Uninsured/Underinsured Motorist Complaint - Pennsylvania

NOTICE TO DEFEND

You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you.

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.

IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.

[COUNTY-DESIGNATED LAWYER-REFERRAL OFFICE NAME]

[OFFICE ADDRESS]

[OFFICE TELEPHONE NUMBER]

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. Stacking of Coverage
8. Tort Option Election
9. Count I — Breach of Contract (UM/UIM Benefits)
10. Count II — Bad Faith (42 Pa.C.S. § 8371)
11. Damages
12. Prayer for Relief
13. Exhibit A — Policy or Material Provisions (If Accessible)

Caption

IN THE COURT OF COMMON PLEAS OF [COUNTY NAME] COUNTY, PENNSYLVANIA

CIVIL DIVISION

Parties

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

2. Defendant, [INSURANCE COMPANY NAME] ("Defendant Insurer"), is an insurance company organized under the laws of [STATE OF INCORPORATION], authorized to conduct business in the Commonwealth of Pennsylvania, 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 subject-matter jurisdiction pursuant to 42 Pa.C.S. § 931.

5. Venue is proper in [COUNTY] County under Pa.R.Civ.P. 2179(a) because [☐ Defendant has its registered office or principal place of business here / ☐ Defendant regularly conducts business here / ☐ the cause of action arose here / ☐ a transaction or occurrence giving rise to the claim took place here].

General Allegations

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

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

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

☐ Operating at an unsafe speed in violation of 75 Pa.C.S. § 3361
☐ Following too closely in violation of 75 Pa.C.S. § 3310
☐ Failing to yield the right of way
☐ Failing to maintain a proper lookout
☐ Driving under the influence in violation of 75 Pa.C.S. § 3802
☐ Disregarding a traffic control device in violation of 75 Pa.C.S. § 3111
☐ Making an improper lane change
☐ Using a handheld mobile device while driving
☐ Other: [________________________________]

9. Each such act or omission was a factual cause of harm to Plaintiff.

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").

10A. [Select one: A copy of the Policy, or the material provisions on which this claim is based, is attached as Exhibit A. / The Policy is not accessible to Plaintiff because [SPECIFIC REASON]; its material terms are [STATE COVERAGE, LIMITS, CONDITIONS, AND OTHER TERMS RELIED ON].] Attach the writing when accessible; a claim based on a writing must satisfy Pa.R.Civ.P. 1019(i).

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

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

14. ☐ Plaintiff did not execute a valid written rejection of UM/UIM coverage under 75 Pa.C.S. § 1731. Accordingly, UM/UIM coverage is deemed elected at limits equal to the Policy's bodily injury liability limits.

15. ☐ Plaintiff affirmatively elected UM/UIM coverage at the limits stated above.

UM vs. UIM Status

Select one:

☐ Uninsured Motorist (UM) Claim:

16. 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].

16A. [IF THE MOTOR VEHICLE WAS UNIDENTIFIED: The accident was reported to [POLICE OR PROPER GOVERNMENTAL AUTHORITY] on [DATE], report no. [NUMBER]. Plaintiff notified [INSURER] on [DATE] that Plaintiff or the legal representative had a legal action arising from the accident, within 30 days or as soon as practicable thereafter. Explain any later notice: [FACTS].]

☐ Underinsured Motorist (UIM) Claim:

17. The at-fault motorist maintained bodily injury liability coverage with limits of $[TORTFEASOR POLICY LIMIT]. Those available liability limits are insufficient to pay Plaintiff's losses and damages, so the vehicle is underinsured as defined in 75 Pa.C.S. § 1702.

18. Plaintiff [☐ settled with the at-fault motorist for $[AMOUNT] / ☐ obtained a judgment and recovered $[AMOUNT] / ☐ has not yet resolved the claim against the at-fault motorist]. The applicable tortfeasor liability limits are $[LIMIT]. If Plaintiff settled for less than those limits, Plaintiff seeks UIM benefits only for damages exceeding the full applicable liability limits, subject to the Policy and governing law.

