Uninsured/Underinsured Motorist Complaint - District of Columbia

UNINSURED/UNDERINSURED MOTORIST COMPLAINT

Filing package: File this complaint with a summons for each defendant and the court's Civil Actions Information Sheet. The Superior Court requires an information sheet when opening a Civil Actions case.

District of Columbia Superior Court

TABLE OF CONTENTS

1. Caption
2. Parties
3. Jurisdiction and Venue
4. Insurance Policy Information
5. Coverage Type — UM or UIM
6. Facts of the Accident
7. Uninsured/Underinsured Status of At-Fault Driver
8. Liability Coverage Payments
9. Breach of Contract
10. Damages
11. Stacking Allegations
12. Arbitration vs. Litigation
13. Prayer for Relief
14. Verification

1. CAPTION

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
CIVIL DIVISION

2. PARTIES

2.1 Plaintiff

1. Plaintiff, [PLAINTIFF FULL LEGAL NAME], is an individual who at all relevant times resided at [ADDRESS, CITY, STATE, ZIP].

2. Plaintiff was, at the time of the incident described herein, an insured under a motor vehicle insurance policy issued by Defendant.

2.2 Defendant — Insurance Company

3. Defendant, [INSURANCE COMPANY FULL LEGAL NAME], is an insurance company organized under the laws of [________________________________], authorized to conduct business and issue motor vehicle insurance policies in the District of Columbia, with its principal place of business at [________________________________].

3. JURISDICTION AND VENUE

4. This Court has subject-matter jurisdiction over this civil action under D.C. Code § 11-921(a), subject to subsection (b).

5. The policy was issued or delivered at [LOCATION], and the accident giving rise to this claim occurred at [LOCATION].

4. INSURANCE POLICY INFORMATION

6. At all relevant times, Plaintiff was insured under a motor vehicle insurance policy issued by Defendant, Policy No. [________________________________], with an effective period from [__/__/____] to [__/__/____].

7. The policy provided the following relevant coverages:

☐ Uninsured Motorist Bodily Injury: $[________] per person / $[________] per accident
☐ Uninsured Motorist Property Damage: $[________] per accident (subject to $200 deductible per D.C. Code § 31-2406(f)(3))
☐ Underinsured Motorist Coverage: $[________] per person / $[________] per accident
☐ Personal Injury Protection (PIP): $[________]

8. Plaintiff paid all required premiums and complied with all conditions of the policy.

5. COVERAGE TYPE — UM OR UIM

9. This claim is brought under (select applicable):

☐ Uninsured Motorist (UM) Coverage — The at-fault driver maintained no applicable bodily injury liability insurance at the time of the accident.

☐ Underinsured Motorist (UIM) Coverage — The at-fault vehicle was insured, but its third-party liability limits were insufficient to pay the loss up to the requested UM coverage limit, within D.C. Code § 31-2402(32A).

☐ Uninsured Motorist (UM) Coverage — Unidentified Vehicle — The vehicle caused bodily injury or property damage and its owner or operator cannot be identified, within D.C. Code § 31-2406(f)(1)(C).

6. FACTS OF THE ACCIDENT

10. On or about [__/__/____], at approximately [____] ☐ a.m. ☐ p.m., Plaintiff was operating/occupying a motor vehicle at or near [________________________________], Washington, DC.

11. At said time and place, a motor vehicle operated by [AT-FAULT DRIVER NAME, if known] (hereinafter "Tortfeasor") struck Plaintiff's vehicle.

12. The collision occurred under the following circumstances: [________________________________]
    [________________________________]
    [________________________________]

13. The Tortfeasor was negligent in one or more of the following respects:

☐ Failing to maintain a proper lookout
☐ Failing to yield the right-of-way
☐ Operating a vehicle at an excessive speed
☐ Following too closely
☐ Operating a vehicle while impaired
☐ Violating applicable traffic laws, specifically: [________________________________]
☐ Other: [________________________________]

14. As a direct and proximate result of the Tortfeasor's negligence, Plaintiff sustained serious bodily injuries and damages.

