Uninsured Motorist Coverage

A man who regularly rode his bicycle to work was struck one morning by a 79-year old driving an aging pickup truck.  Predictably, the driver “didn’t see” the bicyclist nor could he afford the mandatory liability insurance required by state law.

Luckily the injured man had purchased a $100,000 uninsured motorist policy which provided coverage when he was riding his bicycle.  Our rider suffered significant, permanent injuries that will bother him for the rest of his life, or so his treating health care providers believe.

When the rider had convalesced to maximum medical improvement he made a claim to his insurance carrier for policy limits.  The adjustor, apparently without reading the supplied medical records or sending them to a physician of the company’s choice, responded by offering $17,000.

Under the terms of the policy, Mr. Crandall demanded arbitration and an in-house attorney became involved.  Eventually the rider was examined by an “independent” physician (one regularly used by the insurance companies because of his consistent opinions) and, not surprisingly, the physician proclaimed that any injuries suffered by the bicyclist were either pre-existing or healed up.  This, of course, was completely contrary to all the rider’s treating health care providers.  The insurance company, probably at the prompting of its attorney, made a new offer of $70,000 before the arbitration date.  The offer was declined.

At arbitration the rider brought friends, family, and co-workers to testify that no prior physical problems existed.  His health care providers testified as predicted and consistent with their chart notes.  The arbitrator found our rider’s damages to be $152,529.

Once the policy limits of $100,000 plus $10,000 in medical coverage were tendered, Mr. Crandall threatened the insurance company with an IFCA claim and the insurer paid the additional $42,529 in settlement.  The claim was based on a Washington Administrative Code section that states it is an “unfair claims practice” for an insurer, when dealing with their own insureds, to offer substantially less than the claim is worth thereby forcing the insured to hire a lawyer and go through the time, expense, and anxiety of litigation.

Something to remember…while an insurance company can be misleading, unfair, rude, and arrogant with people who have been injured by their own insureds (their own policyholders) insurance companies must treat their own insureds with honesty and fair dealing.  As seen above, there are consequences when adjustors forget to take off their brutal third party hats when dealing with their own first party customers.