Uninsured/Underinsured Motorist Complaint

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. § 33-4-6)
10. Damages
11. Jury Demand
12. Prayer for Relief

Caption

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

STATE OF GEORGIA

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

4. This Court has jurisdiction over this civil action.

5. Venue is proper in [COUNTY] County, Georgia, pursuant to O.C.G.A. § 9-10-31 because [☐ the cause of action arose in this county / ☐ Defendant may be found in this county / ☐ Defendant has an agent or place of doing business in this county].

General Allegations

6. 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.

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

8. 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. § 40-6-241.2)
☐ Other: [________________________________]

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

Policy Identification and Coverage

10. 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").

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

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

13. Plaintiff did not execute a valid written rejection of UM coverage as permitted by O.C.G.A. § 33-7-11(a)(1).

UM Status — Uninsured or Underinsured

Select one:

☐ Uninsured Motorist Claim:

14. 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:

15. 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.

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

17. 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

18. 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)

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

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

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

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

23. 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. § 33-4-6)

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

25. Pursuant to O.C.G.A. § 33-4-6, when an insurer refuses to pay a claim within 60 days after demand and the refusal is in bad faith, the insurer is liable for:
    - A penalty not exceeding 50% of the claim amount;
    - Reasonable attorney's fees; and
    - All reasonable litigation expenses.

26. 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].

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

28. 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: [________________________________]

29. As a result, Plaintiff is entitled to the statutory bad faith penalty, attorney's fees, and litigation expenses.

Damages

30. 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 50% of claim — § 33-4-6)
☐ Attorney's fees (§ 33-4-6)
☐ Litigation expenses (§ 33-4-6)
☐ 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 50% of the claim pursuant to O.C.G.A. § 33-4-6;
4. Reasonable attorney's fees and litigation expenses;
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

Sources and References

• O.C.G.A. § 33-7-11 — Justia
• Georgia UM/UIM Coverage — Scholle Law
• How UM Works in Georgia — W Firm