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The following is taken from a website:

Sir, do you realize your wife fell out of the car several miles back?

The expression fell out here, as I checked in the dictionary, doesn't make any sense.
Does it mean fell off?

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Please check fall out – Mustafa Feb 5 '12 at 20:06
up vote 0 down vote accepted

You have laid the stress on the wrong phrase thereby getting distracted. Look now:

"Sir, do you realize your wife fell out of the car several miles back?"

out of = off
With the substitution, it begins to make sense and you should find it fine.

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You get in a car and so you get/fall out.

You get on a bus and so you get/fall off.

I have heard that the reason behind this is that you step down into cars while you step up onto buses.

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