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Georgia Court Holds Underinsured Motorist Policy Would Not “Duplicate” Prior Damages

If you are seriously hurt in an accident, there are many types of legal injuries that may entitle you to compensation. In addition to paying your immediate medical bills following an accident, you may face future expenses for ongoing care. You may also face lost wages—again, present and future—as well as pain and suffering.

In car accident cases, if a negligent driver lacks sufficient insurance to compensate you for all of your injuries, your own insurance carrier may be responsible pursuant to uninsured/underinsured motorist (UM) coverage. The exact amount of coverage you receive depends on the specific language of your policy. Unfortunately, litigation often arises between accident victims and their insurance carriers over the interpretation of such language.

Mabry v. State Farm Mutual Automobile Insurance Company

Here is a recent example from here in Georgia. This case arises from a two-car accident. The plaintiff “sustained an injury to his back and, as a result, underwent surgery and extensive medical treatment.” The plaintiff also claimed lost wages due to his inability to return to work following the accident.

The other driver had insurance and his carrier agreed to pay the plaintiff the limit on the policy, which was $100,000. Since the plaintiff was driving in the course of his employment, he also received approximately $100,000 in worker’s compensation benefits. This did not totally compensate the plaintiff for his injuries, however, as his medical bills totaled nearly $115,000 (as of 2011) and his total lost wages were nearly $160,000.

Accordingly, the plaintiff sought underinsured motorist benefits from his insurance carrier. The plaintiff had such coverage through three policies totaling $75,000. The insurer rejected the claim, arguing UM benefits would “duplicate” compensation the plaintiff received from other workers’ compensation, the negligent driver’s insurance policy, and other sources such as the plaintiff’s medical coverage. A Georgia trial court agreed with the insurer there would be a duplication of benefits, which was barred by the terms of the UM policies at issue and therefore dismissed the plaintiff’s complaint.

But the Georgia Court of Appeals reversed. The appeals court noted the plaintiff is not seeking compensation for “amounts already paid under workers’ compensation law or already paid as expenses under medical payments coverage of the policies or any other policy.” Instead, the plaintiff claims UM benefits for “uncompensated losses” not covered by these other sources. This includes “future medical expenses, future lost earnings, and past and future pain and suffering.”

The court added nothing in the UM policy entitled the plaintiff to recover more than his total losses. The very point of the policy is to ensure the plaintiff can recover whatever damages he would otherwise get from the underinsured driver who caused his injuries. In no case would the plaintiff “receive more than his actual damages.”