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Graf v. State Farm Mutual Automobile Insurance Co.

Supreme Court of Maine

July 14, 2016

ALBERTA GRAF
v.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY

          Submitted On Briefs: October 21, 2015

          Reissued: October 13, 2016

         Reporter of Decisions

         On the briefs:

          N. Laurence Willey, Jr., Esq., Willey Law Offices, Bangor, for appellant Alberta Graf.

          James B. Main, Esq., Hoy & Main, P.A., Gray, for appellee State Farm Mutual Automobile Insurance Company.

          Panel: SAUFLEY, C.J., and ALEXANDER, MEAD, GORMAN, JABAR, and HJELM, JJ.

          SAUFLEY, C.J.

         [¶1] Alberta Graf was injured when the car she was driving was struck from behind by an underinsured motorist. She claimed uninsured/underinsured motorist (UM/UIM) coverage and medical payments coverage under two separate State Farm Mutual Automobile Insurance Company policies. Graf and State Farm agreed to arbitrate the amount of damages caused by the accident, but to leave to the court the dispute regarding the extent of coverage, if any, available to Graf through the identified policies. An arbitration panel determined that the accident caused Graf $378, 000 in damages, $125, 000 of which were identified as medical costs. The Superior Court (Somerset County, Mullen, J.) determined that Graf had coverage under only one of the State Farm policies; deferred to the arbitration award as to her actual damages; established the amount owed by State Farm; and reduced the arbitration award accordingly upon entry of judgment. We affirm the courts determination that only one of the policies covered Graf, but we vacate the courts decision regarding the amount due under that policy.[1]

         I. BACKGROUND

         [¶2] The parties do not dispute that on August 4, 2005, Alberta Graf was operating her personal vehicle when it was struck from behind by a vehicle operated by another motorist who was fully responsible for causing the accident. At the time of the accident, that motorist had liability motorist coverage with Progressive Insurance Company in the amount of $50, 000.

         [¶3] Graf and her husband held two State Farm policies at the time of the accident. The first (Policy 1) was in Grafs husbands name; provided $1, 000, 000 of UM/UIM coverage; provided $100, 000 of medical payments coverage; and did not cover Grafs vehicle. The UM/UIM section contained a provision entitled "When [UM/UIM Coverage] Does not Apply" that stated: "There is no coverage ... for bodily injury to an insured [sustained] while occupying a motor vehicle owned by... you, your spouse or any relative if it is not insured for this coverage under this policy." The medical payments coverage under Policy 1 contained a similar provision. The second policy (Policy 2) was in Grafs name; provided $300, 000 of UM/UIM coverage; provided $100, 000 of medical payments coverage for medical expenses incurred for services furnished within three years of the accident; and covered Grafs vehicle. It provided: "The uninsured motor vehicle coverage shall be excess over and shall not pay again any medical expenses paid under the medical payments coverage." It also provided that medical payments coverage would be denied "to the extent workers compensation benefits are required to be payable."

         [¶4] In October 2009, Graf, with State Farms consent, settled her claim against the other motorist for his policy limits of $50, 000 through Progressive Insurance. In September 2011, Graf filed a three-count complaint against State Farm in the Superior Court (Somerset County) seeking coverage from State Farm pursuant to both policies.

         [¶5] On August 20, 2013, [2] as the parties were preparing to go to trial, Graf filed a motion for stay of proceedings due to an arbitration clause in the policies, which the court (Nivison, J.) granted. See generally Uniform Arbitration Act, 14 M.R.S. ...


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