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Court Denies Plaintiff’s Request to Interpret Unambiguous Term in Insurance Policy

Posted in Auto Accidents

An insurance policy is essentially just a contract between the insured and the insurance company. The insurance company agrees to provide certain coverage, detailed in the policy, and the insured agrees to pay a stated premium. In some New Mexico car accidents, an insurance company’s obligation to provide coverage is clear. However, in many cases insurance companies dispute coverage.

A recent opinion issued by a state appellate court illustrates the difficulties a plaintiff may encounter when attempting to file a claim with an insurance policy. In that case, the plaintiff was the estate of a man who was killed while mowing his lawn by a motorist that was driving while under the influence. The at-fault driver did not have car insurance.

The employer of the man who was killed in the accident, however, maintained an insurance policy with uninsured motorist (UIM) protection. Thus, in hopes of obtaining compensation for the loss of the decedent’s life, the estate filed a claim with his employer’s insurance policy.

The employer’s policy explained the UIM coverage in a section titled “Our Promise.” That section provided that UIM coverage was extended to “you or others we protect.” Immediately below that section was a definition of the term “others we protect,” which included the following categories of people:

  • Any relative (if “you” are an individual);
  • Anyone else riding in an insured owned auto;
  • Anyone else entitled to recover damages based on the policy; and
  • Anyone else riding in a non-owned auto that is covered, unless it is owned by another member of the same household, it is furnished for the regular use of the insured, or it was being operated by someone other than the insured or a relative.”

Importantly, the term “you” in this context would refer to the employer, as that was the party who took out the policy. Thus, the deceased was not covered in any of the categories of people described in “others we protect.”

The estate acknowledged this, but asked the court to apply its own interpretation to the term and, in so doing, include the deceased. However, the court declined the estate’s invitation to do so. The court explained that, under state law, a court is only able to interpret ambiguous contractual terms. Here, the court held, the term “others we protect” was not ambiguous because a concise definition of the term was given within the contract. Thus, the court explained that it was without the authority to assign a definition other than that which was contained in the contract. As a result, the estate’s claim against the employer’s insurance company was rejected.

Have You Been Injured in a New Mexico Car Accident?

Liability in a New Mexico car accident is not always easy to determine or establish. In some cases, there are liable parties that may not initially be known. In others, parties that would seem to be liable for injuries may later turn out not to be. The skilled Albuquerque car accident lawyers at the Fine Law Firm have decades of experience assisting New Mexico injury victims in recovering compensation for their injuries by helping them navigate the complex legal system. Not only that, but we advocate zealously on behalf of our clients to ensure they are awarded the compensation they deserve for the injuries they have sustained. Call 505-889-FINE to schedule your free consultation today.

More Blog Posts:

Court Enforces Clause in Residential Lease Agreement Limiting the Amount of Time the Tenant Had to File a Lawsuit, New Mexico Personal Injury Lawyer Blog, June 20, 2017.

Court Dismisses Plaintiff’s Gas Station Slip-and-Fall Case, New Mexico Personal Injury Lawyer Blog, July 6, 2018.