Zalma on Insurance
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May 07, 2025
There is no Free Lunch

Insured May Limit the Extent of UM Coverage Acquired

You Only Get What You Pay For

Post 5068

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Sonya Harness was employed as a home health nurse with Volunteer Staffing, Inc. On July 10, 2021, Ms. Harness was injured in a two-car collision while driving her vehicle in connection with her employment. She later sought uninsured motorist benefits under a business automobile liability policy issued to her employer.

In Sonya Harness v. John Mansfield et al., No. E2023-00726-COA-R3-CV, the Court of Appeals of Tennessee, Knoxville (April 30, 2025) resolved the dispute.

FACTS

Arguing that the uninsured motorist coverage in the business policy did not apply to the Ms. Harness’ accident, the insurer successfully moved for summary judgment.

At the time of the accident, she was driving her own vehicle, a Chevrolet Trax, within the course and scope of her employment. Ms. Harness had insurance coverage for her vehicle under a personal automobile liability insurance policy issued by Tennessee Farmer’s Mutual Insurance Company. Her policy included uninsured motorist coverage. Volunteer Staffing maintained a business automobile liability policy issued by The Cincinnati Insurance Company that also provided liability coverage for Ms. Harness under these circumstances.

The Commercial Policy

By its plain terms, the policy limited uninsured motorist coverage to injuries that occurred while the insured was occupying an automobile specifically listed in the declarations. Because Ms. Harness’s Chevrolet Trax was not listed, the insurer argued that the uninsured motorist coverage in the Cincinnati policy did not apply.

ANALYSIS

By statute, every general automobile liability policy issued or renewed in Tennessee must include uninsured motorist coverage. The named insured may reject coverage completely or select lower limits not less than the minimum coverage limits in [he Financial Responsibility Law in a signed writing.

It is undisputed that Ms. Harness was an additional “insured” under the liability provisions of the Cincinnati policy. As required by the statute, the Cincinnati policy includes uninsured motorist coverage with limits equal to the liability limits for bodily injury.

The Coverage Form specifies that each type of coverage in the policy only applies to the automobiles shown as covered. By its plain terms, the policy expressly limits uninsured motorist coverage to injuries that occur while occupying the one described vehicle and Ms. Harness suffered her injuries while driving her vehicle, the Chevrolet Trax not the described vehicle.

The statute mandates the coverage amount. Otherwise, the statute does not explicitly address the scope of the required coverage or dictate the form of coverage. Ms. Harness contended that the statutory requirement is “for the protection of persons insured under the policy” who are injured by an uninsured motorist. And she is an “insured” under the liability provisions of the Cincinnati policy.

The Court of Appeals noted that the statutory language does not guarantee uninsured motorist coverage for Ms. Harness in this instance. Ms. Harness’ rights under the policy necessarily depend on the choices and selections of coverage made by the named insured Volunteer Staffing that chose to include the mandated amount of uninsured motorist coverage in the Cincinnati policy. Volunteer Staffing decided to limit that coverage to specifically listed vehicles and its choices did not contravene the plain language of the uninsured motorist statute.

Because the Cincinnati policy unambiguously limits uninsured motorist coverage to injuries that occur while the insured is occupying a specifically listed vehicle and because Ms. Harness was not in that automobile the statute allowed Cincinnati to exclude from UM coverage. The limitation in the Cincinnati policy appears to be designed to avoid duplicate coverage. As such, it is a permissible limitation under the statute. The Cincinnati policy does not provide uninsured motorist coverage for Ms. Harness’s injuries.

ZALMA OPINION

Statutory interpretation by an appellate court must be reasonable and directed to fulfill the intention of the Legislature. Finding that it was appropriate to allow an insured and its insurer to limit its uninsured motorist coverage to named vehicles and limit Ms. Harness’ coverage to that she purchased for her own vehicle and not allow her to double the available coverage by recovering from her employer’s insurance which the insured refused to purchase. Reasonable interpretation made it appropriate to affirm the trial court.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:59
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Southern Insurance Company Of Virginia v. Justin D. Mitchell, et al., No. 3:24-cv-00198, United States District Court, M.D. Tennessee, Nashville Division (October 10, 2024) Southern Insurance Company of Virginia sought a declaratory judgment regarding its duty to defend William Mitchell in a wrongful death case pending in California state court.

KEY POINTS

1. Motion for Judgment on the Pleadings: The Plaintiff moved for judgment on the pleadings, which was granted in part and denied in part.
2. Duty to Defend: The court found that the Plaintiff has no duty to defend William Mitchell in the California case due to a specific exclusion in the insurance policy.
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Post 5119

Default of Settlement Agreement Reduced to Judgment

In Government Employees Insurance Company, Geico Indemnity Company, Geico General Insurance Company, and Geico Casualty Company v. Dominic Emeka Onyema, M.D., DEO Medical Services, P.C., and Healthwise Medical Associates, P.C., No. 24-CV-5287 (PKC) (JAM), United States District Court, E.D. New York (July 9, 2025)

Plaintiffs Government Employees Insurance Company and other GEICO companies (“GEICO”) sued Defendants Dominic Emeka Onyema, M.D. (“Onyema”), et al (collectively, “Defendants”) alleging breach of a settlement agreement entered into by the parties to resolve a previous, fraud-related lawsuit (the “Settlement Agreement”). GEICO moved the court for default judgment against ...

00:07:38
July 15, 2025
Zalma’s Insurance Fraud Letter – July 15, 2025

ZIFL – Volume 29, Issue 14
Post 5118

See the full video at https://lnkd.in/geddcnHj and at https://lnkd.in/g_rB9_th, and at https://zalma.com/blog plus more than 5100 posts.

You can read the full 20 page issue of the July 15, 2025 issue at https://lnkd.in/giaSdH29

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL

This issue contains the following articles about insurance fraud:

The Historical Basis of Punitive Damages

It is axiomatic that when a claim is denied for fraud that the fraudster will sue for breach of contract and the tort of bad faith and seek punitive damages.

The award of punitive-type damages was common in early legal systems and was mentioned in religious law as early as the Book of Exodus. Punitive-type damages were provided for in Babylonian law nearly 4000 years ago in the Code of Hammurabi.

You can read this article and the full 20 page issue of the July 15, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-07-15-2025.pdf

Insurer Refuses to Submit to No Fault Insurance Fraud

...

00:08:27
July 16, 2025
There is no Tort of Negligent Claims handling in Alaska

Rulings on Motions Reduced the Issues to be Presented at Trial

Read the full article at https://lnkd.in/gwJKZnCP and at https://zalma/blog plus more than 5100 posts.

CASE OVERVIEW

In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.

FACTS

Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.

Prior to trial Bernier had three remaining claims against State Farm:

1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.

Both Bernier and State Farm dispositive motions before ...

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May 15, 2025
Zalma's Insurance Fraud Letter - May 15, 2025

ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional

See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.

Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:

Health Care Fraud Trial Results in Murder for Hire of Witness

To Avoid Conviction for Insurance Fraud Defendants Murder Witness

In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...

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CGL Is Not a Medical Malpractice Policy

Professional Health Care Services Exclusion Effective

Post 5073

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This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.

In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:

Insurance Coverage Dispute:

Travelers issued a Commercial General Liability ...

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