Massachusetts Court Rules Against Son Who Claimed to be an Insured Under UIM Policy of Mother Who Lived in Separate Apartment Unit – Progressive Direct Insurance Company v. Wilson

When a driver fails to act in a reasonably prudent manner, and someone else is hurt, the negligent driver can be held liable for the injured person’s medical expenses, lost wages, and pain and suffering. Unfortunately, not every at-fault driver has high enough limits on his or her automobile liability policy to pay fair compensation in serious accident cases.

Underinsured motorist coverage helps protect those who are injured as a result of the negligence of an underinsured driver. However, disputes can arise as to whether a particular person is considered to be an “insured” under a given policy.

Facts of the Case

In the recent (unreported) case of Progressive Direct Insurance Company v. Wilson, the plaintiff was an insurance company that issued a policy for underinsured motor vehicle insurance coverage (UIM) to one of the defendants (the mother). The other defendant (the son) was involved in an automobile accident with an underinsured motorist.

The insurance company filed a declaratory judgment action, seeking a declaration that it had no obligation to provide UIM coverage to the son with regard to the accident. The trial court granted summary judgment in favor of the insurance company.

Resolution of the Case

The mother and son appealed the trial court’s decision, insisting that 1) the lower court had erred in determining that the son was not a “household member” for the purposes of the mother’s UIM policy; 2) the insurance company should be estopped from denying UIM benefits, due to a conversation between the mother and a representative of the insurance company; and 3) the son was an intended third-party beneficiary under the UIM policy. The Commonwealth of Massachusetts Appeals Court rejected all of these arguments and affirmed the trial court’s order granting summary judgment to the insurance company.

With regard to the mother and son’s assertion that the son was a member of the mother’s household, the court noted that the policy in question defined “household member” as “anyone living in your household.” Although the son apparently lived in the same apartment complex as the mother, the son’s medical records, driver’s license, and lease showed that he lived in a separate unit from the one occupied by the mother. Moreover, the mother herself told the insurance company’s representative that she and her son lived in different units (although she later claimed that the son ate and did laundry in her unit and that they did not lock the back doors between the units).

As to the conversation through which the mother and son sought to estop the insurance company from denying UIM coverage to the son, the court found that the conversation at issue pertained to liability coverage on the mother’s vehicle in situations in which the son drove her car and that the mother’s apparent intent was to avoid paying a higher premium to list the son as an occasional driver on her policy. Thus, the court opined that the mother could not claim that the son lived in a separate unit to avoid adding him for liability coverage and then turn around and say that he was a household member for the purposes of UIM coverage.

Finally, the appellate court agreed with the lower tribunal that the son was not a third-party beneficiary of the mother’s UIM policy, finding that the opposite – to purposely not list him on her policy to avoid the cost of such coverage – was the mother’s actual intention.

For Help with Your Cape Cod Accident Case

When the at-fault driver in an automobile accident case has only minimal coverage, a serious car crash case can quickly escalate into an insurance coverage dispute. Although the case discussed above was not resolved in the insured’s favor, the case turned on a very specific set of facts. Another case with similar issues could result in a verdict for the insured under different facts. To talk to a knowledgeable Cape Cod car accident lawyer about your case, call the Law Offices of John C. Manoog, III, at (888) 262-6664 today. We have offices in both Hyannis and Plymouth, from which we serve clients throughout the Cape Cod area, as well as elsewhere in Massachusetts.

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