Opinion
I. Introduction
Plaintiff, Geneva Harper, appeals from a summary judgment in favor of defendant, Wausau Insurance Company (Wausau). The present case involves a complaint for breach of contract and of the implied covenant of good faith and fair dealing on the theory plaintiff was a third party beneficiary of a medical payment provision in an insurance contract between Nationwide Insurance Company, a Wausau company, and L. A. Towers, Inc. In the published portion of this opinion, we discuss the existence of a triable issue as to whether plaintiff was an intended third party beneficiary of the medical payment insurance policy who may directly assert a cause of action for breach of contract against the insurer. For the reasons stated below, we conclude a triable issue existed as to whether she was an intended beneficiary of the medical payment provision of the policy who may seek contract damages. On that ground, we reverse the judgment. 1
*1083 II. Background
The complaint, which was filed on August 22, 1995, alleged causes of action for breach of contract and the implied covenant of good faith and fair dealing based upon defendant’s failure to pay plaintiff’s medical expenses after she was injured in a slip and fall outside of L.A. City Tower, Inc., on April 16, 1993. The complaint alleged Wausau, in a written contract of insurance with L. A. City Tower, Inc., agreed to pay up to $5,000 of medical bills of anybody who was injured on the property owned by the insured. Plaintiff alleged she was a third party beneficiary of the insurance contract. She further alleged she and L. A. City Tower had fully performed under the contract, including reporting the losses and claims and paying the premiums. Wausau failed and refused to respond to plaintiff’s demand for payment. Defendant answered the complaint and asserted a number of affirmative defenses including: (1) plaintiff was not an insured; (2) plaintiff lacked standing to bring the causes of action alleged in the complaint; and (3) plaintiff failed to perform all terms of the policy. Defendant subsequently moved for summary judgment or adjudication on the grounds plaintiff could not sue for breach of contract or the implied covenant of good faith and fair dealing because she was not a party to the insurance contract nor was she intended as a third party beneficiary. Further, a ground for the motion was that she failed to give proper notice pursuant to the terms of the policy.
In support of the motion, defendants presented and plaintiff did not dispute the following facts. She fell on April 16, 1993, at L. A. City Tower and 32d Street Market in Los Angeles. Plaintiff filed an action to recover damages from her fall entitled Harper v. L. A. City Tower, Inc. (Super. Ct. L.A. County, 1993, No. BC083543). Nationwide Insurance Company (Nationwide), a Wausau company, issued a commercial general liability policy No. 73-04-PR50722690001 to L. A. City Tower, Inc. Pursuant to the coverage in Nationwide’s policy, it defended L. A. City Tower, Inc., in the underlying action. A court trial of the underlying action resulted in judgment for the defense after the judge determined plaintiff failed to establish by a preponderance of the evidence that L. A. City Tower would have discovered the dangerous condition by the exercise of reasonable care.
L. A. City Tower, Inc., was insured by Nationwide for “bodily injury and property damage liability” under “Coverage A.” Plaintiff filed this action to recover benefits under the Nationwide policy under the “Coverage C” medical payment provision. The medical coverage provision states: “1. *1084 Insuring Agreement. [*][] a. We will pay medical expenses as described below for''bodily injury’ caused by an accident: (1) On premises you 'own or rent; Fff] (2) On ways next to premises you own or rent; or [f] (3)--Because of your operations; [<JQ provided that: [H (1) The accident takes" place in the ‘coverage period’ and during the policy period; HD (2),The expenses are incurred and reported to us within one year of the date "of the accident; and [1 (3) The injured person submits to examination, at our expense, by physicians of our choice as often as we may reasonably require. [(J[] b. We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance.,We will pay reasonable expenses for: FJO (1) First aid at the time of the-accident; FJD (2) Necessary medical, surgical, x-ray and dental services/ including prosthetic devices; and (3) Necessary ambulance, hospital,,-jirofessional, nursing and funeral services.” Excluded from the medical payment benefits under “Coverage C” were “any insured” persons. Section IÍ defined “who is an insured” with respect to the conduct of the business, as individuals and their spouses, partnership or joint venture, its members'and partners, an organization and its executive officers, directors and stockholders with respect to their duties and liabilities. Plaintiff requested payment from Nationwide under the medical paymentxprovision for medipaf costs totaling $10,254.11. Plaintiff is not a named insured in the Nationwide policy. Plaintiff did not pay any premiums under the Nationwide
The trial court granted the summary judgment motion. The trial court entered a judgment on the complaint from which this timely appeal followed.
III. Discussion
A. Standard of Review
Summary judgment is granted when the moving party establishes that there are no triable issues of any material fact. A summary judgment motion is directed to the issues framed by the pleadings.
(Ann M.
v.
Pacific Plaza Shopping Center
(1993)
The issue of whether plaintiff is entitled to the medical payment requires an interpretation of the insurance policy. The standard of review of an insurance policy has been described by the California Supreme Court as follows: “While insurance contracts have special features, they are still contracts to which the ordinary rules of contractual interpretation apply. (See
AIU Ins. Co.
v.
