Opinion ID: 169357
Heading Depth: 4
Heading Rank: 2

Heading: As a pedestrian when struck by:

Text: a motor vehicle designed for use mainly on public roads . . . . -3- Id., Vol. I at 135. The term “family member” is defined in the policy as, in pertinent part: “a person related to you by blood, marriage or adoption who is a resident of ‘your’ household.” Id., Vol. I at 117. As used in the policy, the terms “you” and “your” refer to “[t]he ‘named insured’ shown in the Declarations” and “[t]he spouse if a resident of the same household.” Id. Even if the spouse is not a resident of the same household as the named insured, coverage may be provided. The policy also states: If the spouse ceases to be a resident of the same household during the policy period or prior to the inception of this policy, the spouse will be considered “you” and “your” under this policy but only until the earlier of: 1. The end of 90 days following the spouse’s change of residency; 2. The effective date of another policy listing the spouse as a named insured; or 3. the end of the policy period. Id. The district court held that M s. Dalpaos-Lawrence was an “insured” for the purposes of loss of income benefits coverage. It held that although M s. Dalpaos-Lawrence was not a “family member” because she was not a resident of M r. Dalpaos’s household, she did qualify as a “you” or “your” under the policy and was therefore covered. -4- The district court also had to decide whether two exclusions in Part B of the policy applied to the loss of income benefits coverage. Part B’s “exclusions” section states, in pertinent part: W e do not provide M edical Payments Coverage for any “insured” for “bodily injury”: 1. Sustained while “occupying” any motorized vehicle having few er than four wheels. .... 5. Sustained while “occupying,” or when struck by, any vehicle (other than “your covered auto”) which is: a. Owned by you; or b. Furnished or available for your regular use. 1 Id., Vol. I at 121-22. The district court held that although the additional benefits endorsement amended Part B of the policy, it made no change to the exclusions section including the particular exclusions at issue. The exclusions, therefore, continued to explicitly apply only to “M edical Payments Coverage.” The district court awarded summary judgment and attorneys’ fees to M s. Dalpaos-Lawrence and GuideOne filed its appeal. 2 1 The motorcycle on which M s. Dalpaos-Lawrence was riding at the time of the accident was not owned by her but was available for her regular use so it was clear that if either exclusion applied, coverage would be denied. 2 The parties stipulated to the dismissal of M s. Dalpaos-Lawrence’s bad faith claim with prejudice. -5-