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  • Writer's pictureRobert Hester

GoBo’s Top Ten Things to Know about Uninsured/Underinsured Motorist Coverage and Claims in California

You’re walking down the street, a car jumps the curb and hits you and your husband as you’re going home from a friend’s birthday party. You sustain minor injuries, but your husband needs to spend a week in the ER, leaving you traumatized, and you need months of psychiatric treatment which you struggle to afford.

You’re riding your bike across an intersection on a green light when a truck runs a red light, and you wake up in the emergency room with no recollection of the event. You leave with a large medical bill your insurance doesn’t cover and are out of work for months.


You’re sitting in traffic on a freeway, and you get rear-ended by an SUV whose driver wasn’t paying attention and failed to realize you and the vehicles in front of you had stopped or slowed down. You and your children all have to go to the urgent care clinic that evening, some of you with more complaints of pain than the others.

Scenarios like these have happened to Gomerman Bourn clients in the past. In some situations, the at-fault motorist fled the scene, never to be found. In others, the drivers had no insurance (uninsured) or had insurance, but not enough (underinsured) so very little, if anything, is left over after the hospital bills and health insurance liens are paid.

For bodily injuries caused to others (liability insurance for at-fault drivers), California only requires personal automobile liability insurance to cover up to $15,000 per person/$30,000 per incident to drive in this state. Cal. Ins. Code § 11580.1(b)(1), Cal. Veh. Code § 16056. This will increase to $30,000 per person/$60,000 per incident for policies issued beginning on January 1, 2025, but many pedestrians, bicyclists, and motorists will still be left with nothing if hit by an uninsured motorist or very little should they ever be hit by a underinsured motorist, ie, a motorist whose coverage isn’t enough to rise to the full value of their medical debts, lost wages and pain and suffering.

A. How can you protect yourself and your family members who live with you from

dangerous uninsured and underinsured drivers?

While there are several ways to do so (obtaining health insurance or government programs to cover medical services, adding medical payments coverage to cover healthcare services your health insurance/government programs does not), one of the best ways to get protection from the uninsured and underinsured is by adding uninsured/underinsured (UM/UIM) coverage to your automobile policy. Uninsured/Underinsured (UM/UIM) coverage on automobile policies issued in California must follow the provisions of The Uninsured Motorist Act, which is codified in Cal. Ins. Code §§ 11580.2-11580.5.


Policies issued outside of California will cover losses that occur inside of California, but the agreements will follow the law of the insurance code for the state of issuance, many of which are more consumer friendly than California’s law (e.g., by allowing stacking of policies or by allowing consumers to sue their insurance company in state court, rather than follow an arbitration procedure, as the insurance code requires).


B. How does a UM/UIM Claim Work?


When the tortfeasor doesn’t have insurance, assets to cover your claims in full, or doesn’t have enough insurance to cover the full value of your claims, your own insurance will allow you to open an uninsured or underinsured motorist policy and make a claim.


When you make an uninsured or underinsured motorist claim, your automobile insurance acts as if it’s the insurance for the at-fault party, the driver who hit you, who is called the tortfeasor.


C. Is Uninsured/Underinsured Motorist Coverage Worth the Cost?


Just because you’ve purchased uninsured/underinsured motorist coverage, does not mean that you’ll get the payout you deserve from your insurance company should you ever be in the unfortunate circumstance of needing to make a claim. Despite the drawbacks of uninsured motorist coverage in California, and there are many, we at Gomerman Bourn firmly believe that it is still a great way for you to protect yourself from drivers who don’t have the means or coverage to compensate you for their negligent acts.

 

We’re providing our Top Ten, below, so you have enough information to make an informed decision about purchasing uninsured/underinsured motorist coverage and about making a claim, on your own or with an attorney. Because no article is a good substitution for legal advice, we recommend that you consult an attorney to assist you with your situation.


What are the top ten things to know about UM/UIM coverage and claims in California?


