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Georgia Court Refuses to Enforce Clause in Insurance Contract against the Insured

Earlier this month, an appellate court issued an opinion in a Georgia car accident case, raising the question of whether the accident victim was entitled to compensation from his own insurance carrier under the underinsured motorist clause of the insurance policy. The court ultimately determined that, although the insurance contract clearly prevented the plaintiff from being compensated given the specific facts of the case, that clause was unenforceable because it was contrary to Georgia’s Underinsured Motorist statute.

Rear-End AccidentThe Facts of the Case

The plaintiff was injured in a serious car accident. The plaintiff filed a personal injury case against the other driver. However, the plaintiff soon realized that the other driver did not have adequate insurance to compensate him for the injuries he sustained in the accident. The plaintiff received $25,000 from the other driver’s insurance company.

The plaintiff, who was employed at the time of the accident, also obtained workers’ compensation benefits in the amount of nearly $200,000. However, these benefits provided a weekly benefit that was less than what the plaintiff was normally earning, and they did not include any compensation for pain and suffering or future medical expenses. Thus, the plaintiff was still owed compensation for his lost wages as well as compensation for his pain and suffering and future medical expenses.

The plaintiff filed a claim with his own insurance company, citing the underinsured motorist provision of the contract. At the time, the plaintiff had four policies with the insurance company, each with $25,000 in underinsured motorist protection.

The insurance company rejected the plaintiff’s claim, citing a clause in the insurance contract stating that an insured’s claim amount will be reduced by any amount the insured has received through workers’ compensation. Thus, the insurance company’s position was that, while the plaintiff had a total of $100,000 in coverage under his four policies, the plaintiff received more than that amount from workers’ compensation and therefore was not entitled to recover any additional sum from the insurance company.

The court agreed with the insurance company that the contract, as written, would prevent the plaintiff from obtaining additional compensation. However, the court explained that the contractual clause is contrary to a state statute. The statute states that an insurance company can reduce the amount payable on a claim by any amount for which the plaintiff has been compensated under workers’ compensation.

Here, it was uncontested that the plaintiff was not compensated for his pain and suffering and future medical expenses. Thus, since the plaintiff did not obtain any compensation for these damages, the court would not permit a dollar-for-dollar reduction of the plaintiff’s claim.

Have You Been Injured in a Georgia Auto Accident?

If you or a loved one has recently been injured in a Georgia auto accident, you may be entitled to monetary compensation. However, dealing with insurance companies in the wake of a serious accident can be frustrating. At McAleer Law, we take charge of negotiating our clients’ claims with an insurance company and make sure that our clients are provided fair compensation for any insurance claim. If an insurance company is unwilling to play fair, we have no hesitation in taking the case to trial. Call 404-622-5337 to schedule a free consultation with a dedicated Georgia personal injury attorney at McAleer Law today.

See More Posts:

Georgia Supreme Court Dismisses Defendant’s Summary Judgment Challenge in Recent Premises Liability Opinion, Georgia Injury Attorney Blog, October 18, 2017.

Court Excludes Key Witness at Trial Due to Plaintiff’s Failure to Identify Witness Before Trial, Georgia Injury Attorney Blog, September 27, 2017.