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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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October 22, 2024
UM/UIM Coverage Requires Accident With a “Motor Vehicle”

When a UTV is not a Motor Vehicle

Post 4915

See the full video at https://rumble.com/v5jjnc5-umuim-coverage-requires-accident-with-a-motor-vehicle.html and at https://youtu.be/FjWX4e8Nv7g

In Shaun and Jennifer Lopez, et al v. Erie Insurance, No. 23-ICA-338, West Virginia Intermediate Court of Appeals (October 16, 2024) agreed that a UTV is not a "motor vehicle."

FACTUAL BACKGROUND

The petitioners, Shaun and Jennifer Lopez, and Keith and Melissa Chapman (“Petitioners”), appealed the Order Granting Summary Judgment. Petitioners contended that the circuit court erred in applying contractual terms from the insurance policy’s general definitions section of a utility-terrain vehicle (“UTV”) to the uninsured and underinsured motorists endorsement finding it did not fit the definition of “motor vehicle.”

In Shaun and Jennifer Lopez, individually, and as Next Friends and Legal Guardians of S.L., G.L., and J.L., minors; and Keith and Melissa Chapman, individually, and as Next Friends and Legal Guardians of H.C., a minor, Plaintiffs Below v. Erie Insurance, No. 23-ICA-338, West Virginia Intermediate Court of Appeals (October 16, 2024) agreed that a UTV is not a “motor vehicle.”

Petitioners made a claim for uninsured/underinsured motorists (“UIM”) benefits under Mr. Cox’s Erie Policy on October 22, 2020. The Erie Policy includes UIM bodily injury limits of $100,000 per person and $300,000 per accident.

Erie denied coverage for the Petitioners’ UIM claims by finding that Mr. Kidd’s UTV did not qualify as a “motor vehicle” as defined under the Erie Policy. Erie filed a motion for summary judgment and the circuit court ruled in Erie’s favor.

RELEVANT POLICY LANGUAGE

The policy defined “Motor vehicle” as “any vehicle that is self-propelled and is required to be registered under the laws of the state in which “you” reside at the time this policy is issued.” (Emphasis Added)

DISCUSSION

The primary issue in this case is whether, under the Erie Policy, the UTV meets the general definition of “motor vehicle.”

Each exclusion category is predicated upon the subject of the exclusion being a “motor vehicle,” which is written in quotations and bolded. Each and every exclusion for “underinsured motor vehicle” begins with an explicit reference to a “motor vehicle,” which is modified in some way. The Court needed to determine whether the UTV is a “motor vehicle” under the Erie Policy.

In the Erie Policy’s general policy definitions, “motor vehicle” is defined as “any vehicle that is self-propelled and is required to be registered under the laws of the state in which ‘you’ reside at the time this policy is issued.” (Emphasis added.)

It is well-settled that contracts should be read as a whole. To be considered an “underinsured motor vehicle” pursuant to the UIM Endorsement, a vehicle must first be considered a “motor vehicle” under the Erie Policy’s general definitions section.

Coverage as an “underinsured motor vehicle” can only apply to the UTV if it is a “motor vehicle” as defined by the general definitions section of the Erie Policy. However, it is undisputed that the UTV here does not meet the second prong of the Erie Policy’s “motor vehicle” definition, the legal requirement that the vehicle be registered.

A claim for underinsured motorists coverage for injuries caused by an off-roading vehicle not subject to West Virginia’s registration and licensing requirements the UTV was not legally required to be registered (and thus be insured) and was being driven on a road that was closed off to normal traffic, the denial of underinsured motorists coverage does not conflict with West Virginia Code.

ZALMA OPINION

People often forget that insurance is a contract whose terms and conditions control the obligations of the insurer and its insureds. In this case the accident was caused by the a person operating an UTV which was neither licensed nor registered in accordance with the law of the state of West Virginia and, therefore, did not fit the definition of “motor vehicle” and there was no coverage under the UIM coverage of the policy.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:08:07
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The Zalma Philosophy of Claims Handling – Part 8

The Professional Claims Handler

Post 5218

Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-8-barry-zalma-esq-cfe-zdwsc, see the full video at https://rumble.com/v70zl4s-the-zalma-philosophy-of-claims-handling-part-8.html and at https://youtu.be/MIYcF71ffRQ, and at https://zalma.com/blog plus more than 5200 posts.

Claims Commandment X – Thou Shall Not Pretend to be a Lawyer

Some experienced and professional claims people know the law in their area of expertise better than most lawyers.

Adjusters should be adjusters and leave lawyering to lawyers. Similarly, lawyers should be lawyers and never try to be adjusters.

Claims Commandment XI – Thou Shall Empathize With the Claimant

Everyone presenting a claim is unhappy, disturbed, shocked, injured and needs help.

Empathy is identification with and understanding of another’s situation, feelings, and motives. It is the ability to understand another person’s circumstances, point of view, thoughts, and feelings....

00:11:08
October 28, 2025
The Zalma Philosophy of Claims Handling – Part 6

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See the full video at https://rumble.com/v70wb2i-the-zalma-philosophy-of-claims-handling-part-6.html and at https://youtu.be/tL5nDKPEs40 and at https://zalma.com/blog plus more than 5200 posts.

Post 5217

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry.

An Excellence in Claims Handling program begins with a statement in the insurer’s claims manual or statement of professionalism that it is dedicated to providing excellence in claims handling to every insured who presents a claim.

The excellence in claims handling program should include, at a minimum:

A series of lectures supported by text materials explaining:
A definition of insurance.
How to read and understand an insurance policy.
How to interview an insured, witness, or claimant.
How to assist an insured in the insured’s obligation to ...

00:08:40
October 27, 2025
The Zalma Philosophy of Claims Handling – Part 5

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Post 5216

Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-5-barry-zalma-esq-cfe-jde8c, see the full video at https://rumble.com/v70q4x8-the-zalma-philosophy-of-claims-handling-part-5.html and at https://youtu.be/6b9tZQsEkB4, and at https://zalma.com/blog plus more than 5200 posts.

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry.
Standards to be a Professional Claims Adjuster

The Insurance claims professional should be a person who:

1. Can read and understand the insurance policies issued by the insurer.
2. Understands the promises made by the policy.
3. Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
4. Are competent investigators.
5. Have empathy and recognize the difference between empathy and sympathy.
6. ...

00:08:18
13 hours ago
The Zalma Philosophy of Claims Handling – Part 9

The Professional Claims Handler
Post 5219

Posted on October 31, 2025 by Barry Zalma

An Insurance claims professionals should be a person who:

Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.

How to Create Claims Professionals

To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...

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October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

post photo preview
October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail

Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.

My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

post photo preview
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