Salazar v. State Farm Mutual Automobile Insurance

548 N.E.2d 382, 191 Ill. App. 3d 871, 138 Ill. Dec. 969, 1989 Ill. App. LEXIS 1735, 1989 WL 139802
CourtAppellate Court of Illinois
DecidedNovember 20, 1989
Docket1-88-2977
StatusPublished
Cited by14 cases

This text of 548 N.E.2d 382 (Salazar v. State Farm Mutual Automobile Insurance) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Salazar v. State Farm Mutual Automobile Insurance, 548 N.E.2d 382, 191 Ill. App. 3d 871, 138 Ill. Dec. 969, 1989 Ill. App. LEXIS 1735, 1989 WL 139802 (Ill. Ct. App. 1989).

Opinion

JUSTICE O’CONNOR

delivered the opinion of the court:

This is an appeal from a summary judgment for defendant in an action brought by plaintiff to recover medical payment benefits under certain policies of automobile insurance issued by defendant.

The plaintiff, Michael Salazar, while a pedestrian, was struck by a car and injured. As a result of his injuries, he incurred $28,418.15 in medical expenses. Defendant, State Farm Mutual Automobile Insurance Company (State Farm), had issued three policies of automobile liability insurance to members of plaintiff’s family, each of which provided medical payments coverage with limits of $25,000.

All three policies in issue contain the following provisions:

“(1). If There Are Other Medical Payments Coverages
* * *
4. If other vehicle medical payments coverage applies to bodily injury sustained by a pedestrian, this coverage is excess.
(2). Medical Expenses
We will pay reasonable medical expenses, for bodily injury caused by accident, for services furnished within one year of the date of the accident. These expenses are for necessary medical, surgical, x-ray, dental, ambulance, hospital, professional nursing and funeral services, eyeglasses, hearing aids and prosthetic devices.”

State Farm paid the entire amount of plaintiff’s medical expenses, totalling $28,418.15. Of this sum, $25,000 was paid under policy No. 8333 896—13, issued to plaintiff’s sister, and $3,418.15 was paid under policy No. 8419 237—13, issued to plaintiff’s father. Defendant declined to pay the remainder of $21,581.85 under policy No. 8419 237—13 and the sum of $25,000 under policy No. 8498 043—13.

Plaintiff then brought this action seeking payment of the remaining $21,581.85 of medical coverage available under policy No. 8419 237—13 and $25,000 of medical coverage available under policy No. 8498 043—13 issued to plaintiff’s father. The parties filed cross-motions for summary judgment, and following a hearing, summary judgment was entered in favor of defendant and against plaintiff. Plaintiff now brings this appeal.

Plaintiff’s principal argument is that as the premiums had been paid on each of the three policies issued to members of his family, he was entitled to recover the full amount of the medical payments coverage under all three policies. He asserts that by retaining premiums on three separate policies while refusing to pay valid claims under the policies, State Farm has, in effect, been unjustly enriched. Plaintiff argues that as a named insured under each of the policies, he is entitled to “stack” the coverages under each policy, thereby recovering the full amount under each policy.

With respect to the exclusionary clause, plaintiff argues that the language is ambiguous and, therefore, under Kaufmann v. Economy Fire & Casualty Co. (1979), 76 Ill. 2d 11, 17, 389 N.E.2d 1150, and Glidden v. Farmers Automobile Insurance Association (1974), 57 Ill. 2d 330, 336, 312 N.E.2d 247, the clause must be construed in his favor so as to “stack” the primary coverage under each of the three policies. Plaintiff maintains that in other portions of the policy, State Farm explicitly limited its liability for multiple coverage, and if State Farm had desired to limit its liability to actual loss suffered or medical expenses incurred, it could have done so by the use of proper limiting language.

Plaintiff makes specific reference to section 3 of the policy, related to “other underinsured motor vehicle coverage,” in which the language of the policy differentiates between coverage available on “policies issued by us to you” and coverage available “from other sources.” He claims that defendant’s failure to similarly differentiate which policy provides primary coverage for medical payments where there are multiple policies held by the insured is what creates an ambiguity here.

We have reviewed the provision to which plaintiff refers and disagree with plaintiff’s assertion that the exclusionary clause in the three policies is ambiguous. While State Farm chose to differentiate between other coverage available from the same insurer and coverage available from other sources with respect to uninsured motor vehicle coverage, it chose not to use similar language with respect to medical expense payments. Defendant instead chose to provide a complete exclusion under each policy if other medical payments coverage was available under any other policies. It makes no difference, in fact, which of the three policies is regarded as the primary policy, because under the policies, all of plaintiff’s medical bills would be covered up to the maximum coverage of $75,000. We do not believe that the medical payments limitation here is ambiguous, and therefore, plaintiff is not entitled to multiple recovery under the three policies.

The issue raised by the instant appeal was first addressed by Illinois courts in Laurie v. Holland America Insurance Co. (1961), 31 Ill. App. 2d 487, 176 N.E.2d 678. The plaintiff in Laurie had two policies of automobile liability insurance with the defendant insurance carrier. Both policies had medical payments coverage and a provision whereby the insurer agreed to pay all reasonable medical expenses incurred within a year of an accident. Both policies also contained a clause providing that “ ‘the insurance shall be excess over any other valid and collectible automobile medical payments insurance available to an insured under any other policy.’ ” Laurie, 31 Ill. App. 2d at 439.

The court in Laurie held that the insured was not entitled to be paid twice for the medical bills incurred, the basis for the court’s opinion being that the policy was a contract of indemnity under which the insured was entitled to only one recovery. (Laurie, 31 Ill. App. 2d at 445, 449.) Plaintiff here contends, however, that the rationale of Laurie is no longer applicable in light of Strzelczyk v. State Farm Mutual Automobile Insurance Co. (1986), 113 Ill. 2d 327, 497 N.E.2d 1170.

While it is true that the court in Strzelczyk rejected the indemnity analysis of Laurie (Strzelczyk, 113 Ill. 2d at 330), Strzelczyk is factually distinguishable from the instant appeal. In Strzelczyk, the two claimants were injured on a CTA bus which did not have medical payments coverage for its occupants. The mother and daughter claimants resided in the same household and each had a policy of insurance with State Farm. Each claimant made a claim under her own and the other person’s policy.

The clause intended to prevent double payment of medical bills provided:

“2. *** If a temporary substitute car, a non-owned car or a trailer has other medical payments coverage on it this coverage is excess.”

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Bluebook (online)
548 N.E.2d 382, 191 Ill. App. 3d 871, 138 Ill. Dec. 969, 1989 Ill. App. LEXIS 1735, 1989 WL 139802, Counsel Stack Legal Research, https://law.counselstack.com/opinion/salazar-v-state-farm-mutual-automobile-insurance-illappct-1989.