Uninsured/Underinsured Motorist Complaint - Louisiana

Louisiana Personal Injury Updated September 8, 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 vs. UIM Status
  7. First Cause of Action — Breach of Contract (UM/UIM Benefits)
  8. Second Cause of Action — Bad Faith / Statutory Penalties
  9. Damages
  10. Stacking Allegations
  11. Prayer for Relief
  12. Verification

Caption

[JUDICIAL DISTRICT] JUDICIAL DISTRICT COURT

PARISH OF [PARISH NAME], LOUISIANA

[PLAINTIFF FULL NAME], Docket No.: [________________________________]
Plaintiff,
vs. PETITION FOR DAMAGES
[INSURANCE COMPANY NAME], (Uninsured/Underinsured Motorist)
Defendant.
Division: [____]

Parties

  1. Petitioner [PLAINTIFF FULL NAME] ("Petitioner") is a person of the full age of majority, domiciled in [CITY], [PARISH] Parish, Louisiana, and is an insured under the automobile insurance policy described herein.

  2. Defendant [INSURANCE COMPANY NAME] ("Defendant Insurer") is a foreign/domestic insurance corporation authorized to transact business in the State of Louisiana, with its principal place of business at [INSURER ADDRESS], which may be served through the Louisiana Secretary of State or its registered agent.

  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 Petitioner's damages].


Jurisdiction and Venue

  1. This Court has jurisdiction over this matter pursuant to La. Const. art. V, § 16, and La. C.C.P. art. 1 et seq.

  2. Venue is proper in [PARISH] Parish pursuant to La. C.C.P. art. 76.1 because [☐ the accident occurred in this parish / ☐ Petitioner is domiciled in this parish].

  3. The amount in controversy exceeds the jurisdictional minimum of this Court.


General Allegations

  1. On or about [DATE OF ACCIDENT], at approximately [TIME], Petitioner was [☐ operating / ☐ a passenger in] a motor vehicle on [STREET/HIGHWAY], in [CITY], [PARISH] Parish, Louisiana.

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

  3. The Uninsured/Underinsured Motorist was at fault due to the following acts of negligence:

☐ Failure to maintain a safe speed
☐ Failure to yield the right of way
☐ Failure to maintain a proper lookout
☐ Following too closely
☐ Driving under the influence of alcohol or drugs
☐ Running a red light or stop sign
☐ Improper lane change
☐ Violation of La. R.S. 32:[SPECIFIC TRAFFIC STATUTE]
☐ Other: [________________________________]

  1. As a direct and proximate result of the collision, Petitioner sustained serious bodily injuries, incurred medical expenses, lost wages, and experienced pain and suffering.

Policy Identification and Coverage

  1. At the time of the accident, Petitioner 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/underinsured motorist ("UM") bodily injury coverage with limits of $[UM LIMIT PER PERSON] per person / $[UM LIMIT PER ACCIDENT] per accident.

  3. Petitioner [☐ did not reject UM coverage / ☐ selected UM coverage at limits lower than liability limits / ☐ selected economic-only UM coverage] pursuant to La. R.S. 22:1295(1)(a)(ii).

  4. Petitioner has paid all premiums due under the Policy and has complied with all conditions precedent.


UM vs. UIM Status

Select one:

☐ Uninsured Motorist (UM) Claim:

  1. The at-fault motorist was uninsured at the time of the accident within the meaning of La. R.S. 22:1295, in that [☐ the at-fault motorist had no bodily injury liability insurance in effect / ☐ the at-fault motorist is unknown (hit-and-run) / ☐ the at-fault motorist's insurer is insolvent / ☐ the at-fault motorist's insurer has denied coverage].

☐ Underinsured Motorist (UIM) Claim:

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

  2. Petitioner has exhausted or is prepared to exhaust the at-fault motorist's liability policy limits and has [☐ settled with / ☐ obtained a judgment against] the at-fault motorist in the amount of $[AMOUNT RECOVERED FROM TORTFEASOR].

  3. Defendant Insurer was given written notice of the settlement and the opportunity to pay the tortfeasor's limits in exchange for subrogation rights.