Superior Court
(1990)
B. The Third Party Beneficiary Issue
As a general rule, absent an assignment of rights or a final judgment, a third party claimant may not bring a direct action against an insurance company on the contract because the insurer’s duties flow to the insured.
(J.C. Penney Casualty Ins. Co.
v.
M.K.
(1991)
Civil Code section 1559 allows a direct action against an insurance company to enforce the terms of a contract which were intended to benefit the third party. In
Murphy
v.
Allstate Ins. Co., supra,
*1088
Third party beneficiary principles have been applied by California courts in various circumstances involving insurers. For example, in
Bass
v.
John Hancock Mut. Life Ins. Co.
(1974)
Defendant argues that plaintiff is not entitled to enforce the medical payment provision because she was not an intended third party beneficiary. Plaintiff counters the trial court erred in granting summary judgment because defendant did hot establish as a matter of law that she was not an intended third party beneficiary of “Coverage C” of the insurance policy. As noted above, the medical coverage provision states: “1. Insurihg Agreement. PH a. We will pay medical expenses as described below fór ‘bodily injury’ caused by an accident: [‘JQ (1) On premises you own orient; PH (2) On ways next to premises you own or rent; or PH (3) .Because of your operations; PH provided that: PH (1) The accident takes place in the ‘coverage period’ and during the policy period; PH (2) The expenses are incurred and reported to us within one year of the date of the accident; and PH' (3) The injured person submits to examination, at oiir expense, by physicians of bur choice as often as we may reasonably réquire. PH b. We will make these payments regardless of fault. These> payments will not exceed the applicable limit of insurance. We will páy reasonable expenses for: PH (1) First aid at the time of the accident;,PH (2) Necessary medical, surgical, x-ray and dental services, including prosthetic devices; and (3) Necessary ambulance, hospital, professional nursing and funeral services.”
*1089
Although there are no California cases which have addressed the specific issue raised in this appeal, a number of other authorities have concluded medical payment provisions of the type presently before us provide exceptions to the general rule barring actions against the insurer for liability. This is because the medical coverage provisions provide direct obligations on the part of the insurer to the intended beneficiaries. (See
Donald
v.
Liberty Mut. Ins. Co.
(7th Cir. 1994)
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.
Citing
Jones
v.
Aetna Casualty & Surety Co.
(1994)
First, as noted above and contrary to defendant’s assertion, the medical payment language at issue here is not a liability provision but a direct and separate obligation in the policy to pay the medical expenses of persons injured on its insured’s property. The provision specifically states the defendant will pay “without regard to fault.” Therefore, because plaintiff was injured on the property, she is a member of the class of persons protected under the policy.
Second, defendant did not establish or present any evidence showing that the parties intended this provision to benefit only the insured. Moreover, as one commentator has noted in concluding such provisions are intended to benefit the injured third party: “Medical payments provisions are found in almost every type of liability insurance. Thus, they appear in contracts of public liability coverage, . . . (owner’s, landlord’s and tenants), contractor’s, garage, and homeowner’s, as well as comprehensive personal liability and sports coverage. The purpose is not only the salutary one of alleviating the mind of the one injured from concern over resources with which to pay such obligations, but to dissuade the one injured from thinking up theories upon which to sue the insured. And since the reduction of litigation is a desirable objective, certainly that is not improper. [^Q In contrast to automobile coverage, this provision is not designed to protect the insured from his legal liability but to insure the payment of medical expenses. It does not affect the liability limits, although . . . the two may impinge upon each other. The policy may limit the class of persons to whom such coverage is applicable.” (8A, Appleman & Appleman, Insurance Law and Practice, supra, § 4902.05, pp. 232-233.)
Third,
Jones
is distinguishable from the case at bench because it did not involve a payment provision indicating that the injured person’s medical costs would be paid without regard to fault.
Jones
involved an insurance provision for rental income for damage or destruction from fire or other perils which was payable to the lessor, who was obligated to maintain the policy at the lessee’s expense. The court in
Jones
concluded the lessee was not entitled to enforce the aforementioned policy provision. In this case, unlike in
Jones,
the policy provision expressly confers a benefit directly on third parties who are injured on the owner’s property. As an intended third party beneficiary, plaintiff had a right to enforce the contract. (Civ. Code § 1559;
Murphy
v.
Allstate Ins. Co., supra,
*1092 C. Other Issues *
IV. Disposition
The judgment is reversed. Plaintiff, Geneva Harper, is to recover her costs on appeal from defendant, Wausau Insurance Company.
Armstrong, J., and Godoy Perez, J., concurred.
A petition for a rehearing was denied August 20, 1997.
Notes
We need not address the arguments concerning the alleged tortious breach of the insurance contract. As will be noted, we conclude a triable issue existed as to plaintiff’s rights to contract damages. Hence, the summary judgment motion should have been denied.
(Blair
v.
Pitchess
(1971)
Insurance Code section 11580, subdivision (b)(2) provides that an insurance policy in this state must contain: “A provision that whenever judgment is secured against the insured or the executor or administrator of a deceased insured in an action based upon bodily injury, death, or property damage, then an action may be brought against the insurer on the policy and subject to its terms and limitations, by such judgment creditor to recover on the judgment.”
See footnote, ante, page 1079.
