To Recover UIM Benefits the At Fault Driver Must be Underinsured
Post 5092
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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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Fraud Eliminates Right to No Fault Benefits
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Post 5091
Court Eliminates an Attempt to Defraud No Fault Placement Facility
Aric Lynn Holloway II (plaintiff), appealed the stipulated order of dismissal in favor of defendant-appellee, Citizens Insurance Company of the Midwest (defendant).
In Aric Lynn Holloway II, et al v. Memberselect Insurance Company et al, Michigan Automobile Insurance Placement Facility, No. 367611, Court of Appeals of Michigan (May 29, 2025) the plaintiff attempted to convince the Court of Appeals to allow his fraud to succeed.
In a case involving issues of insurance claims, alleged fraud, and the eligibility for Personal Injury Protection (PIP) benefits the Court of Appeals affirmed the trial court.
FACTUAL BACKGROUND
The case arises from a car accident where the plaintiffs, Holloway and his friends, were rear-ended by another vehicle that fled the scene. Holloway ...
False Report of Theft of Vehicle Established
Post 5090
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Creating a Fake Theft of Vehicle and Insurance Claim is a Crime
Shonda Brown faced multiple charges, including felonies related to false reporting and insurance fraud changed to class A misdemeanors such as tampering with public records and making false statements.
The case arose from allegations that Brown paid an informant to move her inoperable vehicle and then reported it stolen to the NYPD, despite evidence suggesting the vehicle had been tampered with and was found in a damaged state.
In The People of the State of New York v. Shonda Brown, Index No. CR-024423-24KN, 2025 NY Slip Op 25122, Criminal Court of the City of New York, Kings County (May 23, 2025) the Criminal Court concluded that the charges were appropriately filed and rejected Brown’s motion to dismiss.
Sufficiency of the Accusatory Instrument
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Notice of Claim Later than 60 Days After Expiration is Too Late
Post 5089
Injury at Massage Causes Suit Against Therapist
Read the full article at https://lnkd.in/gziRzFV8, see the full video at https://lnkd.in/gF4aYrQ2 and at https://lnkd.in/gqShuGs9, and at https://zalma.com/blog plus more than 5050 posts.
Hiscox Insurance Company (“Hiscox”) moved the USDC to Dismiss a suit for failure to state a claim because the insured reported its claim more than 60 days after expiration of the policy.
In Mluxe Williamsburg, LLC v. Hiscox Insurance Company, Inc., et al., No. 4:25-cv-00002, United States District Court, E.D. Missouri, Eastern Division (May 22, 2025) the trial court’s judgment was affirmed.
FACTUAL BACKGROUND
Plaintiff, the operator of a massage spa franchise, entered into a commercial insurance agreement with Hiscox that provided liability insurance coverage from July 25, 2019, to July 25, 2020. On or about June 03, 2019, a customer alleged that one of Plaintiff’s employees engaged in tortious ...
ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional
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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 ...
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 ...
A Heads I Win, Tails You Lose Story
Post 5062
Posted on April 30, 2025 by Barry Zalma
"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone 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."
Immigrant Criminals Attempt to Profit From Insurance Fraud
People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.
The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...