19. Defendant Insurer was provided with written notice and the opportunity to consent to the settlement with the tortfeasor's insurer, as required by the Policy terms.

20. Plaintiff's total damages exceed the tortfeasor's coverage, entitling Plaintiff to recover UIM benefits under the Policy pursuant to 75 Pa.C.S. § 1731(c). To the extent Plaintiff is an insured under more than one applicable policy, priority of recovery among those policies is governed by 75 Pa.C.S. § 1733.

Stacking of Coverage

21. The Policy insures [NUMBER] vehicles.

22. ☐ Stacking Applies: Plaintiff did not execute a valid written waiver of stacking under 75 Pa.C.S. § 1738. Accordingly, Plaintiff's UM/UIM limits are stacked, providing total available coverage of $[STACKED LIMIT] ($[PER-VEHICLE LIMIT] x [NUMBER OF VEHICLES]).

23. ☐ Inter-Policy Stacking: Plaintiff is also an insured under [NUMBER] additional automobile insurance policies in the household. Plaintiff is entitled to stack UM/UIM coverage across these policies, providing additional available coverage of $[INTER-POLICY STACKED AMOUNT].

24. ☐ Stacking Waiver Invalid: Plaintiff contends the stacking waiver was defective because [☐ it was not signed by the first named insured / ☐ it did not use the approved form / ☐ it was not obtained at the time of initial policy issuance / ☐ other: [________________________________]]. Stacked limits apply.

25. ☐ Stacking Validly Waived: The named insured executed a valid stacking waiver under § 1738. Plaintiff's UM/UIM limits are $[NON-STACKED LIMIT] per vehicle.

Tort Option Election

26. At the time of the accident, Plaintiff had elected [☐ full tort / ☐ limited tort] under 75 Pa.C.S. § 1705.

27. ☐ (If limited tort): Plaintiff sustained a "serious injury" as defined by 75 Pa.C.S. § 1702, specifically: [________________________________], and is therefore entitled to recover non-economic damages.

28. ☐ (If limited tort): Plaintiff retains full tort rights under 75 Pa.C.S. § 1705(d) because [☐ the at-fault driver was convicted of or accepted ARD for DUI arising from this accident / ☐ the at-fault driver operated a vehicle registered in another state / ☐ the at-fault driver lacked required financial responsibility / ☐ the at-fault driver intended to injure himself or another / ☐ Plaintiff was an occupant of a motor vehicle other than a private passenger motor vehicle / ☐ the claim arises from a qualifying vehicle defect caused or not corrected by a business described in § 1705(d)(2)]. State supporting facts: [________________________________].

Count I

Breach of Contract (UM/UIM Benefits)

29. Plaintiff incorporates by reference all preceding paragraphs.

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

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

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

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

34. This action is timely commenced within the four-year statute of limitations applicable to actions upon a contract founded upon a writing, 42 Pa.C.S. § 5525(a)(8), which accrues upon the insurer's breach of its contractual duty (e.g., denial of the claim or refusal to arbitrate), not merely the date of the underlying accident.

Count II

Bad Faith (42 Pa.C.S. § 8371)

35. Plaintiff incorporates by reference all preceding paragraphs.

36. Under 42 Pa.C.S. § 8371, a court may award additional damages when an insurer acts in bad faith toward the insured.

37. Defendant Insurer acted in bad faith by:

☐ Failing to conduct a prompt and thorough investigation
☐ Unreasonably denying the claim without a reasonable basis
☐ Failing to make a prompt, fair, and equitable settlement when liability was clear
☐ Compelling Plaintiff to institute this action to recover amounts clearly owed
☐ Engaging in dilatory tactics to delay payment
☐ Other: [________________________________]

38. As a result of Defendant Insurer's bad faith conduct, Plaintiff is entitled to:
    • Interest on the amount of the claim from the date the claim was made at the prime rate plus 3%;
    • Punitive damages;
    • Court costs and attorney's fees; and
    • Such other relief as the Court deems appropriate.

