No Coverage for UIM if not Purchased

Claim Insurer Defrauded Insured Needs Evidentiary Allegations
Post 5201

It Doesn't Pay to Accuse an Insurer of Fraud Without Evidence

In Yarisleidy Suarez Rodriguez  v. Safeco Insurance Company Of America, Civil Action No. 3:25-CV-00154-GNS, United States District Court, W.D. Kentucky, Louisville Division (September 30, 2025) an insured accused her insurer for fraud in not honoring underinsured motorist coverage.  

Case Background:

Plaintiff Yarisleidy Suarez Rodriguez  (the Insured) filed a claim for underinsured motorist (UIM) benefits with Defendant Safeco Insurance Company of Illinois, which was denied. Rodriguez alleged that her policy included UIM coverage, which Safeco fraudulently removed without her knowledge.

Legal Claims:
Insurance Fraud:

Rodriguez claims that Safeco committed a fraudulent insurance act by knowingly removing her UIM policy.

Violation of KUCSPA:

Rodriguez alleged that Safeco's actions violated the Kentucky Unfair Claims Settlement Practices Act (KUCSPA).

Fraud:

Rodriguez claims that Safeco made intentional, material, and false representations regarding her insurance policy.

MOTION TO DISMISS

A complaint must contain a short and plain statement of the claim showing that the pleader is entitled to relief, and is subject to dismissal if it fails to state a claim upon which relief can be granted. Courts must accept as true all material allegations of the complaint and must construe the complaint in favor of the complaining party. A complaint will be dismissed pursuant to Rule 12(b)(6) if no law supports the claim made, if the facts alleged are insufficient to state a claim, or if the face of the complaint presents an insurmountable bar to relief.

When a court is presented with a Rule 12(b)(6) motion, it may consider the Complaint and any exhibits attached thereto, public records, items appearing in the record of the case and exhibits attached to defendant's motion to dismiss so long as they are referred to in the Complaint and are central to the claims contained therein. Moreover, although a court must accept all well-pled facts as true, if a document referenced in the complaint contradicts the allegations in the complaint, the document trumps the allegations.

Rodriguez alleged that the Policy covers losses caused by underinsured motorists. The Policy does not include UIM coverage. UIM coverage is not listed on the Policy's declaration page and no limits or premiums are given for UIM coverage. Kentucky law does not require insurers to provide UIM coverage. Because the Court should not, and cannot give the Plaintiff coverage she never bought and paid for, Rodriguez's UIM claim was dismissed.

Rodriguez claimed that Safeco violated KRS 304.47-020 by committing a fraudulent insurance act by knowingly and with intent to defraud or deceive, removing the Plaintiff's underinsured motorist policy. Accordingly, her insurance fraud claim was dismissed because there was no evidence alleged that it actually happened.

When a plaintiff alleges fraud, she must state with particularity the circumstances constituting fraud. At a minimum, the Sixth Circuit requires the allegations to contain the time, place, and content of the alleged misrepresentation on which he or she relied; the fraudulent scheme; the fraudulent intent of the defendant] and the injury resulting from the fraud. Rodriguez's sparse, conclusory allegations plainly do not satisfy the heightened pleading requirements of Fed.R.Civ.P. 9(b), so her fraud claim was dismissed.

Defendant's Motion to Dismiss was granted, and the Complaint was dismissed without prejudice. Plaintiff's Motion to Remand was denied.

ZALMA OPINION

Alleging a defendant defrauded  the Insured, and her lawyers, sued only making sparse, conclusory allegations of fraud that simply failed to meet the requirements of the federal rules. Fraud is a serious allegation and will be disposed of summarily without clear allegations of the time, place and content of the allegedly fraudulent activities. The insured failed to have enough to support a claim of fraud.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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