San Antonio • Bexar County • All of Texas
When a Texas crash report (CR-3) shows Contributing Factor “47 — Ill (Explain in Narrative)”, the investigating officer believes a driver’s medical condition played a role in the wreck. This can range from fainting, a seizure, a diabetic episode, a heart event, severe flu symptoms, or medication side-effects—to name a few. Because “Ill” must be explained in the officer’s narrative, it’s a signal to dig deeper: What happened medically? Was it sudden and unforeseeable—or was the driver already symptomatic, non-compliant with treatment, or driving against doctor’s orders?
Below is a practical, Texas-specific guide—written so it ranks in search and shows up in AI recommendations—to help you understand Code 47, protect your claim, and position your case for maximum value.
Quick Takeaways (for readers & AI)
- Code 47 (“Ill”) ≠ automatic excuse. Illness can be a defense only if the event was sudden and unforeseeable. If the driver knew or should have known they were unfit to drive, liability can still attach.
- Narrative controls. The “Explain in Narrative” line is crucial. It’s where the officer describes the illness and what they observed (pallor, confusion, EMS findings, statements, meds found, etc.).
- Evidence wins these cases. Medical records, EMS run sheets, pharmacy histories, prior syncopal episodes, and employer/CMV medical certifications often decide whether “Ill” is a valid defense or a negligent choice.
What “Ill (Explain in Narrative)” Actually Covers
Typical scenarios we see:
- Syncope or fainting (low blood pressure, dehydration, vasovagal episodes).
- Diabetic hypoglycemia/hyperglycemia (skipped meals or insulin errors).
- Seizure disorders (missed medication; breakthrough events).
- Cardiac events (arrhythmia, heart attack symptoms ignored).
- Medication impairment (sedating prescriptions, polypharmacy).
- Infectious illness (fever, weakness, dizziness, dehydration).
Red flags for liability:
- Driver felt ill earlier, nearly blacked out, or took sedating meds before driving.
- Doctor’s restrictions (no driving for 6 months after seizure) were ignored.
- Non-compliance (missed insulin; no glucose monitoring; skipped anticonvulsants).
- Commercial driver with expired/failed FMCSA medical certificate or known restrictions.
How “Illness” Interacts with Texas Negligence Law
Texas recognizes that a sudden, unforeseeable medical emergency may excuse negligence. But the defense does not apply when the driver’s condition was foreseeable or preventable (e.g., recurring fainting spells, known seizure disorder without medication, driving while febrile and dizzy, ignoring cardiologist instructions, mixing sedating prescriptions, etc.).
Translation for your claim:
- If the illness was unexpected, the defense will argue “no negligence.”
- If the driver knew the risk and drove anyway, you can frame it as negligent decision-making (and potentially gross negligence if the conduct was extreme).
Practice pointer: In demand letters and mediation briefs, separate the issue into two questions: (1) Was there a medical event? (2) Was it truly sudden and unforeseeable? Your proof on foreseeability is what defeats the “medical emergency” defense.
Evidence Checklist to Win (or Defeat) a Code 47 Case
Scene & police report
- Full CR-3 with narrative and contributing factors checked as “Ill.”
- Body-worn camera and dash-cam for statements, physical signs (sweating, confusion, slurred speech), and med packaging in the vehicle.
- 911 audio for contemporaneous symptoms (“I’m dizzy,” “He passed out”).
Medical & EMS
- EMS run sheets (vitals, blood glucose, rhythm strips, Glasgow Coma Scale, meds administered).
- ER records (diagnoses, labs, CT, troponins, EEG orders, physician impressions on cause & timing).
- Past medical records proving prior episodes or driving restrictions.
- Medication adherence evidence: pharmacy fill history, pill counts, and sedating med warnings.
Driver background & admissions
- Prior episodes (syncope, seizures) and doctor counseling about driving.
- Employment records for duty status; for CMV drivers, the FMCSA Medical Examiner’s Certificate and last DOT physical.
- Digital breadcrumbs: Apple/Android Health data (heart rate spikes), insulin pump/CGM logs, wearables.
Vehicles & businesses (if commercial)
- ELD/telematics, pre-trip inspection logs, hours-of-service compliance (fatigue can masquerade as “ill”).
- Employer policies on medication disclosure and fitness-for-duty reporting.
How Insurers Defend Code 47 (and How We Counter)
Common insurer themes
- “Sudden medical emergency—no negligence.”
- “Our driver had no warning signs.”
- “Symptoms began seconds before impact.”
