Uninsured/Underinsured Motorist Complaint - Georgia

Georgia Personal Injury Updated July 13, 2026 Free Word and PDF

UNINSURED / UNDERINSURED MOTORIST COMPLAINT

Table of Contents

  1. Caption
  2. Parties
  3. Jurisdiction and Venue
  4. General Allegations
  5. Policy Identification and Coverage
  6. UM Status — Uninsured or Underinsured
  7. Add-On vs. Reduced-By Coverage
  8. Count I — Breach of Contract (UM Benefits)
  9. Count II — Bad Faith Penalty (O.C.G.A. § 33-7-11(j))
  10. Damages
  11. Jury Demand
  12. Prayer for Relief

Caption

IN THE [STATE/SUPERIOR] COURT OF [COUNTY NAME] COUNTY

STATE OF GEORGIA

[PLAINTIFF FULL NAME], Civil Action File No.: [________________________________]
Plaintiff,
v. COMPLAINT
[INSURANCE COMPANY NAME], (Uninsured Motorist Claim)
Defendant.

Parties

  1. Plaintiff, [PLAINTIFF FULL NAME] ("Plaintiff"), is a resident of [COUNTY] County, Georgia, and is an insured person under the automobile insurance policy described herein.

  2. Defendant, [INSURANCE COMPANY NAME] ("Defendant Insurer"), is a corporation authorized to transact insurance business in the State of Georgia, which may be served at [INSURER ADDRESS / REGISTERED AGENT ADDRESS].

  3. [JOHN/JANE DOE] ("Uninsured/Underinsured Motorist") is an individual who, at all relevant times, operated a motor vehicle [☐ without bodily injury liability insurance / ☐ with bodily injury liability insurance inadequate to compensate Plaintiff's damages].


Jurisdiction and Venue

  1. This Court has jurisdiction over this civil action.

  2. Venue is proper in [COUNTY] County, Georgia, pursuant to O.C.G.A. § 14-2-510 because [☐ this is the county where Defendant Insurer maintains its registered office / ☐ the cause of action (tort) originated in this county and Defendant Insurer has an office and transacts business in this county / ☐ this is the county where the Policy (contract) was made or is to be performed and Defendant Insurer has an office and transacts business in this county].


General Allegations

  1. On or about [DATE OF ACCIDENT], at approximately [TIME], Plaintiff was [☐ operating / ☐ a passenger in] a motor vehicle on [STREET/HIGHWAY], in [CITY], [COUNTY] County, Georgia.

  2. At said time and place, the Uninsured/Underinsured Motorist negligently operated a motor vehicle and caused a collision with Plaintiff's vehicle.

  3. The Uninsured/Underinsured Motorist was negligent in one or more of the following respects:

☐ Failure to maintain a safe speed
☐ Failure to yield the right of way
☐ Failure to maintain a proper lookout
☐ Following too closely (O.C.G.A. § 40-6-49)
☐ Driving under the influence (O.C.G.A. § 40-6-391)
☐ Running a red light or stop sign
☐ Improper lane change (O.C.G.A. § 40-6-123)
☐ Distracted driving / use of wireless device (O.C.G.A. § 40-6-241, Hands-Free Georgia Act)
☐ Other: [________________________________]

  1. Each such act or omission was a proximate cause of the collision and Plaintiff's injuries.

Policy Identification and Coverage

  1. At the time of the accident, Plaintiff was insured under an automobile insurance policy issued by Defendant Insurer, Policy No. [POLICY NUMBER], effective from [POLICY START DATE] to [POLICY END DATE] (the "Policy").

  2. The Policy provides uninsured motorist ("UM") bodily injury coverage with limits of $[UM LIMIT PER PERSON] per person / $[UM LIMIT PER ACCIDENT] per accident.

  3. Plaintiff has paid all premiums due under the Policy and has complied with all conditions precedent.

  4. Plaintiff did not execute a valid written rejection of UM coverage as permitted by O.C.G.A. § 33-7-11(a)(3).


UM Status — Uninsured or Underinsured

Select one:

☐ Uninsured Motorist Claim:

  1. The at-fault motorist was uninsured at the time of the accident in that [☐ no bodily injury liability policy was in effect / ☐ the at-fault motorist is unknown (hit-and-run) / ☐ the at-fault motorist's insurer denied coverage or is insolvent].

