Zalma on Insurance
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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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June 25, 2025
Failure to Read Policy Fatal to Claim

Ignorance of UM Coverage for Pedestrian Hit by Car is Inexcusable
Post 5107

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Dennis Malcolm Patterson was struck by an automobile while crossing the street, he sued the driver who hit him and sought uninsured/underinsured motorist coverage from his own insurer, United Services Automobile Association (“USAA”). USAA filed a motion to dismiss, arguing that Patterson failed to comply with the policy provision requiring prompt notification. Following a hearing, the trial court granted the motion and Patterson appealed.

In Patterson v. United Services Automobile Association, No. A25A0259, Court of Appeals of Georgia, Fifth Division (June 20, 2025) the trial court’s judgment was affirmed.

Key Points:

Trial Court’s Decision:

It treated the court’s order as a denial of summary judgment

Incident Details:

Patterson was injured on May 17, 2019, when a car driven by Abhay Kumar Singh ran a stop sign and hit him. Patterson hired an attorney on February 17, 2021, and forwarded the police report to a USAA adjuster on March 5, 2021 .

USAA’s Denial:

USAA denied coverage, arguing that Patterson failed to comply with the policy’s provisions requiring prompt notice .

Policy Provisions:

The policy required insureds to notify the insurer promptly of how, when, and where an accident or loss happened. Patterson’s 21-month delay in notifying USAA was deemed a failure to provide prompt notice .

Court’s Conclusion:

The Court of Appeals found Patterson’s delay unreasonable as a matter of law and affirmed the trial court’s order .

DISCUSSION

The trial court found that the policy provision requiring insureds to notify the insurer “promptly of how, when, and where an accident or loss happened” was a condition precedent to coverage. Patterson’s 21-month delay in notifying USAA meant that he failed “as a matter of law” to provide prompt notice.

The trial court also determined that Patterson’s ignorance of the fact that a pedestrian can benefit from his own uninsured motorist coverage is not an excuse that creates a jury issue.

A notice provision expressly made a condition precedent to coverage is valid and must be complied with. Where an insured has not demonstrated justification for failure to give notice according to the terms of the policy, then the insurer is not obligated to provide either a defense or coverage.

An insured may be able to present justification for delay in giving notice, and whether that justification was sufficient is generally a fact-based inquiry for a jury.

Georgia law is replete with cases finding that an insured’s reasons for delay are unreasonable as a matter of law. Patterson’s appeal falls into this category. Its courts have held that mere ignorance of coverage, without other justification for delay, presents no jury question.

If an insured does not read or otherwise make himself aware of the policy provisions, the Court of Appeals concluded that any ambiguity in the unread policy cannot have been a reason for his delay in providing prompt notification. It is well settled that the general rule is that an insured has an obligation to read and examine his insurance policy to determine the nature of the coverage therein.

The Court of Appeals explained that there was no evidence – indeed, not even an assertion – that Patterson’s ignorance of the terms of the insurance policy was due to any fraud or overreaching on the part of the insurer or its agents. The law requires more than just ignorance, or even misplaced confidence, to avoid the terms of a valid contract.

The Court of Appeals concluded that Patterson’s delay unreasonable as a matter of law. The trial court’s order properly dismissed his claim.

ZALMA OPINION

Since law in most states required insurance companies to write their insurance policies in “easy to read language” there is no way to claim the policy was difficult or impossible to read. States like Georgia require an insured to read the policy and find that if the insured is ignorant of the conditions of the policy is not an excuse for failing to comply with conditions precedent. A 21 month delay in giving notice defeats coverage and is unreasonable as a matter of law.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:54
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February 20, 2026
ANTI-SLAPP MOTION SUCCEEDS

Convicted Criminal Seeks to Compel Receiver to Protect his Assets

Post number 5291

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The Work of a Court Appointed Receiver is Constitutionally Protected

In Simon Semaan et al. v. Robert P. Mosier et al., G064385, California Court of Appeals, Fourth District, Third Division (February 6, 2026) the Court of Appeals applied the California anti-SLAPP statute which protects defendants from meritless lawsuits arising from constitutionally protected activities, including those performed in official capacities. The court also considered the doctrine of quasi-judicial immunity, which shields court-appointed receivers from liability for discretionary acts performed within their official duties.

