Zalma on Insurance
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April 27, 2022
You Only Get What You Pay For – No UIM Cover No Benefits

If You Refuse to Buy UM/UIM Coverage Mom’s Coverage Doesn’t Cover You

Barry Zalma

Read the full article at https://lnkd.in/gYExHqDp and at https://zalma.com/blog plus more than 4200 posts.
Posted on April 27, 2022 by Barry Zalma

Lloyd, Janet, and Eric Colebank (collectively, Appellants) appealed from the September 22, 2021 order entered in the Fayette County Court of Common Pleas, granting the motion for judgment on the pleadings filed by Erie Insurance Exchange (Erie) in this declaratory judgment action. The crux of Appellants’ argument is that the trial court erred when it relied upon the policy provisions of a separate insurance policy, issued by a separate insurance carrier, to determine whether coverage was owed by Erie. In Erie Insurance Exchange v. Lloyd Colebank, Janet Colebank And Eric Colebank, No. 1244 WDA 2021, Superior Court of Pennsylvania (April 20, 2022) the trial court refused to be controlled by Eric’s serious injuries and found the family exclusion and the rejection of UIM coverage for his own vehicle, gave up the right to UIM benefits.
FACTS

Lloyd and Janet are husband and wife, and Eric is their 27-year-old son, who resides with them in Fayette County. On February 2019, Eric was driving his 2016 Jeep Wrangler SUV, which he owned, southbound on Brownsville Road, Jefferson Township, Fayette County, Pennsylvania. At the same time, the tortfeasor, Wilbert Brown, was operating his vehicle northbound on the same road when he lost control of his vehicle, crossed the center line, and collided with Eric’s vehicle. As a result of the accident, Eric suffered numerous personal injuries, which required several surgeries.

Eric filed a personal injury claim against Brown, who was insured by Allstate Insurance under a policy that provided $25,000.00 in bodily injury liability coverage. On behalf of Brown, Allstate tendered the $25,000.00 liability limits to Eric. Eric, through his counsel, advised Erie of the Allstate tender, and Erie waived subrogation and consented to the settlement with Allstate. The parties agree that the injuries and damages suffered by Eric as a result of the underlying accident exceeded the $25,000.00 policy limits.

At the time of the accident, Eric’s Jeep was insured under a policy issued to Eric by State Farm (the State Farm Policy). Eric specifically rejected underinsured motorist (UIM) coverage under his State Farm Policy.

Eric subsequently submitted a claim for UIM coverage to Erie under an insurance policy issued to Lloyd and Janet, that provided for, inter alia, UIM benefits in specifically defined circumstances (the Erie Policy). The Erie Policy insured two vehicles, neither of which was involved in the accident at issue or owned by Eric. The Erie Policy provides for $100,000.00 of UIM with stacking and two vehicles, for a total of $200,000.00 in UIM benefits. Erie collected premiums from Lloyd and Janet for UIM and stacked UIM benefits under their policy.

The Erie Policy contained a household exclusion clause in its UIM endorsement.

Erie filed a motion for judgment on the pleadings, alleging that:

Eric was operating a vehicle owned by him and insured under a different automobile insurance policy (the State Farm Policy) at the time of the underlying accident;

Eric knowingly and voluntarily rejected UM/UIM coverage under the State Farm Policy, which insured the Jeep he was driving when the accident occurred; and therefore,

Erie did not owe a duty to tender UIM benefits to Eric under the Erie Policy issued to Lloyd and Janet pursuant to applicable Pennsylvania law and the Erie Policy exclusion provision.

Following the argument, the court entered an order granting Erie’s motion. The court stated:

“[It] has applied the persuasive reasoning set forth in Erie Insurance Exchange v. Sutherland, [1113 WDA 2020, 2021 WL 2827321 (Pa. Super. July 7, 2021) (unpub. memo),] and finds that Donovan v. State Farm [Mutual Automobile Insurance Company, 256 A.3d 1145 (Pa. 2021),] is distinguishable from the facts of this case since the insured did not waive or reject underinsured motorist benefits as [Eric] Colebank did here.”

ANALYSIS

The standard of review over a decision sustaining a judgment on the pleadings requires us to determine whether, on the facts averred, the law makes recovery impossible. [Cagey v. Commonwealth, 179 A.3d 458, 463 (Pa. 2018)]. Eric contended that Erie promised to pay UIM benefits to the named insureds and their resident relatives if they were injured by an underinsured motorist up to the amount of UIM coverage purchased.