☐ Underinsured Motorist Claim:

  1. The at-fault motorist maintained bodily injury liability coverage with limits of $[TORTFEASOR POLICY LIMIT], which is insufficient to compensate Plaintiff for the full extent of damages sustained.

  2. Plaintiff has exhausted the at-fault motorist's bodily injury liability limits and received $[AMOUNT RECOVERED FROM TORTFEASOR] in [☐ settlement / ☐ judgment].

  3. Defendant Insurer was provided with timely written notice and the opportunity to consent to the settlement with the tortfeasor's insurer.


Add-On vs. Reduced-By Coverage

  1. The UM coverage under the Policy is:

☐ Add-On Coverage: Plaintiff is entitled to recover UM benefits up to the full policy limits, without reduction for amounts recovered from the tortfeasor's insurer.

☐ Reduced-By Coverage: Plaintiff is entitled to recover UM benefits reduced by amounts recovered from the tortfeasor's insurer, for a net available UM benefit of $[REDUCED-BY AMOUNT] ($[UM LIMIT] minus $[AMOUNT RECOVERED FROM TORTFEASOR]).


Count I

Breach of Contract (UM Benefits)

  1. Plaintiff re-alleges and incorporates by reference paragraphs 1 through 18.

  2. The Policy constitutes a valid and enforceable contract between Plaintiff and Defendant Insurer.

  3. Plaintiff has performed all conditions, covenants, and obligations required under the Policy, or has been excused from performance.

  4. Defendant Insurer has breached the Policy by failing and refusing to pay UM benefits owed to Plaintiff despite proper and timely demand.

  5. As a direct and proximate result of Defendant Insurer's breach, Plaintiff has been damaged in an amount to be proven at trial.


Count II

Bad Faith Penalty (O.C.G.A. § 33-7-11(j))

  1. Plaintiff re-alleges and incorporates by reference paragraphs 1 through 23.

  2. Uninsured/underinsured motorist coverage is governed by its own bad-faith remedy, O.C.G.A. § 33-7-11(j), and is not subject to the general first-party bad-faith statute, O.C.G.A. § 33-4-6. Pursuant to O.C.G.A. § 33-7-11(j), when a UM/UIM insurer refuses to pay a covered loss within 60 days after demand and the refusal is found to be in bad faith, the insurer is liable, in addition to the loss, for:
    - A penalty not exceeding 25% of the recovery under this Code section or $25,000.00, whichever is greater; and
    - All reasonable attorney's fees for the prosecution of the case against the insurer.

The question of bad faith, the amount of any penalty, and the attorney's fees are determined in a separate action brought by the insured after judgment on the underlying UM/UIM claim.

  1. On or about [DATE OF DEMAND], Plaintiff made a written demand upon Defendant Insurer for payment of UM benefits in the amount of $[DEMAND AMOUNT].

  2. More than 60 days have elapsed since the demand, and Defendant Insurer has failed to pay or offer a reasonable amount.

  3. Defendant Insurer's refusal to pay is in bad faith in that:

☐ There was no reasonable basis for denying or delaying the claim
☐ Defendant failed to conduct a fair and thorough investigation
☐ Defendant offered an unreasonably low amount unrelated to the actual damages
☐ Defendant engaged in dilatory tactics
☐ Other: [________________________________]

  1. As a result, Plaintiff is entitled to the statutory bad faith penalty and reasonable attorney's fees pursuant to O.C.G.A. § 33-7-11(j).

Damages

  1. As a result of the accident and Defendant Insurer's breaches, Plaintiff has suffered the following damages:

☐ Past medical expenses: $[AMOUNT]
☐ Future medical expenses: $[AMOUNT]
☐ Past lost wages/earnings: $[AMOUNT]
☐ Future lost wages/earning capacity: $[AMOUNT]
☐ Past pain and suffering: $[AMOUNT]
☐ Future pain and suffering: $[AMOUNT]
☐ Mental anguish and emotional distress: $[AMOUNT]
☐ Loss of enjoyment of life: $[AMOUNT]
☐ Loss of consortium (if applicable): $[AMOUNT]
☐ Bad faith penalty (up to 25% of recovery, or $25,000.00, whichever is greater — § 33-7-11(j))
☐ Attorney's fees (§ 33-7-11(j))
☐ Prejudgment interest (O.C.G.A. § 7-4-15)
☐ Costs of suit


Jury Demand

Plaintiff hereby demands a trial by jury on all issues so triable.