First Cause of Action

Breach of Contract (UM/UIM Benefits)

  1. Petitioner incorporates by reference all preceding paragraphs.

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

  3. Petitioner has performed all conditions required under the Policy.

  4. Defendant Insurer has breached the Policy by failing and refusing to pay UM/UIM benefits owed to Petitioner, despite Petitioner's timely demand and submission of proof of loss.

  5. As a direct result of Defendant Insurer's breach, Petitioner has been damaged in an amount to be proven at trial, but not less than $[ESTIMATED DAMAGES].


Second Cause of Action

Bad Faith / Statutory Penalties (La. R.S. 22:1892; former § 22:1973 repealed eff. 7/1/2024)

  1. Petitioner incorporates by reference all preceding paragraphs.

  2. Petitioner made written demand upon Defendant Insurer for payment of the UM/UIM claim on or about [DATE OF DEMAND].

  3. More than thirty (30) days have elapsed since receipt of satisfactory proof of loss, and Defendant Insurer has failed to tender payment without just cause.

  4. Defendant Insurer's failure to timely pay constitutes a violation of La. R.S. 22:1892, entitling Petitioner to a penalty of fifty percent (50%) of the amount due, or $1,000, whichever is greater, plus reasonable attorney's fees and costs.

  5. Defendant Insurer's conduct further constitutes a breach of the insurer good-faith and fair-dealing duty under La. R.S. 22:1892(I), entitling Petitioner, if the statutory elements are proven, to proven economic damages and the non-immovable-claim penalty, attorney fees, and costs authorized by that subsection. Act 932 of 2026 is scheduled to amend § 22:1892(I) effective August 1, 2026 and restrict Subsection I causes of action for personal- or bodily-injury claims in specified circumstances; counsel must apply the version governing the claim and alleged conduct. Any alternative reliance on former § 22:1973 requires claim-specific retroactivity analysis.

  6. Defendant Insurer's bad faith conduct includes:

☐ Unreasonably delaying investigation of the claim
☐ Failing to make a reasonable offer within the statutory period
☐ Denying benefits without reasonable basis
☐ Misrepresenting coverage terms or policy provisions
☐ Compelling Petitioner to initiate litigation to recover amounts due
☐ Other: [________________________________]


Damages

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

☐ Past medical expenses: $[AMOUNT]
☐ Future medical expenses: $[AMOUNT]
☐ Past lost wages/earnings: $[AMOUNT]
☐ Future lost wages/earning capacity: $[AMOUNT]
☐ Physical pain and suffering (past and future): $[AMOUNT]
☐ Mental anguish and emotional distress: $[AMOUNT]
☐ Loss of enjoyment of life: $[AMOUNT]
☐ Scarring and disfigurement: $[AMOUNT]
☐ Loss of consortium (if applicable): $[AMOUNT]
☐ Property damage (UMPD, if applicable): $[AMOUNT]
☐ Statutory penalties under La. R.S. 22:1892(B) (50% or $1,000, whichever is greater) and/or § 1892(I) (consolidated good-faith duty, post-7/1/2024: proven economic damages plus 50% or $5,000, whichever is greater) or, for pre-7/1/2024 losses, former § 22:1973 (up to twice damages or $5,000, whichever is greater)
☐ Reasonable attorney's fees and costs
☐ Legal interest from date of judicial demand


Stacking Allegations

  1. ☐ Stacking Applicable: The Policy insures [NUMBER] vehicles. Petitioner did not execute a valid written waiver of stacking of UM coverage. Accordingly, pursuant to La. R.S. 22:1295(1)(c), the UM coverage limits available to Petitioner are $[STACKED LIMIT] (i.e., $[PER VEHICLE LIMIT] × [NUMBER OF VEHICLES]).

  2. ☐ Stacking Waived: Petitioner executed a valid written waiver of stacking on the form prescribed by the Commissioner. UM coverage limits are $[SINGLE VEHICLE LIMIT].


