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 vs. UIM Status
7. First Claim — Breach of Contract (UM/UIM Benefits)
8. Damages
9. Jury Demand
10. Prayer for Relief

Caption

IN THE DISTRICT COURT OF [COUNTY NAME] COUNTY, KANSAS

Parties

1. Plaintiff, [PLAINTIFF FULL NAME] ("Plaintiff"), is an individual residing at [PLAINTIFF ADDRESS], [CITY], [COUNTY] County, Kansas [ZIP CODE], and is an insured under the automobile insurance policy described herein.

2. Defendant, [INSURANCE COMPANY NAME] ("Defendant Insurer"), is an insurance company authorized to transact business in the State of Kansas, with its principal place of business at [INSURER ADDRESS].

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

Jurisdiction and Venue

4. This Court has jurisdiction over this matter pursuant to K.S.A. § 60-201.

5. Venue is proper in [COUNTY] County pursuant to K.S.A. § 60-602 because [☐ the accident occurred in this county / ☐ Defendant transacts business in this county / ☐ Plaintiff resides in this county].

6. The amount in controversy exceeds $[AMOUNT].

General Allegations

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

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

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

☐ Operating at an excessive or unreasonable speed (K.S.A. § 8-1557)
☐ Failure to yield the right of way (K.S.A. § 8-1526)
☐ Following too closely (K.S.A. § 8-1523)
☐ Driving under the influence (K.S.A. § 8-1567)
☐ Failure to obey a traffic control device (K.S.A. § 8-1507)
☐ Improper lane change (K.S.A. § 8-1522)
☐ Texting while driving (K.S.A. § 8-15,111)
☐ Other: [________________________________]

10. As a direct and proximate result of the above-described negligence, Plaintiff sustained serious bodily injuries and damages.

Policy Identification and Coverage

11. 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").

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

13. The Policy includes underinsured motorist ("UIM") bodily injury coverage with limits of $[UIM LIMIT PER PERSON] per person / $[UIM LIMIT PER ACCIDENT] per accident.

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

15. Plaintiff [☐ accepted UM/UIM coverage / ☐ did not execute a valid written rejection of UM/UIM coverage].

Anti-Stacking Provision

16. ☐ Multiple policies may apply to this claim.

☐ Anti-stacking provision applies; Plaintiff claims the highest single policy limit of $[AMOUNT]
☐ Stacking is not at issue in this claim

UIM Subrogation / Settlement Notice

17. ☐ Plaintiff has reached a tentative settlement with the tortfeasor's insurer.

☐ Written notice by certified mail was provided to Defendant Insurer on [DATE]
☐ Defendant Insurer's 60-day response period has expired
☐ Defendant Insurer [☐ elected / ☐ declined] to substitute payment

UM vs. UIM Status

Select one:

☐ Uninsured Motorist (UM) Claim:

18. 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 (UIM) Claim:

19. The at-fault motorist maintained bodily injury liability coverage with limits of $[TORTFEASOR POLICY LIMIT], which is less than Plaintiff's UIM coverage limits.

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

21. Defendant Insurer was provided the required certified mail notice and opportunity to substitute payment per K.S.A. § 40-284(f).

First Claim

Breach of Contract (UM/UIM Benefits)

22. Plaintiff re-alleges and incorporates by reference paragraphs 1 through 21.

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

24. Plaintiff has performed all obligations and satisfied all conditions precedent required under the Policy.

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

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

Damages

27. As a result of the accident and Defendant Insurer's breach, 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]
☐ Pain and suffering (past and future): $[AMOUNT]
☐ Mental anguish and emotional distress: $[AMOUNT]
☐ Physical disability and disfigurement: $[AMOUNT]
☐ Loss of enjoyment of life: $[AMOUNT]
☐ Loss of consortium (if applicable): $[AMOUNT]
☐ Prejudgment interest (K.S.A. § 16-201)
☐ Attorney's fees (if contractually authorized)
☐ Costs of suit

Jury Demand

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

Prayer for Relief

WHEREFORE, Plaintiff demands judgment against Defendant Insurer as follows:

1. Compensatory damages in an amount to be determined at trial;
2. UM/UIM benefits in the full amount owed under the Policy;
3. Prejudgment interest pursuant to K.S.A. § 16-201;
4. Costs of this action; and
5. Such other and further relief as this Court deems just and equitable.

Respectfully submitted,

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

State-Specific Notes — Kansas

Sources and References

• K.S.A. § 40-284 — Kansas Statutes (2024)
• K.S.A. § 40-284 — Kansas Revisor of Statutes
• K.S.A. § 40-3107 — Kansas Revisor of Statutes
• Kansas UM/UIM Overview — Bruer Law Firm