7. UNINSURED/UNDERINSURED STATUS OF AT-FAULT DRIVER

15. The Tortfeasor's vehicle qualifies for the selected UM or UIM coverage because (select the facts supported by evidence and the policy):

☐ No bodily injury liability insurance was in effect at the time of the accident
☐ The applicable insurer has denied coverage
☐ The applicable insurer is insolvent
☐ The vehicle is a hit-and-run vehicle whose owner/operator cannot be identified
☐ The liability coverage limits ($[________]) are insufficient to pay the loss up to the applicable UM coverage limit

16. [If UIM:] The Tortfeasor carried bodily injury liability insurance through [________________________________] with limits of $[________] per person / $[________] per accident. The limits are insufficient to pay Plaintiff's loss up to the applicable UM coverage limit.

8. LIABILITY COVERAGE PAYMENTS (UIM Claims)

17. [If applicable:] Plaintiff received $[________] from the Tortfeasor's bodily injury liability coverage. The available policy limit was $[________].

18. Plaintiff's proven loss exceeds the available liability payment, and Plaintiff seeks UIM benefits under the policy, subject to applicable coverage terms and set-offs under D.C. Code § 31-2406(c-1).

9. COUNT I — BREACH OF CONTRACT

19. Plaintiff re-alleges and incorporates all preceding paragraphs as though fully set forth herein.

20. The insurance policy between Plaintiff and Defendant constitutes a binding contract.

21. Plaintiff has performed all conditions required under the policy, including timely notice of the claim, cooperation with the investigation, and payment of all premiums.

22. Defendant has breached the insurance contract by failing and refusing to pay UM/UIM benefits to which Plaintiff is entitled under the policy and D.C. Code § 31-2406.

23. As a direct and proximate result of Defendant's breach, Plaintiff has suffered damages in an amount to be proven at trial.

10. DAMAGES

24. As a direct and proximate result of the accident and Defendant's failure to pay benefits, Plaintiff has suffered the following damages, to the extent covered by the policy:

☐ Past medical expenses: $[________]
☐ Future medical expenses: $[________]
☐ Past lost wages/income: $[________]
☐ Future lost earning capacity: $[________]
☐ Pain and suffering: $[________]
☐ Mental anguish and emotional distress: $[________]
☐ Property damage (subject to $200 deductible): $[________]
☐ Other covered loss: $[________]

11. STACKING ALLEGATIONS

25. ☐ Plaintiff seeks benefits from more than one policy or vehicle coverage because [IDENTIFY POLICY TERMS SUPPORTING THE CLAIM].

26. ☐ The policy's applicable UM provisions permit the claimed combination of coverages; D.C. Code § 31-2406(f)(7) permits policies to preclude stacking of UM coverages, so Plaintiff identifies the supporting policy language: [QUOTE OR ATTACH TERMS].

12. ARBITRATION VS. LITIGATION

27. ☐ The policy does not contain a mandatory arbitration clause, and Plaintiff pursues this claim through litigation.

28. ☐ The policy contains an arbitration clause, but Plaintiff contends it is unenforceable because: [________________________________]

29. ☐ Plaintiff previously submitted this claim to arbitration. The arbitration resulted in [________________________________], and Plaintiff seeks [SPECIFY RELIEF AND BASIS].

13. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that this Court enter judgment in Plaintiff's favor and against Defendant as follows:

a. Compensatory damages in an amount to be determined at trial, but not less than $[________];

b. UM/UIM policy benefits in the full amount owed under the policy;

c. Pre-judgment and post-judgment interest as permitted by law;

d. Costs of suit as allowed by law; and

e. Such other and further relief as this Court deems just and proper.

14. VERIFICATION (OPTIONAL)

I, [PLAINTIFF FULL LEGAL NAME], declare under penalty of perjury under the laws of the District of Columbia that the foregoing is true and correct to the best of my knowledge, information, and belief.

Date: [__/__/____]

Signature: [________________________________]

RESPECTFULLY SUBMITTED,

[________________________________]
Attorney for Plaintiff
[________________________________]
[________________________________]
Washington, DC [__________]
Telephone: [________________________________]
Email: [________________________________]
D.C. Bar No.: [________________________________]