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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Agent Loses License for Misappropriating Insurers Funds
Post 5254
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Insurance Agent Fraud Fails
In Rochell Provost v. State Of Louisiana Division Of Administrative Law And Louisiana Department Of Insurance, No. 2025 CA 0492, Court of Appeals of Louisiana, First Circuit (December 19, 2025) the Louisiana Department of Insurance (LDI) successfully appealed a district court judgment that reinstated Rochell Provost’s insurance producer license and reversed a $5,000 fine previously assessed against her.
FACTUAL BACKGROUND
The underlying dispute began when Union National Life Insurance Company/Kemper Life terminated Ms. Provost for cause, alleging she had committed fraudulent activity and misappropriated $31,471.39 in company funds. An investigative report supporting these findings was sent to LDI.
Following receipt of the report, LDI notified Ms. Provost of proposed regulatory action concerning ...
Post 5254
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Help a Person Commit Insurance Fraud & Go to Jail
Guilty of Tampering With Evidence by Hiding it in Garage
In State Of Montana v. Lila Lynn Lord, 2025 MT 302, No. DA 24-0343, Supreme Court of Montana (December 30, 2025) Lila Lord (Lord) appealed her conviction for Tampering with Evidence following a jury trial in the Seventh Judicial District Court, Richland County. The case centered on a staged burglary in Sidney, Montana, orchestrated by Marie Chris Entzel with the intent to collect insurance proceeds to cover her son’s legal fees. Entzel recruited several individuals — including David Skaw, Lawrence Pohl, Laurie McGregor, and the defendant, Lila Lord — to assist in removing valuable items from her home, causing property damage and theft of items such as an enclosed trailer, boat and trailer, refrigerator, pistol, and television....
Posted on January 2, 2026 by Barry Zalma
ZIFL – Volume 30 Number 1
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
See the video at https://rumble.com/v73nifg-zalmas-insurance-fraud-letter-january-2-2026.html and at https://youtu.be/vZC1e-_qwDg
Supreme Court of Louisiana Removes Judge
Judge Who Lied to Get Elected Cannot Serve
In In Re: Judge Tiffany Foxworth-Roberts, No. 2025-O-01127, Supreme Court of Louisiana (December 11, 2025) the Louisiana Supreme Court in an opinion by Chief Justice Weimer dealt with the recommendation of the Judiciary Commission of Louisiana (Commission) that Judge Tiffany Foxworth-Roberts be removed from office for:
1. making false and misleading statements regarding her judicial campaigns;
2. making false and misleading statements to police investigating the reported burglary of her car; and
3. withholding information and providing false, incomplete, or misleading information during the investigation by the Office of Special Counsel (OSC), as well as in the proceedings before the Commission....
Court Must Follow Judicial Precedent
Post 5252
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Insurance Policy Interpretation Requires Application of the Judicial Construction Doctrine
In Montrose Chemical Corporation Of California v. The Superior Court Of Los Angeles County, Canadian Universal Insurance Company, Inc., et al., B335073, Court of Appeal, 337 Cal.Rptr.3d 222 (9/30/2025) the Court of Appeal refused to allow extrinsic evidence to interpret the word “sudden” in qualified pollution exclusions (QPEs) as including gradual but unexpected pollution. The court held that, under controlling California appellate precedent, the term “sudden” in these standard-form exclusions unambiguously includes a temporal element (abruptness) and cannot reasonably be construed to mean ...
Lack of Jurisdiction Defeats Suit for Defamation
Post 5250
Posted on December 29, 2025 by Barry Zalma
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He Who Represents Himself in a Lawsuit has a Fool for a Client
In Pankaj Merchia v. United Healthcare Services, Inc., Civil Action No. 24-2700 (RC), United States District Court, District of Columbia (December 22, 2025)
FACTUAL BACKGROUND
Parties & Claims:
The plaintiff, Pankaj Merchia, is a physician, scientist, engineer, and entrepreneur, proceeding pro se. Merchia sued United Healthcare Services, Inc., a Minnesota-based medical insurance company, for defamation and related claims. The core allegation is that United Healthcare falsely accused Merchia of healthcare fraud, which led to his indictment and arrest in Massachusetts, causing reputational and business harm in the District of Columbia and nationwide.
Underlying Events:
The alleged defamation occurred when United ...
Zalma’s Insurance Fraud Letter
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ZIFL Volume 29, Issue 24
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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/
Zalma’s Insurance Fraud Letter
Merry Christmas & Happy Hannukah
Read the following Articles from the December 15, 2025 issue:
Read the full 19 page issue of ZIFL at ...