While we at Gomerman Bourn encourage everyone to purchase UM/UIM coverage if available to them, there are a few important things to know about California policies:


  1. You must purchase liability coverage greater than or equal to your UM/UIM coverage. (Ins. Code § 11580.2(m)).

  2. Arbitration is required in all UM/UIM claims for California policies that cannot be timely resolved by issuing a demand letter to your insurance company. (Ins. Code § 11580.2(f)). If you have an out-of-state policy, you may be able to file your claim in state court depending on the policy language (our office has successfully filed UM and UIM claims in California state court for clients who had policies from states including Oregon and Texas). Arbitration can be cost prohibitive and full of procedural rules that are difficult to follow without an attorney’s guidance, so we strongly encourage you to consult with one even if you’ve navigated the rest of the claims process well on your own.

  3. What is the statute of limitations in the uninsured motorist context? UM claims must have arbitration demanded two years after the date of loss because they follow the two-year statute of limitations that apply to any personal injury claim filed in state court against a negligent third party. (Ins. Code § 11580.2(i)). You must file in state court or demand arbitration with a certified mail letter (with return receipt requested) sent to your insurance company. Failing to make a timely demand for arbitration will result in you losing your ability to make or continue your claim.

  4. What is the statute of limitations in the underinsured motorist context? Less clear than in the UM context, UIM claims do not have to have arbitration demanded within two years but must be submitted to your insurance carrier within a reasonable time, so do not wait long after you’ve completed treatment or reached maximum medical improvement to demand arbitration. (Quintano v. Mercury Casualty Co. (1995) 11 Cal.4th 1049, 1064).

  5. When making an underinsured motorist (UIM) claim, always show your insurance company proof that you settled for the policy limits of the third party. Ask the at-fault party’s insurance for a copy of their declarations page and inquire about any additional insurance prior to settling with the at-fault party.

  6. Stacking is not allowed on a California UIM claim. What this means is that your insurance company will get credit for any money paid out by the at-fault party to you, most often by their automobile insurance. (Ins. Code § 11580.2(p)(5)). For those of you with a worker’s compensation claim because you were injured while working, your UIM claim will also not apply if your worker’s compensation benefits exceed the amount of your UM/UIM coverage and will be reduced by the total amount received. (“Insurer may assert a [Ins. Code, § 11580.2](h) setoff for the amount of workers' compensation benefits paid to Insured.” Rudd v. California Casualty Gen. Ins. Co. (1990) 219 Cal.App.3d 948, 956).

  7. Your car or truck’s UM/UIM policy won’t likely extend to any motorcycle you own, so you’ll need to add it onto your motorcycle’s coverage separately from your other automobiles. Check your vehicles’ insurance contract to see which vehicles are excluded and covered and find out if you need to buy separate UM/UIM coverage for your motorcycle’s policy.

  8. UM/UIM claims may cover intentional acts of third parties who are uninsured or underinsured. There are no cases directly addressing whether UM/UIM coverage directly extends to intentional acts (e.g., intentionally hitting someone with a car). However, there is a general prohibition on insurance extending to intentional acts, so expect a fight from your insurer if you try to make such a claim. (Ins. Code. § 533.)

  9. Watch out for any liens! Seek waiver or reduction of any liens you have to pay back from your UM/UIM settlement. Your health insurance will often have a subrogation provision that allows it to seek reimbursement from you for any money you receive from your insurance company and your UM/UIM coverage. However, not all health insurance contracts define third party in ways that include UM/UIM recovery, so always ask your health insurance if they have any rights to UM/UIM recovery and, if they say that they do, ask them for the Summary Plan Description to verify that they have such rights. Governmental entities (local hospitals), Medi-Cal, and Medicare have statutory rights of reimbursement, so you must contact them if you receive any compensation. It’s always best to contact them prior to any settlement so you’re aware of what you’re actually receiving!

  10. Your automobile insurance has an entire section dedicated to this coverage, so review it before you even open a claim. Provisions requiring your cooperation, the existence or non-existence of any offsets for medical payments coverage claims, and more should be the focus of your attention because you don’t want to do anything that will hinder your ability to claim the full benefits you have a right to by purchasing this coverage.

 

Unlike the Top Ten lists from David Letterman’s Late Show (for those of you old enough to remember them), UM/UIM coverage and claims are no laughing matter. There are many more things to consider when deciding to pursue a UM/UIM claim than what’s listed in this article.


Secure your peace of mind today! Reach out to Robert Hester at Gomerman Bourn & Associates for a free consultation!



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