Prayer for Relief

WHEREFORE, Plaintiff prays for judgment against Defendant Insurer as follows:

  1. Compensatory damages in an amount to be determined at trial;
  2. UM benefits in the full amount owed under the Policy;
  3. Bad faith penalty not exceeding 25% of the recovery, or $25,000.00, whichever is greater, pursuant to O.C.G.A. § 33-7-11(j);
  4. Reasonable attorney's fees pursuant to O.C.G.A. § 33-7-11(j);
  5. Prejudgment interest at the legal rate;
  6. Costs of this action; and
  7. Such other and further relief as this Court deems just and proper.

Respectfully submitted,

[ATTORNEY NAME], Georgia Bar No. [BAR NUMBER]
[FIRM NAME]
[FIRM ADDRESS]
[CITY], Georgia [ZIP CODE]
Telephone: [________________________________]
Email: [________________________________]
Attorney for Plaintiff


Verification

Personally appeared before me [PLAINTIFF FULL NAME], who, being duly sworn, deposes and states that the facts set forth in the foregoing Complaint are true and correct to the best of affiant's knowledge and belief.

Signature: [________________________________]
Printed Name: [PLAINTIFF FULL NAME]

Sworn to and subscribed before me this [____] day of [__________], [____].

Notary Public: [________________________________]
My Commission Expires: [__/__/____]


State-Specific Notes — Georgia

Topic Detail
UM Coverage Mandatory? Must be included/offered at the statutory minimum (O.C.G.A. § 33-7-11(a)(1)); insured may reject in writing (§ 33-7-11(a)(3))
UIM Separate? No — Georgia's UM statute covers both uninsured and underinsured situations
Minimum Limits $25,000/$50,000 bodily injury
Add-On vs. Reduced-By Two UM coverage forms: "add-on" (full limits regardless of recovery) or "reduced-by" (offset by tortfeasor's payment)
Stacking Limited; depends on policy language and number of vehicles
Arbitration Affirmatively prohibited — a UM endorsement may not contain a provision requiring arbitration of a UM claim (§ 33-7-11(g))
Bad Faith UM/UIM bad faith is governed by § 33-7-11(j) (NOT § 33-4-6): penalty up to 25% of the recovery, or $25,000.00, whichever is greater, plus reasonable attorney's fees, in a separate post-judgment action
60-Day Demand Required before bad faith penalty; insurer has 60 days to pay after demand
Insurer Protections Cannot increase premiums or cancel policy for filing UM claim (§ 33-7-11)
Jury Concealment Insurer's identity may be withheld from jury at trial
Exhaustion (UIM) Must exhaust tortfeasor's limits; insurer entitled to notice/consent

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About this template

Last updated
July 13, 2026
Citations checked
July 9, 2026
Jurisdiction
Georgia
Category
Personal Injury

Legal authority

  • O.C.G.A. § 33-7-11 (UM Coverage Requirements)
  • O.C.G.A. § 33-7-11(j) (UM/UIM Bad Faith Penalty — 25% of recovery or $25,000, whichever greater, + attorney's fees; separate post-judgment action; NOT § 33-4-6)
  • O.C.G.A. § 40-6-391 (DUI)
  • O.C.G.A. § 9-11-8 (General Rules of Pleading)

Personal injury cases are brought by people who were hurt because of someone else's carelessness: car crashes, slip and falls, defective products, and more. Demand letters, settlement agreements, and court filings in these cases have to document the injuries, the medical treatment, the lost income, and the exact legal basis for holding the other side responsible. Well-prepared paperwork is what drives higher settlements and forces insurers to take the claim seriously.

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This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.

Checked against the law it cites

A reviewer verified this template's legal citations against the official source on July 9, 2026.

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