Prayer for Relief

WHEREFORE, Petitioner prays that after due proceedings, judgment be rendered in favor of Petitioner and against Defendant Insurer as follows:

  1. For compensatory damages in an amount according to proof at trial;
  2. For UM/UIM policy benefits in the full amount owed under the Policy;
  3. For statutory penalties under La. R.S. 22:1892 (50% penalty or $1,000, whichever is greater);
  4. For statutory penalties under La. R.S. 22:1892(I) (consolidated good-faith duty, post-7/1/2024: proven economic damages plus 50% of damages sustained or $5,000, whichever is greater) or, in the alternative for losses pre-dating July 1, 2024, former La. R.S. 22:1973 (up to twice damages sustained or $5,000, whichever is greater);
  5. For reasonable attorney's fees;
  6. For legal interest from date of judicial demand;
  7. For all costs of these proceedings; and
  8. For such other and further relief as this Court deems just and equitable.

Verification

I, [PLAINTIFF FULL NAME], declare under penalty of perjury under the laws of the State of Louisiana that the foregoing is true and correct.

Dated: [__/__/____]

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


RESPECTFULLY SUBMITTED,

[ATTORNEY NAME], La. Bar Roll No. [BAR NUMBER]
[FIRM NAME]
[FIRM ADDRESS]
[CITY], Louisiana [ZIP CODE]
Telephone: [________________________________]
Email: [________________________________]
Attorney for Petitioner


State-Specific Notes — Louisiana

Topic Detail
UM/UIM Mandatory? Yes; mandatory unless validly rejected in writing on Commissioner-prescribed form (La. R.S. 22:1295(1)(a)(ii))
Default Coverage Level Equal to liability limits if no valid rejection/selection
Economic-Only Option Available; excludes noneconomic loss (pain, suffering, mental anguish, etc.) (La. R.S. 22:1295(1)(a)(i)–(ii))
Stacking Default rule; waiver must be in writing on prescribed form (La. R.S. 22:1295(1)(c))
Direct Action Permitted — suit directly against insurer (La. R.S. 22:1269(B))
Prescriptive Period Separate the delict claim against the tortfeasor from the UM/UIM policy claim. Art. 3493.1 supplies two years from sustained injury or damage only for delictual actions within Act 423's prospective scope; it does not state the policy claim's prescription or accrual. Identify current contract/insurance authority before calculating either deadline.
UMPD Optional; $25,000 max with $250 deductible
Hit-and-Run UM Independent, disinterested witness required (La. R.S. 22:1295(1)(f))
Bad Faith Remedies La. R.S. 22:1892(B) and (I) have distinct elements and measures. Act 932 of 2026 is scheduled to limit Subsection I personal/bodily-injury causes of action effective 8/1/2026. Former § 22:1973 was repealed 7/1/2024; prior-law reliance requires claim-specific analysis.
Arbitration Not mandated by statute; depends on policy terms
Exhaustion (UIM) Must exhaust tortfeasor's limits; insurer entitled to notice and subrogation opportunity

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About this template

Last updated
September 8, 2026
Jurisdiction
Louisiana
Category
Personal Injury

Legal authority

  • La. R.S. 22:1295
  • La. R.S. 22:1296
  • La. R.S. 22:1892 (bad faith penalties — Subsection B: 50% or $1,000; Subsection I: proven economic damages plus 50% or $5,000, consolidated good-faith duty as amended by Acts 2024, No. 3 (SB 323), eff. July 1, 2024; former § 22:1973 repealed and folded into § 1892(I))
  • La. C.C. art. 3493.1 (two-year prescription for delictual claims within Act 423's prospective scope; not the UM/UIM policy-claim period)
  • La. C.C.P. art. 1001 et seq.

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.

Not legal advice

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

The statutes this template relies on are listed under Legal authority.

La. C.C. art. 3493.1 (checked September 8, 2026): "Delictual actions are subject to a liberative prescription of two years. This prescription commences to run from the day that injury or damage is sustained."

2024 La. Act 423, §§ 2-4 (checked September 8, 2026): "The provisions of this Act shall be given prospective application only and shall apply to delictual actions arising after the effective date of this Act."

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