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. SUM/UIM Status
7. Serious Injury Threshold
8. First Cause of Action — Breach of Contract (UM/SUM Benefits)
9. Second Cause of Action — Bad Faith
10. Damages
11. Arbitration / Litigation Election
12. Prayer for Relief
13. Verification

Caption

[SUPREME COURT / COUNTY COURT] OF THE STATE OF NEW YORK

COUNTY OF [COUNTY NAME]

Parties

1. Plaintiff [PLAINTIFF FULL NAME] ("Plaintiff") is an individual residing at [PLAINTIFF ADDRESS], County of [COUNTY], State of New York, and is an insured person under the automobile insurance policy described herein.

2. Defendant [INSURANCE COMPANY NAME] ("Defendant Insurer") is a domestic [or foreign] insurance corporation authorized to conduct business in the State of New York, with offices 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 action pursuant to N.Y. CPLR § 301 and § 302.

5. The amount in controversy exceeds the jurisdictional limits of all lower courts.

6. Venue is proper in [COUNTY] County pursuant to N.Y. CPLR § 503 because [☐ Plaintiff resides in this county / ☐ a substantial part of the events occurred in this county / ☐ Defendant has its principal office in this county].

General Allegations

7. On or about [DATE OF ACCIDENT], at approximately [TIME], Plaintiff was [☐ operating / ☐ a passenger in / ☐ a pedestrian struck by] a motor vehicle at or near [LOCATION OF ACCIDENT], [CITY/TOWN], [COUNTY] County, New York.

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

9. 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
☐ Driving while intoxicated (VTL § 1192)
☐ Running a red light or stop sign
☐ Improper lane change
☐ Failure to exercise due care for pedestrians (VTL § 1146)
☐ Other: [________________________________]

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

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 provides mandatory uninsured motorist ("UM") bodily injury coverage with limits of $[UM LIMIT PER PERSON] per person / $[UM LIMIT PER ACCIDENT] per accident, as required by N.Y. Ins. Law § 3420(f)(1).

13. ☐ The Policy also provides Supplementary Uninsured/Underinsured Motorist ("SUM") coverage with limits of $[SUM LIMIT PER PERSON] per person / $[SUM LIMIT PER ACCIDENT] per accident, pursuant to N.Y. Ins. Law § 3420(f)(2).

14. Plaintiff has paid all premiums due under the Policy and has complied with all conditions precedent, including timely notice of the accident and claim.

UM vs. SUM/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 11 NYCRR § 60-2.3 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 has disclaimed coverage / ☐ the at-fault motorist's insurer is insolvent].

☐ Supplementary Uninsured/Underinsured Motorist (SUM) Claim:

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

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

18. Defendant Insurer was provided with written notice and the opportunity to consent to the settlement with the tortfeasor's insurer, as required by the SUM endorsement.

19. Plaintiff's total damages exceed the tortfeasor's policy limits, and Plaintiff is entitled to recover the difference under the SUM provisions of the Policy.

Serious Injury Threshold

20. Plaintiff sustained a "serious injury" within the meaning of N.Y. Ins. Law § 5102(d), specifically:

☐ Death
☐ Dismemberment
☐ Significant disfigurement
☐ Fracture
☐ Loss of a fetus
☐ Permanent loss of use of a body organ, member, function, or system
☐ Permanent consequential limitation of use of a body organ or member
☐ Significant limitation of use of a body function or system
☐ A medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person's usual and customary daily activities for not less than ninety (90) days during the one hundred eighty (180) days immediately following the occurrence of the injury or impairment

First Cause of Action

Breach of Contract (UM/SUM Benefits)

21. Plaintiff repeats and re-alleges each and every allegation contained in paragraphs 1 through 20 as if fully set forth herein.

22. The Policy constitutes a valid and binding contract between Plaintiff and Defendant Insurer.

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

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

25. As a result of Defendant Insurer's breach, Plaintiff has been damaged in an amount to be determined at trial.

Second Cause of Action

Bad Faith

26. Plaintiff repeats and re-alleges each and every allegation contained in paragraphs 1 through 25 as if fully set forth herein.

27. Defendant Insurer owed Plaintiff a duty of good faith and fair dealing in the handling and resolution of the UM/SUM claim.

28. Defendant Insurer acted in bad faith by:

☐ Unreasonably delaying investigation and/or payment of the claim
☐ Denying benefits without a reasonable basis
☐ Failing to make a good-faith effort to settle the claim
☐ Engaging in a pattern or practice of claim denials
☐ Other: [________________________________]

29. As a direct and proximate result of Defendant Insurer's bad faith, Plaintiff has been damaged, including consequential damages beyond the Policy limits.

Damages

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

☐ Past medical expenses (beyond No-Fault basic economic loss): $[AMOUNT]
☐ Future medical expenses: $[AMOUNT]
☐ Past lost wages (beyond No-Fault wage loss benefits): $[AMOUNT]
☐ Future lost wages/earning capacity: $[AMOUNT]
☐ Pain and suffering (past and future): $[AMOUNT]
☐ Emotional distress: $[AMOUNT]
☐ Loss of enjoyment of life: $[AMOUNT]
☐ Loss of consortium (if applicable): $[AMOUNT]
☐ Consequential damages for bad faith: $[AMOUNT]
☐ Prejudgment interest (CPLR § 5001)
☐ Costs and disbursements

Arbitration / Litigation Election

31. ☐ Plaintiff demands arbitration of the UM/SUM coverage dispute pursuant to the Policy and N.Y. CPLR § 7503.

32. ☐ Plaintiff elects to proceed by court action because [☐ the bad faith claim is not subject to arbitration / ☐ the parties have waived arbitration / ☐ other: [________________________________]].

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/SUM benefits in the full amount owed under the Policy;
3. Consequential damages for Defendant Insurer's bad faith;
4. Prejudgment interest pursuant to CPLR § 5001;
5. Costs and disbursements of this action;
6. Such other and further relief as this Court deems just and proper.

Verification

STATE OF NEW YORK
COUNTY OF [COUNTY NAME]

[PLAINTIFF FULL NAME], being duly sworn, deposes and says: I am the Plaintiff in this action. I have read the foregoing Complaint and know the contents thereof. The same is true to my knowledge, except as to matters therein stated to be alleged upon information and belief, and as to those matters, I believe them to be true.

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

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

Notary Public: [________________________________]

Respectfully submitted,

[ATTORNEY NAME]
[FIRM NAME]
[FIRM ADDRESS]
[CITY], New York [ZIP CODE]
Telephone: [________________________________]
Email: [________________________________]
Attorneys for Plaintiff

State-Specific Notes — New York

Sources and References

• N.Y. Ins. Law § 3420 — NY Senate
• Regulation 35-D (11 NYCRR § 60-2) — DFS
• UM/UIM Coverage in New York — Dupee Law