FORM - Under-insured Motorist Policy Limit Demand - Set-off Does not Apply - Other Insurance Clause

Thank you for promptly sending the certified copies of Mr. Critchell’s auto policies with your company.  I have had an opportunity to review the policies and determine what the applicable limits are when construing the policy language with Missouri Law.

Mr. and Mrs. Critchell insured two vehicles with Hanover Insurance and paid a separate premium for each vehicle.  Therefore, the policies are stackable to set the under-insured motorist coverage to $100,000.  However, having done extensive research on this topic in the past, as a former insurance defense lawyer, I will concede that Hanover Insurance’s policy language prohibiting anti-stacking is likely valid under Missouri law.

On the other hand, the Hanover policy language regarding “other insurance” often referred to as a “set-off clause” is ambiguous under Missouri law and therefore unenforceable.[1] The Hanover policy language is unenforceable because it describes the UIM as “excess over any other collectable insurance.”  The identical language Missouri Courts have held ambiguous and hence, unenforceable. Therefore, the policy limit for my client’s underinsured motorist claim is $50,000 and there is no setoff.         

As you know, the at-fault party’s insurance company, General Casualty, has paid there insured’s policy limits of $25,000.  My client’s severe injuries required extensive surgical intervention and extensive treatment costing in excess of $200,000.[2] Clearly, the value of this case far exceeds the insurance coverage available to my client under both the primary coverage from the tortfeasor and his underinsured motorist coverage with Hanover Insurance.

Therefore, please be advised that demand hereby is made for settlement for my client’s UIM policy limit of $50,000.  This demand will remain open for sixty (60) days unless rejected earlier.

Your past and future professional courtesies in this matter are appreciated and I look forward to bringing this matter to a prompt resolution. 

                                                                 

 

[1] See Zemelman v. Equity Mut. Ins. Co., 935 S.W.2d 673 (Mo. App. WD 1996)  Court read the policy’s UIM “set-off” provision against the policy’s “other insurance” provision and found it ambiguous because the language described the UIM as “excess over any other collectable insurance.”   

[2] See enclosed medical records and bills.