Based on the nature of the appeal the appellate court found it was necessary to explain the relevant legal history concerning UIM coverage and the household exclusion. A person who has voluntarily elected not to carry underinsured motorist coverage on his own vehicle is not entitled to recover underinsured motorist benefits from separate insurance policies issued to family members with whom he resides where clear and unambiguous “household exclusion” language explicitly precludes underinsured motorist coverage for bodily injury suffered while occupying a motor vehicle not insured for underinsured motorist coverage.

After a detailed review of UM/UIM precedent, the Superior Court, contrary to Appellants’ arguments, found two prior cases dispositive as both cases are substantially similar in facts and procedural posture to this case. In all three cases, the insured suffered injuries while operating a vehicle or motorcycle and the individual had explicitly rejected UIM coverage on that host policy. Likewise, the injured individual sought coverage from a separate policy that included stacked UIM coverage and a household exclusion provision. Since Eric did not purchase UIM coverage for his own policy he did not have the requisite UIM coverage on which to stack his parents household policies with UIM benefit.

For the foregoing reasons Appellants were not entitled to UIM benefits under their Erie policy in the case sub judice. Accordingly, we affirm the trial court’s order granting Erie’s motion for judgment on the pleadings.
ZALMA OPINION

Uninsured and Underinsured Motorist Coverages must be intentionally purchased or rejected. In this case Eric rejected UM/UIM coverage on the vehicle involved in the accident. Because his injuries were greater than the insurance available to the tortfeasor he sought UIM coverage from policies issued to his parents vehicles that were not involved in the accident. Coverage was clearly and unambiguously excluded and the attempt to get an insurer to pay for damages that exceeded available insurance can’t change the facts or the law.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected].

Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe.

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Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com.

Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/

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See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.

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Posted on July 20, 2026 by Barry Zalma

See the video and at https://lnkd.in/gNUs2XzT and at https://lnkd.in/g2MawyzX

Magistrate Issues a Search Warrant if there is a Fair Probability that Contraband or Evidence of a Crime will be Found in a Particular Place.

In United States Of America v. Frank Suess, et al., CRIMINAL No. 3:24-308, United States District Court, M.D. Pennsylvania (July 16, 2026) a federal grand jury indicted Frank Suess, Melissa Driscoll, and others in a 55-count health care fraud and anti-kickback prosecution arising from an alleged scheme involving medically unnecessary prescription “foot baths.”

As part of the investigation, the FBI obtained an August 19, 2022 warrant to search Driscoll’s Sterling Pharmacy Yahoo email account for emails from January 1, 2018 through December 31, 2020. Driscoll moved to suppress the resulting evidence, arguing that the warrant lacked probable cause, was overbroad, and rested on material misstatements and omissions.

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The Great Jewel Theft

Fraud Shouldn’t Pay

Post 5396

See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ¬¬¬Perpetrators than any Other Crime.

The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.

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Plaintiff Sues Because State Employees Stigmatized Her

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Post 5421

Posted on August 11, 2026 by Barry Zalma

First Amendment Right Will be Allowed to Go to Trial

In Betsey J. Grant v. Maine State Department Of Heath And Human Services, No. 1:25-cv-00490-JAW, United States District Court, D. Maine (August 6, 2026), Betsey J. Grant, a licensed childcare provider and operator of Tiny Tikes Daycare in Trenton, Maine, sued Maine DHHS and several employees after she publicly criticized DHHS before Maine’s Government Oversight Committee and alleged that officials retaliated against her.

She claimed DHHS imposed and extended a conditional license, published stigmatizing information, interfered with subsidies and program funding, removed her from a food program, rescinded an expansion grant, and used biased or falsified evidence in licensing proceedings. Following the March 10, 2023, GOC testimony, Ms. Grant alleges that foster children's subsidies (approximately $30,000) were withheld; she was removed from the ...

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August 05, 2026
It Doesn’t Pay to Lie in an Application for Insurance

Rescission for Material Misrepresentation
Post 5418

Posted on August 5, 2026 by Barry Zalma

An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.

In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units. After an underlying personal injury action was filed, Union Mutual determined that the property actually contained three apartment units and rescinded the policies on the ground that the defendants had made a material misrepresentation in the applications.
LAW:

A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true ...

post photo preview
August 05, 2026
It Doesn’t Pay to Lie in an Application for Insurance

Rescission for Material Misrepresentation
Post 5418

Posted on August 5, 2026 by Barry Zalma

An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.

In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units.

LAW:

A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true facts been disclosed. To establish materiality as a matter of law, the insurer must submit documentation of its underwriting practices, such as manuals, guidelines, bulletins, or rules addressing similar risks.

DISCUSSION/ANALYSIS:

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