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 Refusal to Pay (TCA § 56-7-105)
9. Damages
10. Arbitration Under TCA § 56-7-1206
11. Prayer for Relief
12. Verification

Caption

IN THE CIRCUIT COURT FOR [COUNTY NAME] COUNTY, TENNESSEE

AT [CITY]

Parties

1. Plaintiff [PLAINTIFF FULL NAME] ("Plaintiff") is a citizen and resident of [COUNTY] County, Tennessee, and is an insured under the automobile insurance policy described herein.

2. Defendant [TORTFEASOR NAME] ("Defendant Motorist") is, upon information and belief, an individual who [☐ resides in [COUNTY] County, Tennessee / ☐ whose address is unknown].

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

Jurisdiction and Venue

4. This Court has jurisdiction over this action pursuant to Tenn. Code Ann. § 16-10-101 et seq.

5. Venue is proper in [COUNTY] County pursuant to Tenn. Code Ann. § 20-4-101 because [☐ the accident occurred in this county / ☐ Defendant Motorist resides in this county / ☐ Defendant Insurer conducts business in this county].

General Allegations

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

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

8. The Defendant Motorist's negligent acts include but are not limited to:

☐ 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
☐ Distracted driving
☐ Other: [________________________________]

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

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").

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 under the Policy and has complied with all conditions precedent.

14. Plaintiff did not execute a valid written rejection of UM/UIM coverage as contemplated by TCA § 56-7-1201.

UM vs. UIM Status

Select one:

☐ Uninsured Motorist (UM) Claim:

15. The Defendant Motorist was uninsured at the time of the accident within the meaning of TCA § 56-7-1202, in that [☐ the Defendant Motorist had no bodily injury liability insurance in effect / ☐ the Defendant Motorist is unknown (hit-and-run) / ☐ the Defendant Motorist's insurer has denied coverage / ☐ the Defendant Motorist's insurer is insolvent].

☐ Underinsured Motorist (UIM) Claim:

16. The Defendant Motorist maintained bodily injury liability coverage with limits of $[TORTFEASOR POLICY LIMIT], which is less than the Plaintiff's UM/UIM limits, and the tortfeasor's limits are insufficient to fully compensate Plaintiff's damages.

17. Plaintiff has exhausted or is prepared to exhaust the Defendant Motorist's liability policy limits and has obtained [☐ a settlement / ☐ a judgment] in the amount of $[AMOUNT RECOVERED FROM TORTFEASOR].

18. Defendant Insurer was given written notice and the opportunity to consent to or advance the tortfeasor's policy limits before settlement.

First Cause of Action

Breach of Contract (UM/UIM Benefits)

19. Plaintiff incorporates by reference all preceding paragraphs.

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

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

22. Defendant Insurer has breached the Policy by failing and refusing to pay UM/UIM benefits owed to Plaintiff, despite Plaintiff's timely demand.

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

Second Cause of Action

Bad Faith Refusal to Pay (TCA § 56-7-105)

24. Plaintiff incorporates by reference all preceding paragraphs.

25. On or about [DATE OF DEMAND], Plaintiff made a written demand upon Defendant Insurer for payment of UM/UIM benefits owed under the Policy.

26. More than sixty (60) days have elapsed since Plaintiff's demand, and Defendant Insurer has refused to pay said claim.

27. Defendant Insurer's refusal to pay was not in good faith, in that:

☐ Defendant Insurer unreasonably delayed investigation of the claim
☐ Defendant Insurer failed to conduct a thorough and fair investigation
☐ Defendant Insurer unreasonably denied benefits without basis
☐ Defendant Insurer failed to attempt in good faith to effectuate a prompt and fair settlement
☐ Defendant Insurer compelled Plaintiff to initiate litigation to recover amounts due
☐ Other: [________________________________]

28. Pursuant to TCA § 56-7-105, Defendant Insurer is liable for an additional penalty of up to twenty-five percent (25%) of the amount of the claim, together with all reasonable attorney's fees for the prosecution of the claim.

Damages

29. As a result of the accident and Defendant Insurer's breaches, Plaintiff 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]
☐ Pain and suffering (past and future): $[AMOUNT]
☐ Emotional distress: $[AMOUNT]
☐ Loss of consortium (if applicable): $[AMOUNT]
☐ Bad faith penalty up to 25% of the claim (TCA § 56-7-105)
☐ Attorney's fees (TCA § 56-7-105)
☐ Prejudgment interest
☐ Costs of suit

Arbitration Under TCA § 56-7-1206

30. ☐ The liability carrier has invoked the arbitration procedure under TCA § 56-7-1206 by offering the full policy limits of $[TORTFEASOR POLICY LIMIT].

☐ The liability carrier has NOT invoked the arbitration procedure under TCA § 56-7-1206, and this matter shall proceed through normal litigation.

Prayer for Relief

WHEREFORE, Plaintiff prays for judgment against Defendants as follows:

1. For compensatory damages against Defendant Motorist in an amount according to proof at trial;
2. For UM/UIM policy benefits against Defendant Insurer in the full amount owed under the Policy;
3. For a bad faith penalty of up to 25% of the claim pursuant to TCA § 56-7-105;
4. For reasonable attorney's fees pursuant to TCA § 56-7-105;
5. For prejudgment interest as permitted by law;
6. For costs of suit incurred herein; and
7. For such other and further relief as this Court deems just and proper.

Verification

STATE OF TENNESSEE
COUNTY OF [COUNTY NAME]

I, [PLAINTIFF FULL NAME], being duly sworn, state that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief.

Dated: [__/__/____]

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

Sworn to and subscribed before me this [____] day of [____________], [________].

Notary Public: [________________________________]
My Commission Expires: [__/__/____]

RESPECTFULLY SUBMITTED,

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

State-Specific Notes — Tennessee

Sources and References

• TCA § 56-7-1201 — Justia (2024)
• TCA § 56-7-1206 — Justia (2024)
• TCA § 56-7-1206 Explained — Santel Garner
• TCA § 56-7-1206 — FindLaw
• Tennessee Bad Faith — Chartwell Law