Failure to Give Notice of UM Claim Until Two Years After Accident is Fatal to Claim
In Hyde v. State Farm Mutual Automobile Insurance Company, A20A1221, Court of Appeals of Georgia (September 2, 2020) Elizabeth M. Hyde appealed the trial court’s order granting summary judgment to State Farm Mutual Automobile Insurance Company. Hyde contends that the trial court erred in finding that she did not give State Farm sufficient, required notice of her uninsured motorist claim in a timely fashion.
The record shows Hyde alleged that on August 18, 2016, she was injured when she was rear-ended by Courtney Sawyer while stopped at an intersection. Hyde was driving her employer’s vehicle. After the collision, Hyde returned to her workplace, picked up her own car, and went straight to a doctor’s office. The doctor, who examined her and x-rayed her neck that day, told her that she had whiplash. Hyde had surgery on her neck in March 2018 almost two years after the accident.
At the time of the accident, Hyde was an insured under an insurance policy issued by State Farm. Hyde’s policy with State Farm included uninsured motorist coverage. The policy requires that a person making a claim under uninsured motor vehicle coverage must:
“notify [State Farm] of the claim and give [State Farm] all the details about the death, injury, treatment, and other information that [State Farm] may need as soon as reasonably possible after the injured insured is first examined or treated for the injury.”
The policy also provides that:
“Legal action may not be brought against [State Farm] until there has been full compliance with all the provisions of this policy.”
On December 7, 2016, Hyde’s attorney sent a letter to Hyde’s employer, Massey Restoration Group, regarding Hyde’s accident as notice of a potential uninsured motorist’s claim that may arise from the collision. Massey Restoration Group provided a copy of the letter to its State Farm agent not Hyde’s State Farm’s Agent.
On June 13, 2018, Hyde filed suit against Sawyer seeking damages for injuries allegedly sustained in the collision. Hyde served State Farm, as an uninsured motorist carrier, with the complaint and summons.
State Farm answered the complaint and moved for summary judgment claiming, among other things, that Hyde failed to comply with the notice provisions of her insurance policy. The trial court granted summary judgment to State Farm. The trial court determined that, as a matter of law, Hyde did not give notice to State Farm of her claim and did not provide all of the details about the injury, treatment, and other information as soon as reasonably possible after she was first examined or treated for the injury as required by her policy.
Hyde argued that State Farm received notice of her potential claim when Massey Restoration Group’s State Farm agent received the December 7, 2016 letter notifying Massey Restoration Group of Hyde’s potential uninsured motorist claim. In Lankford v. State Farm Mut. Automobile Ins. Co., 307 Ga. App. 12, 15-16 (703 SE2d 436) (2010) Lankford first provided written notice to State Farm that he had been involved in an accident and first raised the issue of uninsured motorist coverage under his own insurance policies almost two years after the accident. On appeal, he argued that State Farm had actual notice of the accident because the defendant also had insurance through State Farm and someone, presumably the defendant or someone on his behalf, notified State Farm of the accident shortly after it occurred. The December 7, 2016 letter from Hyde’s attorney notified Massey Restoration Group of a potential claim under Massey Restoration Group’s insurance policy, not a potential claim under Hyde’s own insurance policy.
It was only a matter of coincidence that Massey Restoration Group and Hyde shared the same insurer. The Court of Appeal found that there is no authority requiring an insurer to cross-reference the names of all parties involved in an accident to determine whether they, too, have insurance through the insurer. A insurer, on the other hand, is entitled to rely upon its contractual notice provisions.
Therefore, State Farm did not receive notice of Hyde’s potential claim under her insurance policy when Massey Restoration Group’s State Farm agent received the copy of the December 7, 2016 letter. The December 7, 2016 letter to Massey Restoration Group did not provide the notice to State Farm required by Hyde’s insurance policy.
Hyde argued that her claim did not arise until it became obvious that she had a claim for uninsured motorist coverage, which she contends was in March 2018 when the seriousness of her injuries began to manifest themselves. Hyde’s policy required otherwise. Notice was required “as soon as reasonably possible after the injured insured is first examined or treated for the injury.” A general provision that no action will lie against the insurer unless the insured has fully complied with the terms of the policy (as existed in Hyde’s State Farm policy) will suffice to create a condition precedent.
A notice provision expressly made a condition precedent to coverage is valid and must be complied with, absent a showing of justification. Where an insured has not demonstrated justification for failure to give notice according to the terms of the policy, then the insurer is not obligated to provide either a defense or coverage.
Hyde’s argument that notice was only required as soon as reasonably possible after it became obvious she had a claim for uninsured motorist coverage.
PURPOSE OF NOTICE REQUIREMENT
The purpose of a notice provision in a policy of insurance is to allow the insurer to investigate promptly the facts surrounding the occurrence and to prepare a defense or determine whether a settlement is feasible, while the facts are still fresh and the witnesses are still available. Hyde’s excuse that she did not realize how serious she was injured was for delay reporting her uninsured motorist claim failed because on December 7, 2016 her attorney wrote the letter notifying Massey Restoration Group of Hyde’s potential uninsured motorist claim.
Hyde’s 22-month delay in notifying State Farm was unexcused and unreasonable as a matter of law.
Notice provisions are conditions precedent in many states. Some will apply the notice prejudice rule to allow a late report to survive a claim of breach of material condition if they could show the insurer was not prejudiced by the late report. In this case, although the notice prejudice rule was not mentioned, the facts clearly showed that a two-year delay deprived State Farm of the ability to thoroughly investigate the claim, that Hyde knew she needed a UM or UIM claim because it was immediately reported to her employer. She is not without a remedy, her lawyer should have reported the potential of a UM/UIM claim to both State Farm policies.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and email@example.com.
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.
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