Massachusetts Appellate Court Upholds Denial of Underinsured Motorist Coverage to Son Based on Discussion with Insurance Representative

Man Holding PhoneIf you are involved in a car accident with a motorist who does not have sufficient policy limits to cover your damages, you may be able to make a claim for underinsured motorist benefits with your own insurer. As seasoned Massachusetts car accident lawyers, we have handled numerous legal actions that involve insurance issues, including underinsured motorist coverage disputes. This coverage is typically optional, and many appellate opinions have discussed whether a party has rejected an underinsured motorist policy explicitly. In a recent opinion, for example, a mother and son were injured in a car accident. The mother sought policy benefits for her son’s injuries, but her insurer denied them. The mother and son appealed the trial court’s decision finding that the insurer was not required to pay benefits to the son. The mother and son filed a timely appeal.

On review, the appellate court first examined the scope of the mother’s insurance policy. In its opinion, the court cited a specific provision in the policy that provides benefits to “any household member . . . while occupying an auto not owned by [the insured].” The provision further provided that the household member was required to be a relation through marriage, blood, or adoption.

In response to the plaintiffs’ claim, the insurance company had provided medical documents, a lease showing that the son did not live in the same apartment unit as his mother, and a driver’s license. The insurance company also referenced a discussion that the mother had with one of its representatives before she purchased her insurance policy. According to the insurer, in that discussion, the mother indicated that her son did not live with her but that he lived in a separate unit downstairs from her unit.

During the lower court proceedings, the mother and son had both testified that they resided in the same house and indicated that they both use the same unit for services like laundry and that they always have access to each other’s units. They also provided testimony indicating that they routinely dined together. The mother and son attempted to argue that the insurer was estopped from denying benefits for the son based on her assertion that she relied on the representative’s understanding that they lived together in issuing the policy. The lower court rejected this argument, and the appellate court agreed.

For a court to find estoppel, it must find that there was a representation by the party to be estopped that induced the other party to act or rely. There must also be a detriment to the party that acted or relied on the assertion. Since the majority of the discussion with the insurance representative involved discussing where the son did not reside, the lower court found it unreasonable that the mother would rely on this conversation in believing that her son was covered. Furthermore, there was no discussion of underinsured motorist benefits during this conversation. As a result, the appellate court upheld the lower court’s denial of policy benefits for the son’s auto accident injuries.

If you are involved in an insurance dispute after you’ve been involved in an auto accident, the dedicated trial lawyers at the Law Offices of Michael O. Smith are prepared to help you fight for your rights and the compensation that you deserve. We have provided compassionate and reliable legal counsel to residents throughout Massachusetts and understand exactly what you are going through. To schedule your free consultation, call us now at 617-263-0060 or contact us online.

Related Posts:

Massachusetts Lawsuit Against School Bus Insurer Highlights Potentially Dangerous Driving Practices

Massachusetts Family’s Lawsuit Against Auto Shop Alleges Improper Tire Installation, Leading to Fatal Crash

Insurance Carrier’s Request for Arbitration Granted in Underinsured Motorist Coverage Claim