To Recover UIM Benefits the At Fault Driver Must be Underinsured
Post 5092
See the full video at https://lnkd.in/gpe6BxQJ and at https://lnkd.in/gVzKcDSr and at https://zalma.com/blog plus more than 5050 posts.
Angie Foresee appealed from the judgment of the district court dismissing her complaint and awarding attorney fees in favor of Metropolitan Group Property and Casualty Insurance Company (Metropolitan). In Angie Foresee v. Metropolitan Group Property And Casualty Insurance Company, and DOES I-V, No. 51902, Court of Appeals of Idaho (June 2, 2025) the trial court award was affirmed.
FACTUAL BACKGROUND
Foresee was involved in a rear-end collision with a third-party driver (at-fault driver). At the time of the accident, the at-fault driver carried a liability automobile insurance policy that had a $100,000 coverage limit per person. Foresee had underinsured motorist coverage (UIM) that included a $50,000 coverage limit per person through Metropolitan. Foresee alleged damages in excess of $100,000.
Foresee settled with the at-fault driver's insurer. She then made a claim against Metropolitan for the limits of her UIM policy. Metropolitan denied coverage and Foresee commenced the present suit. The district court held Metropolitan's offset provision is valid and fully enforceable. The district court awarded attorney fees to Metropolitan.
ANALYSIS
Foresee argued that she is entitled to $25,000 UIM coverage benefits regardless of the offset limit provisions in the contract. Metropolitan argued that the only statutory mandate imposed on the insurer is to offer UIM coverage.
The most straightforward resolution was rooted in the definition of the UIM coverage. Applying the plain meaning of the words, the at-fault driver did not fit the definition of an underinsured motorist. The at-fault driver's liability limit of $100,000 was greater than, not less than, the $50,000 limit of Foresee's UIM coverage. Accordingly, the at-fault driver's vehicle was not an underinsured motor vehicle, and Metropolitan need not provide coverage.
Illusory Coverage
Foresee argued that Metropolitan's UIM coverage of $50,000 was illusory because of the offset provision. When a policy only provides an illusion of coverage for its premiums, the policy limitations and exclusions will be considered void as violating public policy. Therefore, when the insured pays a premium for a benefit that would never be available, the coverage is illusory and is contrary to public policy yet the coverage was not illusory.
Requirement to Provide UIM Coverage
To provide is not synonymous with to pay out. When an insurance company provides coverage, it offers coverage under certain conditions – not a guarantee of an automatic payment. Thus, an insurer may provide coverage under the terms of the policy but may not pay out if the claim does not meet the policy's requirements.
Public Policy
Foresee argues that reduction of UIM coverage below $25,000 is void as against public policy.
Foresee's argument rests on the premise that Idaho public policy allows only excess UIM coverage that would have provided the UIM benefits in addition to the at-fault driver's liability policy. However, the Idaho Supreme Court has specifically articulated that both excess and offset policies are legitimate in Idaho.
District Court's Award of Attorney Fees
The district court recognized that Foresee did not file a challenge to Metropolitan's requested grounds for attorney fees or the reasonableness of the attorney fees. There was no dispute that Metropolitan was the prevailing party.
The trial court's judgment was affirmed and the Court of Appeals awarded costs on appeal to Metropolitan as the prevailing party.
ZALMA OPINION
When a state supreme court establishes a rule of law for its state trial and appeals courts must follow the decision of the Supreme Court and a challenge to the Supreme Court's ruling can be found, as the Idaho Court of Appeals did, is frivolous so Foresee not only lost her case but was required to pay the insurer's attorneys fees at trial and appeal.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Refusal to Provide Workers’ Compensation is Expensive
Post 5240
Read the full article at https://lnkd.in/guC9dnqA, see the video at https://lnkd.in/gVxz-qmk and at https://lnkd.in/gUTAnCZw, and at https://zalma.com/blog plus more than 5200 posts.
In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.
Company Overview:
USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...
Arsonist Incompetently Moves Pro Se to Avoid Prison
Post 5239
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In Christopher A. Barosh v. Morris Houser, et al., Civ. No. 22-0769, United States District Court, E.D. Pennsylvania (November 25, 2025) a convicted arsonist and insurance fraudster moved the USDC acting in Pro se filed Objections to Magistrate Judge Reid’s Recommendation that the US District Judge dismiss his § 2254 Petition to avoid jail.
BACKGROUND
In October 2005, Barosh set fire to his girlfriend’s Philadelphia home — some 25 hours before the cancellation of the property’s insurance policy. Several witnesses saw Barosh leaving the property shortly before the fire erupted. After the fire, Barosh made “two separate admissions of guilt.”
He attempted to pay an acquaintance to provide him with an alibi for the time of the arson. The eyewitnesses, brother, and ...
Conditional Release Allows Supplemental Claims
Post 5238
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A Release Should Totally Resolve Dispute
In Harvey et al. v. Hall, No. A25A1774, Court of Appeals of Georgia, Fourth Division (December 3, 2025) Paul Harvey, an employee of Arthur J. Dovers (d/b/a 3D Mobile Home Services), drove a truck towing a trailer loaded with machinery and equipment. Harvey fell asleep, veered off the road, and crashed into a culvert, causing Lamar Hall serious injuries.
FACTS OF SETTLEMENT
On August 18, 2020, Hall signed a limited liability release under OCGA § 33-24-41.1, releasing Harvey, Dovers, and their insurer (Georgia Farm Bureau Insurance Company) from liability for the accident in exchange for $50,000, “except to the extent other insurance coverage is available which covers the claim.”
Dovers’s general liability insurer (Republic-Vanguard ...
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 ...
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 ...
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 ...