Facts

In September 2021, the State of California filed felony charges against Simon Semaan, alleging violations of Insurance Code section 11760(a) for making...

00:06:14
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February 19, 2026
Who’s On First – an “Other Insurance Clause” Dispute

When There are Two Different Other Insurance Clauses They Eliminate Each Other and Both Insurers Owe Indemnity Equally

Post number 5289

In Great West Casualty Co. v. Nationwide Agribusiness Insurance Co., and Conserv FS, Inc., and Timothy A. Brennan, as Administrator of the Estate of Pat- rick J. Brennan, deceased, Nos. 24-1258, 24-1259, United States Court of Appeals, Seventh Circuit (February 11, 2026) the USCA was required to resolve a dispute that arose when a tractor-trailer operated by Robert D. Fisher (agent of Deerpass Farms Trucking, LLC-II) was involved in a side-impact collision with an SUV driven by Patrick J. Brennan, resulting in Brennan’s death.

Facts

Deerpass Trucking, an interstate motor carrier, leased the tractor from Deerpass Farms Services, LLC, and hauled cargo for Conserv FS, Inc. under a trailer interchange agreement. The tractor was insured by Great West Casualty Company with a $1 million policy limit, while the trailer was insured by Nationwide Agribusiness Insurance Company with a $2 million ...

00:08:46
February 18, 2026
Win Some and Lose Some

Opiod Producer Seeks Indemnity from CGL Insurers

Post number 5288

Read the full article at https://lnkd.in/guNhStN2, see the full video at https://lnkd.in/gYqkk-n3 and at https://lnkd.in/g8U3ehuc, and at https://zalma.com/blog plus more than 5250 posts.

Insurers Exclude Damages Due to Insured’s Products

In Matthew Dundon, As The Trustee Of The Endo General Unsecured Creditors’ Trust v. ACE Property And Casualty Insurance Company, et al., Civil Action No. 24-4221, United States District Court, E.D. Pennsylvania (February 10, 2026) Matthew Dundon, trustee of the Endo General Unsecured Creditors’ Trust, sued multiple commercial general liability (CGL) insurers for coverage of opioid-related litigation involving Endo International PLC a pharmaceutical manufacturer.

KEY FACTS

Beginning as early as 2014, thousands of opioid suits were filed by governments, third parties, and individuals alleging harms tied to opioid manufacturing and marketing.

Bankruptcy & Settlements

Endo filed Chapter 11 in August 2022; before bankruptcy it ...

00:08:32
February 19, 2026

Passover for Americans
Posted on February 19, 2026 by Barry Zalma
“The Passover Seder For Americans”

For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lost the ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah. Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and wonder how did all these wonderful things come into being. Jews believe the force we call G_d created the entire universe and everything in it. Jews feel G_d is all seeing and knowing and although we can’t see Him, He is everywhere and in everyone.We understand...

February 19, 2026

Passover for Americans

Posted on February 19, 2026 by Barry Zalma

Read the full article at https://www.linkedin.com/pulse/passover-americans-barry-zalma-esq-cfe-5vgkc.

Available at https://www.amazon.com/Passover-Seder-American-Family-Zalma-ebook/dp/B0848NFWZP/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=1584364029&sr=8-4

“The Passover Seder For Americans”

For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lostthe ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah.

Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and ...

January 30, 2026
Anti-Concurrent Cause Exclusion Effective

You Get What You Pay For – Less Coverage Means Lower Premium

Post number 5275

Posted on January 30, 2026 by Barry Zalma

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When Experts for Both Sides Agree That Two Causes Concur to Cause a Wall to Collapse Exclusion Applies

In Lido Hospitality, Inc. v. AIX Specialty Insurance Company, No. 1-24-1465, 2026 IL App (1st) 241465-U, Court of Appeals of Illinois (January 27, 2026) resolved the effect of an anti-concurrent cause exclusion to a loss with more than one cause.

Facts and Background

Lido Hospitality, Inc. operates the Lido Motel in Franklin Park, Illinois. In November 2020, a windstorm caused one of the motel’s brick veneer walls to collapse. At the time, Lido was insured under a policy issued by AIX Specialty Insurance Company which provided coverage for windstorm damage. However, the policy contained an exclusion for any loss or damage directly or indirectly resulting from ...

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