Damages

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

☐ Past medical expenses recoverable after applying 75 Pa.C.S. § 1722
☐ Future medical expenses recoverable after applying § 1722
☐ Past lost wages/earnings
☐ Future lost wages/earning capacity
☐ Pain and suffering (past and future)
☐ Mental anguish and emotional distress
☐ Embarrassment and humiliation
☐ Loss of life's pleasures
☐ Disfigurement
☐ Loss of consortium (if applicable)
☐ Punitive damages (bad faith claim): According to proof

Exclude from the UM/UIM damages demand medical costs paid or payable under benefit arrangements to which § 1722 applies. Review the statute's partial repeal concerning workers' compensation separately.
☐ Interest at prime rate + 3% (bad faith claim)
☐ Attorney's fees and costs (bad faith claim)
☐ Delay damages, if recoverable in this civil action under Pa.R.Civ.P. 238

Where a county compulsory-arbitration rule applies, the amount claimed [DOES / DOES NOT] exceed the jurisdictional amount requiring arbitration referral under that local rule.

Prayer for Relief

WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter judgment in favor of Plaintiff and 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, including stacked limits;
3. Punitive damages for Defendant Insurer's bad faith;
4. Interest on the claim at the prime rate plus 3% from the date of the claim;
5. Delay damages if recoverable under Pa.R.Civ.P. 238;
6. Attorney's fees and costs pursuant to 42 Pa.C.S. § 8371;
7. Costs of this action; and
8. Such other and further relief as this Court deems just and proper.

JURY TRIAL DEMANDED ON COUNT I ONLY

Plaintiff demands a jury for the contract claim to the extent triable by jury. The statutory bad-faith claim under 42 Pa.C.S. § 8371 in Count II is submitted to the court under Mishoe v. Erie Insurance Co., 824 A.2d 1153 (Pa. 2003).

Respectfully submitted,

[ATTORNEY NAME], Pa. I.D. No. [ID NUMBER]
[FIRM NAME]
[FIRM ADDRESS]
[CITY], Pennsylvania [ZIP CODE]
Telephone: [________________________________]
Email: [________________________________]
Attorney for Plaintiff

Verification

I, [PLAINTIFF FULL NAME], verify that the statements made in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities.

Date: [__/__/____]

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

Certification of Compliance with Case Records Public Access Policy

I certify that this filing complies with the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania, including its provisions for confidential information and documents.

Date: [__/__/____]

Signature: [________________________________]
Printed Name: [ATTORNEY OR SELF-REPRESENTED PARTY]

Exhibit A — Policy or Material Provisions (If Accessible)

[Attach the Policy or its material provisions relied on in Paragraph 10A. If the writing is unavailable, remove this exhibit heading and complete the alternative allegation in Paragraph 10A.]

State-Specific Notes — Pennsylvania

Sources and References

• Pa.R.Civ.P. 2179 — corporate venue (Cornell LII mirror)
• Pa.R.Civ.P. 1018.1 — Notice to Defend (Cornell LII mirror)
• Pa.R.Civ.P. 1019(i) — writing attachment (Cornell LII mirror)

• Marlette v. State Farm — UM delay damages (FindLaw mirror)

• 75 Pa.C.S. § 1731 — Pennsylvania General Assembly

• 75 Pa.C.S. § 1733 — Pennsylvania General Assembly
• 75 Pa.C.S. § 1738 — Pennsylvania General Assembly
• 42 Pa.C.S. § 8371 — Pennsylvania General Assembly
• 42 Pa.C.S. § 5525 — Pennsylvania General Assembly
• Stacking of UM/UIM in Pennsylvania — RLM Law Firm
• UM Coverage in Pennsylvania — Grungo Law