Section II: Personal Liability (E) & Medical Payments (F)
Key Takeaways
- Coverage E pays damages the insured is legally liable for, plus a defense at the insurer's expense in addition to the limit.
- Coverage F pays reasonable medical bills of injured non-insureds on a no-fault, goodwill basis within a set time after the accident.
- Section II insureds include the named insured, resident spouse, resident relatives, and others under 21 in their care; injuries to insureds are not covered.
- Sort Section II claims by asking whether the injured person is an insured (no coverage) and whether legal liability is required (E) or not (F).
The Liability Side of the Homeowners Policy
Section II of a homeowners policy provides two liability coverages. Coverage E (Personal Liability) pays sums the insured becomes legally obligated to pay as damages for bodily injury or property damage to others, and it provides a legal defense at the insurer's expense, even for groundless suits, until the limit is exhausted. Coverage F (Medical Payments to Others) pays reasonable medical expenses for persons (not insureds) injured on the premises or by the insured's activities, regardless of fault, within a stated time after the accident.
| Coverage | Pays | Fault required? |
|---|---|---|
| E - Personal Liability | Damages the insured is legally liable for, plus defense | Yes (legal liability) |
| F - Medical Payments to Others | Reasonable medical bills of injured non-insureds | No (goodwill, no-fault) |
How Coverage E Works
Coverage E responds when a third party is injured or has property damaged and the insured is legally liable, whether the harm occurs on the premises or away from it, anywhere in the world for personal activities. The single limit applies per occurrence and covers both bodily injury and property damage. The insurer's duty to defend is broad: it pays defense costs in addition to the limit of liability, and it controls the defense and any settlement. Defense ends when the policy limit is paid in settlement or judgment.
How Coverage F Works
Coverage F is a small, no-fault goodwill coverage. It pays medical expenses for a person who is not an insured and who is injured on the insured location with the insured's permission, or off the location if the injury arises from the insured's activities, an animal owned by the insured, or a condition on the premises. It does not apply to the insured or regular residents of the household, and it does not pay for the insured's own injuries. By paying small medical bills quickly without litigation, Coverage F often heads off larger liability claims.
Who Is an Insured
Section II insureds include the named insured, the resident spouse, resident relatives, and other residents under 21 in the named insured's care. Coverage can also extend to others legally responsible for covered animals or watercraft of an insured. Knowing who counts as an insured matters because injuries to an insured are not covered under E or F (an insured cannot sue himself), while injuries by an insured to a third party are covered.
Distinguishing E from F on the Exam
The exam constantly contrasts E and F. A guest slips on the insured's icy steps and is hurt: Coverage F can pay the medical bills immediately without proving fault, and Coverage E pays damages and defense if the guest sues and the insured is found liable. The insured's own child injured at home: neither E nor F applies, because injuries to insureds are excluded. A delivery driver injured by the insured's dog: F pays medical bills, and E responds if the driver sues.
When you see an injury, ask first whether the injured person is an insured (no coverage) or a third party (E and possibly F), then whether legal liability is required (E) or not (F). That two-step sort answers most Section II questions efficiently.
A dinner guest trips on the insured's loose stair tread and breaks an arm. Which coverage can pay the guest's medical bills immediately without any finding of fault?
Why does neither Coverage E nor Coverage F respond when the insured's own resident child is injured at home?
Sorting Section II Injury Claims
Every Section II injury scenario yields to a two-step sort. First, ask whether the injured person is an insured or a third party. Injuries to an insured (the named insured, resident spouse, resident relatives, others under 21 in their care) are not covered under E or F, because an insured cannot recover liability or medical-payments benefits for an insured's own injury. Injuries to a third party may trigger E, F, or both.
Second, ask whether legal liability is required. Coverage F (Medical Payments to Others) pays a third party's reasonable medical bills on a no-fault basis, quickly and without litigation, which often heads off a larger claim. Coverage E (Personal Liability) pays damages and provides a defense (with defense costs in addition to the limit) only when the insured is legally liable.
| Injured person | Coverage |
|---|---|
| An insured | Neither E nor F |
| Third party, no fault needed | F (medical payments) |
| Third party, insured liable | E (damages + defense) |
| Third party, both | F now; E if liability follows |
A classic scenario: a guest slips on the insured's icy steps. Coverage F can pay the medical bills immediately regardless of fault, and Coverage E responds for damages and defense if the guest sues and the insured is found liable. By contrast, the insured's own resident child injured at home gets neither coverage, because the child is an insured. Applying the two-step sort, insured or third party, then fault or no fault, resolves the great majority of Section II questions the exam asks, and it generalizes to the CGL medical-payments and liability grants.
Apply the two-step Section II sort to every injury: first ask whether the injured person is an insured (the named insured, resident spouse, resident relatives, others under 21 in their care), in which case neither E nor F responds, or a third party; then ask whether legal liability is required (Coverage E pays damages and defense only when the insured is liable) or not (Coverage F pays a third party's reasonable medical bills no-fault). Because defense costs under E are paid in addition to the limit, the full limit remains for damages.
This sort generalizes to the CGL's Coverage A and medical-payments grants.