True Crime of Insurance Fraud Video No. 61

Don’t Drive Off a Cliff, It May Not Be CoveredShow more

Jimmy wanted a new pickup truck in the worst way. He decided to deliberately wreck his old car, make a claim against his insurance policy and use the proceeds to buy a new F150.

Jimmy disclosed his plan to his best friend, Winifred. She agreed to help — as a lookout for oncoming traffic —on the night they chose to destroy the car.

Jimmy, with his friend Winifred as a passenger, intentionally drove his pickup off the road and over a small cliff at 35 mph. He did not let her out of the truck to be his “look out” as planned. He thought it would be more realistic a claim — one that would not be questioned by his insurance company, if  Winifred was in the car with him.

As planned, the car did not survive the crash. Unfortunately, neither did Winifred.

The heirs argued they were entitled to Under Insured Motorists (UIM) benefits under the Farmers and County Mutual policy because Jimmy was under insured. Furthermore, they claimed Winifred’s death was “accidental.”

Farmers and County Mutual’s response was, translated from the lawyerese:

“Give us a break.”

The heirs argued that Jimmy and Winifred intended to destroy the truck, not Winifred. The death was accidental.

In the Winifred’s Heirs v. Farmers & County Mutual arbitration, Farmers and County argued that interpretation of “accident” in liability policies is hyper-technical and legalistic and should not apply to the same term in UIM policies. The arbitrator ruled in favor of the insurer.

The heirs sued, lost at the trial court, that adopted the ruling of the Arbitrator. The heirs appealed and a Court of Appeals agreed, saying that, for UIM purposes, an “accident” is an “event” that, from the insured’s and the underinsured motorist’s perspective, is “unforeseen, unintended unexpected or the like.”

An injury is not accidental, the appellate court explained, if the injury-producing event was intended or expected. It is not necessary that the insured intend or expect the injury.

People who do wrong should not profit from it. Paying Winifred’s heirs for her death while admitting that she was intentionally a part of a criminal act is the same as the police paying the heirs of an armed robber who is shot to death by the police in the course of his armed robbery.

If our courts continue to honor criminals, and their heirs, for causing their own injuries the system will destroy itself. If insurers continue to pay to settle this type of fraudulent claim because it is less expensive than fighting to a conclusion all of us who buy insurance will suffer.

Every person who buys insurance should shout to their insurers – GIVE US A BREAK!

(c) 2022 Barry Zalma & ClaimSchool, Inc.

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 practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

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