Fickbohm v. St. Paul Insurance

2003 NMCA 040, 63 P.3d 517, 133 N.M. 414
CourtNew Mexico Court of Appeals
DecidedFebruary 11, 2003
Docket22,344, 22,343
StatusPublished
Cited by4 cases

This text of 2003 NMCA 040 (Fickbohm v. St. Paul Insurance) is published on Counsel Stack Legal Research, covering New Mexico Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fickbohm v. St. Paul Insurance, 2003 NMCA 040, 63 P.3d 517, 133 N.M. 414 (N.M. Ct. App. 2003).

Opinion

OPINION

BUSTAMANTE, Judge.

{1} Plaintiffs Darlene Fickbohm and Jean Jarvis (referred to jointly as Plaintiffs or individually as Fickbohm and Jarvis) appeal from the district court’s order permitting St. Paul Insurance Company (St.Paul) to offset from Plaintiffs’ uninsured/underinsured motorist coverage (UM/UIM) arbitration awards the amount it paid to Plaintiffs under the medical payments (medpay) portion of their respective automobile insurance policies. Although Plaintiffs’ briefs are framed as raising ten and nine issues respectively, they in fact raise multiple arguments with regard to one issue: that St. Paul should not have been allowed to offset from their UM and UM/UIM arbitration awards the amounts it had previously paid Plaintiffs under their medpay coverage. We consolidate the appeals for purposes of this opinion and affirm.

FACTUAL AND PROCEDURAL BACKGROUND

{2} The material facts in this case are undisputed. In 1995 Fickbohm and Jarvis were each injured in separate collisions with automobiles whose owners and drivers were underinsured (Fickbohm) or uninsured (Jarvis). At the time of the accidents Fickbohm was the named insured (Class I insured) on an automobile insurance policy with St. Paul, and Jarvis was a covered insured (Class II insured) on an insurance policy with St. Paul issued to her employers. Fickbohm’s policy included UM/UIM coverage of $100,000 and medpay coverage of $5000. Jarvis’ policy included UM/UIM coverage of $250,000 and medpay coverage of $5000. In each instance separate premiums were paid for the UM/ UIM and the medpay coverage.

{3} As a result of Plaintiffs’ injuries in their respective accidents, St. Paul initially paid $5000 under each Plaintiffs medpay coverage. Fickbohm also received $25,000 from the tortfeasor, which represented the limits of his policy. St. Paul had earlier given Fickbohm written permission to accept the award and waived subrogation against the tortfeasor on the medical payments claim. After failed attempts to settle their claims against St. Paul, each Plaintiff initiated arbitration proceedings of their UM/UIM claims. Each Plaintiff received an arbitration award (Fickbohm $95,000 and Jarvis $80,000). After deducting the amount paid by the under-insured motorist, the amount due from St. Paul pursuant to Fickbohm’s UM/UIM coverage was $70,000. In each case, when St. Paul paid the UM/UIM arbitration award it deducted the $5000 it had previously paid under medpay coverage. Thus, St. Paul paid Fickbohm $65,000 and Jarvis $75,000.

{4} After receiving St. Paul’s payment, less the medpay offset, Fickbohm and Jarvis filed separate complaints seeking confirmation of the full award. St. Paul filed a motion to dismiss or, alternatively, motion for summary judgment, in each case, arguing that it had fully paid the arbitration award and was entitled to offset medpay payments from the UM/UIM awards. With the parties’ consent, the district court held one hearing in both cases. The district court granted summary judgment in favor of St. Paul on the offset issue, stating:

In my view, in reviewing the contract, the contract intended that there not be [a] provision for separate recovery under the medpay section and the uninsured motorist section. I’m reading the contract as a whole. I certainly don’t see it that way.
I can say with almost absolute certainty that this was the — what the parties envisioned. I certainly — and Ms. Fickbohm and Ms. Jarvis as a Class II insured are certainly not going to read the provisions precisely. But I think it’s clear that what was intended under this contract was that there not be separate recoveries for med-pay coverage when there is additional recovery for the uninsured motorist claim.

DISCUSSION

{5} Plaintiffs raise a number of points as to why St. Paul should not be allowed to impose a medpay offset from their UM/UIM awards. They can be reduced to two basic arguments: (1) The offset is not permitted because the policy language is ambiguous, and (2) The offset would violate New Mexico’s Uninsured Motorist Statute, case law, and public policy. Fickbohm raises the additional argument that St. Paul’s waiver of subrogation on the medical payments prevented it from enforcing the offset.

{6} The arguments were preserved below and the parties correctly agree that a de novo standard of review should be applied. “Summary judgment is appropriate where there are no genuine issues of material fact and the movant is entitled to judgment as a matter of law. The issue on appeal is whether [Defendant] was entitled to [judgment] ... as a matter of law. We review these legal questions de novo.” Self v. United Parcel Serv., Inc., 1998-NMSC-046, ¶ 6, 126 N.M. 396, 970 P.2d 582 (internal citation omitted).

A. The Language of the Policies

{7} We begin by examining the language in the policies to determine whether it is ambiguous regarding the offset in dispute. Plaintiffs rely on the principle that ambiguity in policy language concerning coverage is generally construed against the insurance company that drafted it. See Lopez v. Found. Reserve Ins. Co., 98 N.M. 166, 168, 646 P.2d 1230, 1232 (1982). Thus, Plaintiffs contend that a finding of ambiguity will essentially end the analysis with them prevailing. “The question of whether an ambiguity exists [in an insurance policy] is a question of law to be decided by the court.” Richardson v. Farmers Ins. Co., 112 N.M. 73, 74, 811 P.2d 571, 572 (1991).

{8} The medpay section of each policy provides:

Any amounts otherwise payable for expenses under this coverage shall be reduced by any amounts paid or payable for the same expenses under any Bodily Injury Liability, Property Damage Liability, Uninsured Motorists Coverage and/or Underinsured Motorists Coverage provided by this policy.

{9} The UM/UIM Endorsement of each policy provides:

Any payment under this coverage will reduce any amount that person is entitled to recover under the Bodily Injury Liability Coverage/Property Damage Liability Coverage, Medical Payments Coverage or Coverage For Damage To Your Auto of this policy.

These two provisions mirror each other and unambiguously express the intent to impose an offset between the two coverages.

{10} Plaintiffs argue that because the policies say the reverse (that UM/UIM reduces medpay) of what actually happened in these cases (medpay reducing UM/UIM) the language in the policy does not apply at all or at least is ambiguous. We do not agree. There is ambiguity when a contract is “reasonably and fairly susceptible of different constructions.” Levenson v. Mobley, 106 N.M. 399, 401, 744 P.2d 174, 176 (1987). These policy provisions cannot be reasonably interpreted to mean anything other than that they are intended to prevent recovery for the same medical damages from both coverages.

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Cite This Page — Counsel Stack

Bluebook (online)
2003 NMCA 040, 63 P.3d 517, 133 N.M. 414, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fickbohm-v-st-paul-insurance-nmctapp-2003.