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 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

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

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

5. 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].

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

General Allegations

7. 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.

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

9. 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: [________________________________]

10. 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

11. 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").

12. 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.

13. 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).

14. 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:

15. 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:

16. 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.

17. 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].

18. 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)

19. Petitioner incorporates by reference all preceding paragraphs.

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

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

22. 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.

23. 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)

24. Petitioner incorporates by reference all preceding paragraphs.

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

26. 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.

27. 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.

28. Defendant Insurer's conduct further constitutes a breach of the consolidated insurer good-faith and fair-dealing duty under La. R.S. 22:1892(I) (as enacted by Acts 2024, No. 3, eff. July 1, 2024) for losses on or after July 1, 2024 — or, in the alternative for losses arising before July 1, 2024, a violation of former La. R.S. 22:1973, entitling Petitioner to penalties of twice the damages sustained or $10,000, whichever is greater.

29. 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

30. 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 (including § 1892(I) consolidated post-7/1/2024) or, for pre-7/1/2024 losses, former § 22:1973
☐ Reasonable attorney's fees and costs
☐ Legal interest from date of judicial demand

Stacking Allegations

31. ☐ 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]).

32. ☐ 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) or, in the alternative for losses pre-dating July 1, 2024, former La. R.S. 22:1973 (twice damages or $10,000, 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

Sources and References

• La. R.S. 22:1295 — Louisiana Legislature
• La. R.S. 22:1295 — FindLaw
• Louisiana UM/UIM Overview — AKD Law