Why would anyone claim coverage for an uninsured motoring policy when he has convincing evidence that the other party was insured and the insurer offered money to settle? When the insured thought he could get punitive damages from his own insurance company.
Trent Jason purchased car insurance at his local American Automobile Association in Northern California, Nevada & Utah, Incorporated (AAA NCNU) offices. Following a third-party car accident, Jason filed a report with defendant CSAA Insurance Exchange (CSAA). The CSAA rejected its claim for benefits. Jason then sued the CSAA and AAA NCNU, claiming that the AAA NCNU wrongly stated that it was his insurer and that the defendants wrongly denied his claim.
I Trent Jason v American Automobile Association Of Northern California, Nevada & Utah et al. A158369, Court of Appeal of the State of California First Appellate District Division One (December 9, 2020) AAA NCNU and CSAA brought for a summary judgment because Jason Insurance did not cover the accident in question. The trial court granted the proposals and ruled against Jason.
Jason purchased car insurance through an insurance agent whose office was in a "AAA" marked building. The insurance on the insurance states "AAA Members Car Policy", with the subheading "Designed exclusively for members." The name and address of the "CSAA Insurance Exchange" are listed at the bottom of the page. In "car policy declarations", which summarize Jason's coverage, "No coverage" stands for collision. However, Jason had uninsured motorists coverage.
Accident and Subsequent Claims Process
While backing out of a parking lot at a mall, another vehicle backed up Jason & # 39 ;s vehicle. The operator of the other vehicle refused to provide any identification or insurance information and left the scene. Jason received a letter from a CSAA claims representative in which the CSAA had opened a claim on its policy. When a service to the insured CSAA tried to find the other party's insurance information, create a claim on your behalf and provide you with a claim.
A claimant received the other driver's contact information and insurance information. He informed Jason that the other driver "has been identified and has a valid insurance policy" with USAA (United Services Automobile Association). As a result, Adjustment of the Damages Service noted "Non-life property damage insurance will not apply to this loss" and the CSAA had "filed a claim on your behalf."
USAA stated that they were willing to take 50 percent responsibility for the accident. After Jason refused to accept any responsibility for the accident, CSAA's service adjuster informed Jason that he "did not place 100% fault in the accident" in his file. The claims adjuster further explained, "Unfortunately, AAA will not be able to provide you with coverage for the loss, as you do not have any first party coverage (collision)."
Jason subsequently filed a second amended complaint (SAC)) claiming that his policy justified him recovering from injuries caused by a hit-and-run driver, thereby breaching the defendants' insurance obligations by failing to provide coverage. . . The court ruled that the SAC failed to assert facts showing that the CSAA was engaging in unfair, dishonest, misleading or fraudulent practices.
AAA NCNU and CSAA defendants each filed for a summary judgment. CSAA defendants first claimed that Jason could not show that CSAA did not pay insurance benefits that were due because the accident was not covered under the terms of the policy. The trial court granted both the CSAA's and AAA NCNU's draft summary judgment.
With regard to the CSAA's proposal, the Court found that the reasons for the breach of contract and implied alliances with good faith and fair trade must fail because the CSAA did not deny insurance benefits to Jason. The court explained that the evidence showed that there was no coverage for the accident because the other vehicle was insured by the USAA. The Court found that the evidence "only [gave] gives rise to a reasonable conclusion", namely that the CSAA's conduct and its denial of coverage were reasonable.
The trial court ruled against Jason, and he appealed in due time.
Breach of Contract Claim
Jason's breach of contract claim is based on his accusation that the CSAA wrongly denied him coverage under his policy's uninsured motorist provision. He does not identify any other coverage in question. As for the uninsured car insurance, Jason claims that he is entitled to coverage for property damage to his vehicle caused by a collision up to $ 3500, for which loss or damage to the insured is legally entitled to recover from the owner or operator of an uninsured vehicle
Jason's position is based on the assumption that he was hit by an uninsured motorist. He claimed without effect that even if the owner of the other vehicle was insured, the actual driver was another person who was not insured. The indisputable evidence showed that the other vehicle involved in the accident with Jason's vehicle was insured by the USAA, and the USAA did not deny coverage. Thus, the other vehicle did not qualify as an "uninsured motor vehicle" under the terms of the Jason policy, and the uninsured motorist's coverage was not applicable to the accident.
It is a general rule that the receipt of an insurance and its approval of the insured without objection binds both the insured and the insurer and he can then not complain that he did not read it or knew the terms . It is the insured's duty to read his insurance. The insurance language tracks the requirements in insurance code section 11580.26, subsection (a) (2) for uninsured motorist cover.
As the other vehicle does not qualify as an "uninsured motor vehicle" under the insurance, the requirement does not fall within the terms of the policy coverage clauses, there is no coverage. Jason was thus not entitled to cover and consequently the CSAA did not breach the insurance contract. In the absence of an actual holding of overdue benefits, there is no breach of contract.
Allegations of implicit agreement on good faith and fair trade and bad faith insurance
Since the CSAA was entitled to determine the uninsured motorist's coverage under Jason's policy did not apply to the accident, there was no viable basis that the CSAA could have been found have acted in bad faith on the undisputed facts presented.
Neglectful imposition of emotional distress
Because Jason's car policy did not cover the accident in question. the court firmly dismissed his claim for negligent supply of emotional distress.
In California, it has been decided that there is no separate action for criminal damages.
Allegations of breach of contract, breach of implied agreement of good faith and fair trade and bad faith insurance
Jason claims that AAA NCNU is responsible for breach of contract, breach of good faith and fair trade and assurances of unbelief because he "believed" that he was insured by AAA NCNU. He claims that AAA NCNU represented that it was the insurer for its members and thus has responsibility according to the policy.
In particular, the insurance company defines the insurer as CSAA. The evidence also shows that Jason knew the identity of his insurance company since the accident report Jason submitted to DMV lists CSAA as his insurance company. Similarly, in response to the CSAA's separate statement of indisputable facts, Jason did not question that he reported the accident to the CSAA.
Regardless of whether AAA NCNU represented Jason, it was his insurer is not an essential fact for these reasons. Although we assume that AAA NCNU acted as Jason's insurer, allegations of breach of contract, breach of the implied good faith and fair trade agreement, and insurance unfaithfulness must fail for the same reasons that those allegations against CSAA were the subject of a summary judgment.  Negligent Influence of Emotional Emergency Claim and Request for Punishment Damage
Finally, Jason claims that he is entitled to pursue his negligent allotment of claim for emotional distress and to seek punitive damages against AAA NCNU. For the same reason, however, these claims fail as the CSAA, they also fail as the AAA NCNU.
I am surprised that this case was subject to appeal and that the Court of Appeal communicated all of Jason's claims about the insurer's identity despite paying premiums to the CSAA, that he was entitled to UM property damage even if the other car was insured and its insurer offered to settle with Jason. The clear language of the policy logically refused UM coverage when the other vehicle is insured. Regardless, Jason filed an incompetent lawsuit and a second amended complaint, claiming nothing that could give him coverage and attempting to make an unfaithful and criminal tort case of a denial based on a clear and unequivocal exclusion. Courts should not pay any detail to such a suit.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to employment as an insurance consultant specializing in insurance coverage, insurance management, insurance shortages and insurance fraud almost equally for insurers and insurers. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance industry. He is available at http://www.zalma.com and firstname.lastname@example.org.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 53 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their indemnity staff to become professionals in insurance claims.
https://zalma.com/zalmas-insurance-fraud-letter-2/ Last read two issues of ZIFL here.
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