- November 9, 2023
- Posted by: legaleseblogger
- Category: Related News
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Seeking Legal Guidance after a Car Accident with Insurance Company Denial
Background:
Last week in South Carolina, my husband and I were involved in a serious car accident. A deer unexpectedly leaped onto the 60mph highway, causing a collision that left our vehicle in disrepair. The front end and passenger door sustained major damage, the airbags deployed, and the windshield cracked. As a result of the accident, my husband suffered from significant whiplash pain which caused him to miss work, while I sustained a sprained ankle and am currently unable to walk or attend work. Despite having rental car coverage, our insurance company, Root, has failed to provide us with replacement transportation for eight days.
The car was insured in my name, but my husband was driving at the time of the accident, and I was a passenger. We had full coverage with all possible add-ons, except for personal medical coverage. It was my assumption that as we are a married couple living in the same household, my husband would be covered under my policy. However, Root informed us that we would need to be assigned a special agent to investigate our claim since my husband was not a covered driver. Last Friday, we were told that the insurance company was planning to declare our vehicle a total loss, and that they had all the necessary information, but were awaiting “chain of approval.” However, a follow-up call today revealed that they have now denied our claim, citing my husband as an “uninsured 3rd party driver.”
Considering the situation, this denial does not seem right. I have reached out to multiple attorneys, but many have refused to take our case due to the fact that we are in a dispute with our own insurer. I am currently in the process of trying to find an attorney who is willing to help us pursue this matter.
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In such a complex and confusing legal situation, I am seeking advice and insight on potential outcomes from anyone who has experienced a similar situation. Furthermore, I am interested to know if there is any possibility of receiving medical coverage for my injuries as a passenger, and if so, what steps should I take to ensure the appropriate assistance.
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Almost all policies cover ~~permissive users~~ resident relatives, which your husband should have been. Having said that, from my knowledge of Root, it is a national insurance company who covers people that other insurance providers generally don’t because of past history. Is this the case for you? Was this some type of special policy with exclusions for ~~permissive users~~ resident relatives?
Edit: Edit: OP, I went back and dusted off my law school insurance book. Your husband should be covered as an insured person pursuant to [S.C. Code Ann. 38-77-30(7)](https://law.justia.com/codes/south-carolina/2022/title-38/chapter-77/section-38-77-30/) and [S.C. Code Ann. 38-77-140](https://law.justia.com/codes/south-carolina/2012/title-38/chapter-77/section-38-77-140). I believe your husband can still be excluded from a policy but the insurer has to take more actions than just merely providing you their standard policy that requires you to do extra stuff to insure them. I believe they would have to specifically exclude him and inform you they were specifically excluding him.
I’m not currently a licensed insurance agent and I’m not familiar with the specifics of Root policies. As others have said, Root tends to provide coverage for those who may not be able to get insurance from other companies. Because of this they may not have coverage that is as broad as other companies.
Does your husband have his own insurance? It’s rare for an insurance company to insure one person in a married couple but not the other person. That’s because it’s obviously likely that, in a married couple, both people will be using the vehicles and both drivers need to be accounted for when assessing the risk involved.
It’s quite possible that Root would have an exclusion on your policy for any spouse or household member that is not named on the policy. This isn’t a case where you lent the car to your friend. Your husband was driving it. It could easily appear to Root that you intentionally left him off the policy as a way to pay a lower premium.
My best recommendation is to look over your entire policy and ask Root where in your policy it states that your husband isn’t covered.
OP, you need to find an attorney that has a lot of experience in bad faith insurance cases, i.e. suing one’s own insurer for a breach of the implied duty to act in good faith and fair dealing. You can call your city or state’s bar association and get recommendations if you’re having trouble, but there’s a relatively large number of attorneys who specialize in situations like this.
I don’t know the specifics of SC insurance law, but based on your post and the comments, your insurer is trying to fuck you over. Any good plaintiff’s attorney who has experience in bad faith cases should take your case on a contingency fee basis, too. Good luck!
So my understanding is that policies cover people who are permissive users, however if that person is regular user I.e. uses it all the time, they need to be covered. So since itÔÇÖs your husband IÔÇÖm assuming they are assuming that he drove it all the time. Did you tell them any info about how often he drove?
If your husband was not on your policy and did not have his own policy then you technically have what is called a ‘misrep’ situation where you had a permissive driver that was not reported under your policy.
The reason this is important is that each driver needs to be added or excluded under your policy for the insurance company to appropriate evaluate and charge for your policy. Since it seems like your husband was not on your policy you are getting caught by an endorsement called A264 – which allows the insurance company to deny coverage for collision or comp; and property damage; due to misrepresentation.
This is entirely valid and unfortunately a hard lesson to both read your policy in full and to list all drivers under your household rather than to assume. You will want to read your insurance policy yourself to confirm if this is the case and speak with your adjuster to confirm that’s the reasoning. It will be listed in the denial letter too. It’s a law/endorsement that was adopted by most states several years ago to combat fraudulent policies.
You are getting some really good advice here, I would throw out one more suggestion. Since you are unable to find an attorney to help you, you could try the Department of Insurance for your State and explain what’s going on.
It’s not uncommon for an Insurer to deny a claim and wait to see if there is any push back from the Insured.
Since you can’t get a Lawyer to push back you could try the D.O.I. and see if they will contact them on your behalf.
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Contact the South Carolina Insurance CommisionerÔÇÖs office and explain the problem. If necessary, send a letter, preferably to a person youÔÇÖve talked to, explaining the situation. Those people work for you and itÔÇÖs their job to get this sorted out. If thereÔÇÖs no coverage, theyÔÇÖll explain why. If there is coverage, theyÔÇÖll help you get what youÔÇÖre entitled to.
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State specific. PIP personal injury protection is on every auto policy in our state, and would cover medical and lost wages. Also anyone can drive anyone’s car, however they could cancel after fact
Generally, auto insurance applies to the vehicle, not who is driving it. Their argument would seem to imply that their insurance covers you (I.e. You could hop in a vehicle with no insurance coverage and if you were in an accident, they would cover the damage costs). IÔÇÖm surprised attorneys arenÔÇÖt fighting each other for this case unless thereÔÇÖs more to it.
What does your policy say? Do they exclude people not listed on the policy? Most insurance companies ask about other drivers in the household, did you keep him hidden for cheaper rates?? In CT anyone you allow to drive your car is covered by your policy unless they are specifically excluded. If deer was struck you would be covered under comprehensive coverage, if you crash cause you lost control swerving itÔÇÖs under your collision coverage. At least in CT.