Cooperation With Auto Insurer Investigation Imperative for Coverage

Your auto insurance policy is a contract. It outlines your rights and your obligations, and as long as it isn’t ambiguous or contrary to public policy, the terms of it are most likely binding. One of the common terms is the obligation of insured to cooperate with the accident

This does not mean you are required to give a statement before talking to an attorney. But it does mean you may be required to testify under oath at the request of the insurer, or else risk foregoing coverage.

This was exactly what happened in a recent Kentucky Supreme Court decision wherein substantive issues of material fact relating to the crash were in question. 

According to court records, plaintiffs were passengers in a rear-end crash involving an alleged hit-and-run driver. Plaintiffs and driver were injured. All filed a claim against driver’s auto insurer for coverage – both personal injury protection benefits (PIP) and uninsured motorist coverage. PIP is a no-fault system of coverage that provides for a portion of medical bills and lost wages. UM coverage, meanwhile, is available for those whose injuries aren’t fully covered by PIP and yet the at-fault driver either lacks insurance or is not identified (as is the case in a hit-and-run accident).

The insurance company agent initially allocated PIP benefits to each of the claimants. However, following what the agent described as inconsistent statements by claimants on substantive issues, as well as numerous car accident claims filed by these same individuals in the last 12 months, the insurer sought more information about the car accident. Pointing to the terms and conditions of the policy, the insurer asked claimants to submit to being questioned under oath.

The driver of the vehicle agreed to these terms, underwent questioning and subsequently was awarded UM benefits.

The passengers, however, refused to be questioned under oath. As a result, the insurer denied them any further coverage beyond what was available for PIP.

Plaintiffs then filed a car accident lawsuit against the auto insurer, seeking UM benefits.

Plaintiffs argued they should not have needed to undergo such questioning because the insurer did not have a court order and the questions pertained to their medical history. The trial court, however, granted a defense motion for a declaratory judgment, finding plaintiffs were compelled via the terms of the policy to submit to questioning. Their failure to do so was a forfeiture of the benefits therein.

The appellate court reversed, siding with plaintiff’s reasoning that the insurer was required to obtain a court order before it could compel claimants to testify under oath.

Insurer the appealed to the state supreme court, which reversed the appellate court’s ruling. The court reasoned that previous case law did not prevent the insurer from requiring claimants to submit to reasonable questioning regarding substantive issues of the accident. Further, while conceding that sometimes questions pertaining to the accident and medical issues could intertwine, the state high court indicated it would trust lower courts to properly analyze the distinction between these types of question and allow or prohibit such lines of questioning accordingly.

Call Fort Lauderdale Injury Attorney Richard Ansara at (954) 761-4011. Serving Broward, Miami-Dade and Palm Beach counties.

Additional Resources:

State Farm Mutual Automobile Insurance Co. v. Adams, Aug. 24, 2017, Kentucky Supreme Court

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Injury Claimant’s Marijuana Use Excluded in Trial, $3.3M Damage Award Affirmed, Aug. 15, 2017, Fort Myers Car Accident Lawyer Blog

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