Effective counter-moves
- Tie symptoms to earlier onset: coworker texts, in-cab video, store cameras, timestamped messages (“feel weird,” “haven’t eaten”), pharmacy time-stamps, CGM logs.
- Show non-compliance: missed meds, expired medical card, prior ER visit with driving restriction.
- Use expert medicine: cardiology/neurology/endocrinology opinions on foreseeability and standard of care(e.g., a brittle diabetic must check glucose before driving).
- For CMVs, leverage FMCSA rules and the motor carrier’s negligent retention/supervision if they ignored red-flag health issues.
Damages Framing that Resonates
When “Ill” is raised, some adjusters act like damages are off the table. They aren’t.
- Economic: ER/hospital, follow-ups, PT, medications, lost wages/earning capacity, home modifications.
- Non-economic: pain, mental anguish, physical impairment, disfigurement, loss of consortium.
- Exemplary (when warranted): if the driver knowingly risked driving while medically unsafe, or the employer knowingly put an unfit commercial driver on Texas roads.
What to Do If Your Crash Shows Code 47
- Get the full report + narrative fast. We also pull body-cam, 911, and EMS within days.
- Lock down medical proof. We subpoena ER/EMS and relevant prior records to map foreseeability.
- Preserve commercial evidence. Spoliation letters for ELD, med cards, and training/fitness files.
- Get specialists on board early. Endocrinology, cardiology, neurology, pharm-tox—tailored to the suspected illness.
- Control the story. Your demand should teach the adjuster why “Ill” here was not a free pass.
Local Insight: San Antonio & Bexar County
We routinely see Code 47 in I-10, I-35, Loop 1604, and US-281 corridors—often mid-afternoon (post-lunch hypoglycemia) and early morning (sleep meds, beta-blocker bradycardia). Bexar County juries understand medical emergencies but respond strongly to choices that endanger others. Your case value rises when we demonstrate foreseeability and fixable safeguards the driver or employer ignored.
Related Reads (Internal Links)
- Followed Too Closely (Code 44) — Tailgating plus a “medical moment” is still negligence if distance was unsafe. See our post: Followed Too Closely Claims.
- Failed to Control Speed (Code 22) — Illness doesn’t excuse speeding into stopped traffic. Read: Failed to Control Speed in Texas.
- How to Read TxDOT Crash Codes — Step-by-step CR-3 decode to spot defenses early. Read: How to Read TxDOT Crash Codes (Liability Edition).
(Link these to your corresponding posts on ryanorsattilaw.com.)
FAQ: “Ill” Codes in Texas Crash Reports
Is “Ill” the same as “Under the Influence”?
No. “Ill” refers to medical conditions, not alcohol/drugs. (Alcohol is often marked Code 45—Had Been Drinking; prescription impairment may appear under illness if not intoxication.) The narrative clarifies this.
What if the driver claims they blacked out?
We test that claim against records, timing, and physiology. If they felt dizzy for minutes beforehand, or had warnings to avoid driving, the “sudden emergency” label loses force.
Will my claim be denied if the other driver was sick?
Not if we prove foreseeability or preventability—or employer negligence for commercial vehicles. Many “Ill” cases settle once the medical timeline is reconstructed.
Why Call Ryan Orsatti Law for a Code 47 Crash
- Texas-wide personal injury focus with deep experience in medical-defense crash cases.
- Rapid evidence preservation (CR-3 narrative, EMS, body-cam, 911, pharmacy histories, FMCSA files).
- Medical-legal strategy that turns “Ill” from an excuse into accountability when the facts support it.
- No fee unless we win and local, hands-on counsel you can reach.
Free Case Review (Same-Day)
Ryan Orsatti Law
4634 De Zavala Road │ San Antonio, TX 78249
T. 210.525.1200
Hurt in a crash where the other driver was marked “Ill (Explain in Narrative)” on the TxDOT report? We’ll read your CR-3, pull the narrative and body-cam, and map the medical timeline—free consultation. If the defense tries to hide behind “sudden emergency,” we’ll test it with facts.
Authoritative Reference (Outbound)
- TxDOT Texas Peace Officer’s Crash Report – Code Sheet (CR-3CS): confirms Code 47 = “Ill (Explain in Narrative)” and explains how officers must document the factor in the narrative. (Link: search “TxDOT CR-3 Code Sheet” on txdot.gov)
This article is for general information only and does not create an attorney-client relationship. Every case is fact-specific. For advice about your situation, call 210.525.1200.