Missouri Insurance Lawyer Blog

Insurance policies are complicated legal contracts between you, the policy holder, and the insurance company. Very often, when a policy holder makes a claim for damages they believe should be covered by their insurance policy, the insurance company will deny the claim citing a reason unknown or often misunderstood by the policy holder.
On December 27, 2011, the Missouri Court of Appeals, Eastern Division, decided an insurance case based on the disputed definition of "owned" and "resident". The case, Manner v. Schiermeier, et. al, and American Family Mutual Insurance Company and American Standard Insurance Company, Case No. ED96143, was a claim against the insurance companies for underinsured motorists coverage on four separate automobile insurance policies because of serious injuries suffered in a motorcycle collision.

The coverage on at least one of the insurance policies depended upon whether the injured Plaintiff "owned" the motorcycle which he was driving as that word was used in the policy. For purposes of the insurance policy, the Court of Appeals determined that even though the certificate of title was not yet in the Plaintiff's name, the undisputed facts demonstrated that the plaintiff held the motorcycle as his own possession, had paid for it, either in whole or in part; drove it; and was in the process of having title transferred to him; and had separately paid for liability and underinsured motorist insurance. Therefore the Court determined that the Plaintiff did indeed "own" the motorcycle for purposes of insurance coverage.

Continue reading "WHETHER OR NOT YOU RECOVER BENEFITS FROM YOUR AUTOMOBILE INSURANCE POLICY MAY DEPEND UPON THE DEFINITION OF A SINGLE WORD IN THAT POLICY" »

The insured, Michael Blumer filed suit against his own insurance company, Automobile Club Inter-Insurance Exchange (d/b/a AAA Insurance) following a motorcycle accident in Boone County, Missouri. The driver of the other vehicle was never identified. At the time of the motorcycle incident, Blumer had two vehicles insured by AAA. The AAA policy provided uninsured motorist coverage with limits of $100,000 per person for each of two vehicles.

The AAA Policy contained an exclusion which provided "This coverage shall not apply to vehicles, including trailers, owned by you and not insured under this policy". It was not disputed that Blumer's motorcycle was owned by him and was not insured under the AAA policy, but was insured with another insurance company. That company, Progressive Northwestern Insurance Company, paid its uninsured motorist limits of $25,000.

Continue reading "SUIT AGAINST AAA INSURANCE COMPANY FINDS THAT EXCLUSION CONFLICTS WITH MISSOURI'S MOTOR VEHICLE FINANCIAL RESPONSIBILITY LAW" »

In an action by an insurer seeking a declaration that it was not liable under a professional liability insurance policy for the acts of a psychologist who treated a victim of sexual abuse but failed to report the abuse, summary judgment for insurer is reversed where the "knowingly wrongful" exclusion in the policy on which the order was based was ambiguous. The court noted that in order for an act to be intentional for purposes of Missouri tort law as well as of exclusionary clauses in liability insurance policies . . . the actor must desire
to cause the consequences of the act, or the consequences must be substantially certain
to result." the court conclude the knowingly wrongful act exclusion was reasonably subject to different interpretations. The court noted that to entertain a contrary view would work an exclusion from coverage of many, if not most, claims for damages arising out of the negligence of insureds and thus defeat the primary purpose for which liability insurance coverage is purchased.

Roy Rogers once said an insurance policy is one page that tells you what insurance you have and 50 pages that tell you why it does not apply in your particular situation. The 50 pages that take coverage away are called exclusions.
Exclusions are the insurance companies way of narrowing the risk they have accepted under the contract. For example if you have a policy of insurance on your car, but the situation that arises falls within an exclusion you bear the risk of loss and not the insurance company. In a recent post entitled Don't Believe The Hype You Are Not Friends, I made the point that all you get from insurance is the written contract. The nice sales pitch and fuzzy promises on TV give way to the hard realities of what's written in the insurance contract when its time for a claim.
If the insurance company denies your claim, it is usually because of exclusion. By way of example consider a common exclusion in a personal auto insurance policy, the business exclusion, which takes coverage away if your vehicle is used in a business instead of personal use. Even if you have your car insured for liability and you are in a crash and hurt someone you won't have any coverage if you were using a personal auto on business. Fortunately exclusions in the policy must be phrased in clear, plain and unambiguous language. If the insurance company claims that exclusion applies it is their burden to prove that it applies. So to protect yourself read your policy carefully to see what is covered before you need to make a claim.