Opinion ID: 2607086
Heading Depth: 3
Heading Rank: 2

Heading: The Language of Maynard's Policy

Text: The pertinent provisions of the insurance contract are contained in an endorsement amending the policy's Medical Payments Coverage. They provide as follows: When Someone May Be Legally Liable For the Bodily Injury 1. If the injured person has been paid damages for the bodily injury by or on behalf of the liable party in an amount: a. less than the injured person's total medical expenses, the most we will pay under this coverage is the lesser of: (1) the limit of liability of this coverage, or (2) the amount by which the total reasonable and necessary medical expenses exceed the total amount paid by or on behalf of all parties liable for the bodily injury; b. equal to or greater than the total reasonable and necessary medical expenses incurred by the injured person, we owe nothing under this coverage. 2. When we pay medical expenses under this coverage, we are entitled to be paid out of any subsequent recovery for bodily injury from a liable party or such party's insurer the lesser of: a. what we have paid; or b. the amount by which the sum of the total recovery for bodily injury from all liable parties and what we have paid under this coverage exceeds the total amount of reasonable and necessary medical expenses the injured person incurred. The injured person shall: a. execute any legal papers we need; b. when we ask, take action through our representative to seek a recovery; c. not hurt our rights to recover; d. not make claim to that portion of the recovery that we are entitled to be paid; and e. answer truthfully all questions that we may ask. We will not seek reimbursement from payments received from a liable party or such party's insurer by a person who has complied with all of these requirements. This language conclusively bars the double recovery which Maynard seeks in this case. Section one generally provides that State Farm will not pay any expenses for which the claimant has already been compensated. Section two generally states that State Farm is entitled to reimbursement to the extent that the claimant obtains recovery from a liable third party for medical expenses which have been paid for under the Medical Payments Coverage portion of the policy. [6] Also of significance is the absence of any policy language which suggests that these provisions do not apply when State Farm insures both the claimant and the third-party tortfeasor. The fact that State Farm could administratively enforce its rights through a set-off from the subsequent judgment against the tortfeasor rather than through a separate reimbursement action against the insured does not change our analysis. Thus, by denying Maynard a double recovery for his medical expenses, we are merely giving effect to the unambiguous language of the insurance contract.