Opinion ID: 2607677
Heading Depth: 1
Heading Rank: 8

Heading: Expectations of the insured.

Text: In Lopez, the sole apparent cause of ambiguity arose from the payment of separate premiums. Separate premiums give rise to expectations of greater coverage. See Jimenez, 107 N.M. 322, 324-25, 757 P.2d 792, 794-5; see also Lopez, 98 N.M. at 170, 646 P.2d at 1234. The reasonable expectations of the insured thus provide the criteria for examining an insurance contract on the basis both of the actual words used and of unresolved issues that the insurance company has an obligation to address. Sanchez argues that expectations arise not only because of separate premiums paid, but also because of the nature of uninsured motorist coverage. As this court has previously discussed, a problem with uninsured motorist coverage is that a pedestrian, killed by an uninsured driver, could have collected on more than one vehicle or policy (separate premiums paid in both cases), but if that same person were in an insured vehicle, he or she only could have recovered under that one policy or vehicle. See Lopez, 98 N.M. at 169, 646 P.2d at 1233. This would have lead to the insured's being better covered as a pedestrian or in an unowned vehicle. Medical payments, like uninsured motorist coverage, follow the person, leading to the same incongruities, and the same frustration of the insured's expectations. If the insured paid premiums on two cars and is injured while outside of one car, he or she could recover under both policies, whereas if injured inside one car, the insured could recover only under that car's policy. Because most people would expect to carry their maximum amount of coverage while inside an insured car, the preclusion of medical payments recovery would, like with uninsured motorist coverage, frustrate the insured's legitimate expectations. The insurance company's failure to explicitly address those expectations became its failure to clarify ambiguity under Lopez. State Farm argues here, however, that two policy sections unambiguously precluded stacking, making any contrary intention of the insured unreasonable, and we agree.