of” vehicle use.

Case Background

Matter of Encompass Indem. Co. v Rich, 2015 NY Slip Op 06432 (2d Dept. 2015)

Firefighter Kevin Rich responded to a motor vehicle accident scene where an individual named Goodman was trapped inside his vehicle following a collision. Goodman was seriously injured — bleeding, drifting in and out of consciousness, and in obvious distress. To extricate Goodman from the wreckage, Rich and his fellow firefighters had to use the “jaws of life” hydraulic rescue tools to cut away the vehicle’s roof. While Rich and three other firefighters were lifting the severed roof section off the vehicle, Rich sustained injuries to his right shoulder.

Rich sought SUM coverage under his own automobile insurance policy issued by Encompass Indemnity Company. Encompass denied coverage, arguing that Rich’s injuries did not arise from the use of a covered vehicle and that his injuries occurred during rescue operations rather than from the accident itself. The dispute proceeded to the courts to determine whether a first responder injured while rescuing an accident victim can recover SUM benefits.

Jason Tenenbaum’s Analysis:

“When firefighter Kevin Rich’s engine company responded to the scene of the accident, Goodman was trapped inside his vehicle, bleeding, drifting in and out of consciousness, and, when awake, moaning in pain. In order to extract Goodman from the vehicle, the firefighters used the “jaws of life” to cut the vehicle’s roof, and Rich and three other firefighters lifted the roof off of the vehicle. In the process thereof, Rich sustained injuries to his right shoulder.”

“SUM endorsements provide coverage only when the injuries are “caused by an accident arising out of such underinsured motor vehicle’s ownership, maintenance or use""

“Factors to be considered in determining whether an accident arose out of the use of a motor vehicle include whether the accident arose out of the inherent nature of the vehicle and whether the vehicle itself produces the injury rather than merely contributes to cause the condition which produces the injury”

“Here, Encompass failed to establish that Rich was not entitled to coverage under the SUM endorsement. The evidence in the record establishes that Goodman’s negligent use of his vehicle directly caused the accident that led to him being trapped and in obvious need of medical attention, which, in turn, led to Rich’s intervention and resulting injuries”

Legal Significance

This decision represents an important expansion of the “arising out of” standard for SUM coverage, applying a proximate cause analysis that extends beyond immediate physical contact with a vehicle. The Second Department rejected the insurer’s attempt to draw an arbitrary line excluding rescue-related injuries, recognizing that such injuries flow directly and foreseeably from the negligent use of a motor vehicle. This holding aligns with the fundamental purpose of SUM coverage: compensating innocent parties harmed by underinsured motorists.

The court’s analysis emphasizes the distinction between injuries that merely occur near a vehicle versus those that are causally connected to the vehicle’s use. Here, the causal chain was clear and unbroken: Goodman’s negligent driving caused the accident, which created the emergency situation, which necessitated the rescue operation, which resulted in Rich’s injury. Courts in similar circumstances must examine whether the vehicle’s use set in motion a foreseeable chain of events leading to the injury, not whether the injury occurred at the precise moment of impact.

This precedent has implications beyond first responder cases. It suggests that other secondary victims — such as Good Samaritans assisting at accident scenes or medical personnel treating accident victims — may also qualify for SUM coverage when their injuries arise from the original negligent vehicle operation. The decision reinforces New York’s public policy of broadly construing insurance coverage provisions to protect injured parties.

Practical Implications

For first responders and their families, this decision provides critical protection when firefighters, EMTs, and police officers are injured while performing rescue operations at accident scenes. It ensures that professional rescuers are not left financially vulnerable when they suffer injuries that directly result from another driver’s negligence. This coverage becomes particularly important when the at-fault driver lacks sufficient insurance to compensate for serious injuries sustained during rescue operations.

Insurance companies must carefully evaluate SUM denials in cases involving indirect injuries. A reflexive denial based on the absence of direct vehicle contact may not withstand judicial scrutiny when the causal connection between the vehicle’s negligent use and the ultimate injury is clear. Insurers should conduct thorough investigations into the full chain of causation before denying coverage in rescue scenarios.

For practitioners, this case provides a framework for analyzing “arising out of” questions in non-traditional SUM scenarios. The key inquiry focuses on whether the negligent vehicle use was a substantial factor in producing the injury, not whether the injury occurred in a conventional collision. Attorneys representing injured parties should carefully develop the factual record showing how the vehicle’s use created the specific conditions that led to their client’s injuries.

Related Articles

• Appellate division grants summary judgment when loss was not an insured event
• Business record entry absence prevents motor vehicle accident coverage
• Proving intentional accident requires sufficient evidence
• Causation challenges in seeking trial de novo after master arbitrator award
• New York No-Fault Insurance Law

Related Legal Resources

For additional guidance on this topic, see:

• Long Island personal injury lawyer
• New York no-fault defense
• contact our office

If you have a case involving these issues on Long Island or in the New York City metropolitan area, the Law Office of Jason Tenenbaum, P.C. offers free consultations. Call (516) 750-0595 or contact our office online.

Related: What “de novo” means in New York — trial de novo and de novo review, explained.