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Automobile Insurers: Colorado Supreme Court Allows Duplicative Recovery Under UM/UIM Coverage

A divided Colorado Supreme Court held on November 7, 2016, that automobile insurers may not reduce uninsured/underinsured (UM/UIM) benefit awards to account for benefits already received under separate coverages. See Calderon v. American Family Mutual Insurance Co., 14SC494 (Colo. Nov. 7, 2016). This decision effectively permits UM/UIM claimants to recover more than their uninsured loss and has already sparked a small wave of class action lawsuits in Colorado.

The plaintiff-insured in Calderon sustained injuries following a motor vehicle accident with an uninsured motorist. The plaintiff’s auto policy with American Family provided $300,000 in UM/UIM coverage and $5,000 in medical benefits coverage. American Family immediately paid the $5,000 limit of medical benefits coverage but disputed the amount of uninsured motorist benefits due. The insured sued and received a jury verdict in the amount of $68,338.  The trial court reduced the award by $5,000 to account for the medical benefits payment already received.

Although Colorado’s intermediate appellate court affirmed the reduced award, in a 4-3 split decision, the Colorado Supreme Court reversed, finding that set-offs for benefits paid were not permissible. The statute at issue provides as follows: “The amount of the [UM/UIM] coverage available pursuant to this section shall not be reduced by a setoff from any other coverage, including, but not limited to, legal liability insurance, medical payments coverage, health insurance, or other uninsured or underinsured motor vehicle insurance.” The court stated that “coverage available” refers the coverage available on a particular claim rather than the coverage limit under the policy. The court reasoned that a contrary conclusion would result in disparate recoveries depending on the sufficiency of the tortfeasor’s insurance, which undercuts the purpose of UM/UIM coverage.

Three of the court’s members dissented, finding that the majority’s decision was not supported by the statute or public policy. According to the dissent, the statute prevents a reduction in the total amount of coverage available to the insured but does not prohibit a reduction where an insured has been fully compensated. In this case, the jury determined that the plaintiff’s total sum of damages was $68,338, which included medical expenses. According to the dissent, allowing the plaintiff to recover the full amount of the jury verdict plus the previously paid $5,000 in medical payments benefits resulted in a duplicative recovery.

The dissent reasoned that the phrase “coverage available” could only refer to the total limits of available coverage. For example, if the plaintiff had an uninsured loss in excess of $300,000, he would have been entitled to the full limit of his UM/UIM policy notwithstanding his earlier receipt of $5,000 in medical payments coverage. In other words, the statute was intended to prevent a setoff where the insured has not been fully compensated for his damages.

Although the decision in Calderon was issued less than two weeks ago, it has already set off a small wave of class action lawsuits against insurers that have allegedly reduced UM/UIM benefits to account for previously paid medical benefit payments.

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About this Author

Jason P. Gosselin, Commercial Litigation Lawyer, Drinker Biddle
Partner

Jason P. Gosselin is a veteran litigator and trial attorney whose national practice involves a wide range of civil litigation, including insurance coverage, commercial disputes, and constitutional freedoms. He has served as lead counsel in multiple jury trials and dozens of arbitrations. Jason also has an active appellate practice and has argued numerous cases in federal and state appellate courts.

Jason represents clients in a wide range of insurance coverage disputes, including claims involving life, health, disability,...

215-988-3371
Timothy O'Driscoll Insurance Litigation Lawyer Drinker Biddle
Partner

Timothy J. O’Driscoll counsels clients on a broad range of insurance litigation and regulatory matters.

Tim’s insurance litigation experience includes coverage and extra-contractual disputes in state and federal courts across the country, involving life, long-term care, annuity and property and casualty policies. He has successfully resolved many cases, winning jury trials, dispositive pre-trial motions and appeals, prevailing at arbitrations and obtaining favorable settlements.

Tim also advises insurer and broker clients and regularly speaks to organizations across the country on a wide variety of matters, including cost of insurance, structured settlements, the secondary life insurance market, unclaimed property and insurer insolvency issues.

(215) 988-2865