By Christopher J. Robinette, Associate Professor at the Widener University School of Law
Chapter 61 provides an overview of automobile insurance law in the United States, including many matters that will be covered in greater detail in subsequent chapters. The goal in this chapter is to orient the reader to the major components of, and issues concerning, automobile insurance.
Section 61.01 sketches the history of automobile insurance in the United States. Automobile insurance appeared soon after the first automobiles were produced in the late nineteenth century. It evolved rapidly from insurance designed primarily to protect wealthy potential tortfeasors to insurance functioning to compensate victims of automobile accidents. The most significant agent of change was the advent of laws addressing the need for financial responsibility and compulsory automobile insurance, requiring, in many circumstances, motorists to purchase automobile insurance.
Section 61.02 describes the breadth, content, and effects of financial responsibility and compulsory automobile insurance laws. All 50 states and the District of Columbia have some form of financial responsibility requirement setting the amount of insurance or financial resources necessary if an accident occurs. Although compulsory insurance, making it illegal to operate a vehicle without an insurance policy in effect, is the dominant approach, New Hampshire relies solely on a financial responsibility law. In general, financial responsibility laws require a motorist to prove the ability to pay a judgment for damages arising out of an automobile accident after an accident. Financial responsibility and compulsory automobile insurance laws are designed to ensure compensation for victims of automobile accidents.
As discussed in Section 61.02, every jurisdiction requires motorists to be insured against causing property damage, and every jurisdiction except Florida requires motorists to be insured against causing bodily injury. Compulsory insurance laws generally require a minimum amount of coverage for bodily injury per person, a minimum amount for bodily injury per accident, and a minimum amount of property damage coverage per accident. These minimum amounts of coverage are expressed as a series of numbers, e.g., 25/50/10, representing insurance coverage in the amounts of $25,000 for bodily injury per person, $50,000 for bodily injury per accident and $10,000 for property damage per accident. The required amounts vary in the jurisdictions from 15/30/5 or 12.5/25/7.5 on the low end to 50/100/25 on the high end.
Fewer jurisdictions require motorists to purchase uninsured or underinsured motorist insurance. However, many jurisdictions require that such coverage be offered by insurers for purchase. Minimum coverage amounts for uninsured or underinsured motorist coverage generally mirror minimum coverage amounts for bodily injury.
A recurring issue regarding compulsory automobile insurance laws, covered in Section 61.02[c], is whether they invalidate certain exclusions in issued policies. Many courts have invalidated the business exclusion, for vehicles being used for business purposes. Similarly, many courts have invalidated the family exclusion, which excludes coverage of the insured to persons residing in the insured's household. By contrast, named driver exclusions, in which the insurer literally excludes coverage to an individual by name, are generally upheld by courts. Though some courts uphold the intentional acts exclusion, a surprising number hold it is invalid. An alternative approach, taken by some jurisdictions, is to invalidate any objectionable exclusion only to the extent of the statutory insurance coverage limits. For example, if a motorist had $100,000 of bodily injury coverage in a jurisdiction mandating coverage of only $25,000, a victim injured by the motorist in violation of, say, the intentional acts exclusion could recover $25,000, but not the full $100,000.
Section 61.03 reviews the types of coverage available in automobile insurance policies: collision, comprehensive, liability, uninsured and underinsured motorist coverage, medical payments, no-fault, and add-on coverages. Collision and comprehensive coverage, discussed in Section 61.03, are both optional, first-party insurance provisions protecting the insured's property regardless of fault. Collision coverage protects against property damage caused by the upset of the vehicle or by its impact with another vehicle or object. Comprehensive coverage is often defined as covering losses not covered by collision coverage, such as missiles or falling objects; fire; theft; explosion or earthquake; windstorm; hail, water, or flood; and vandalism, riot, or contact with a bird or animal. If a motorist purchases one type of coverage, but not the other, litigation may arise as to whether a particular loss was covered under the provision that the insured purchased. In general terms, collision covers claims in which the vehicle was operational, and comprehensive covers claims in which the vehicle was not operational at the time of the damage. However, exceptions exist, and courts often construe provisions to favor coverage.
The most significant provision in an automobile insurance policy is liability coverage, which provides compensation to third parties for bodily injury and property damage incurred when the insured driver is at fault in causing an accident with another person or piece of property. Liability coverage protects the insured from liability for damage to third parties, but also, due to its compulsory nature, protects third parties from damage caused by negligent motorists. Significantly, liability insurance also covers the cost of defense, primarily attorneys' fees.
Liability insurance is generally limited to accidents in which the insured was engaged in ownership, maintenance, or use of the covered automobile at the time of the damage. Of these, "use" is by far the most significant concept, and it is covered in Section 61.03[b]. Vehicles involved in transportation are likely to be held "in use," and vehicles not involved in transportation are likely to be held not "in use," though there are numerous exceptions and some jurisdictions are more liberal than others. Moreover, most courts require there to be a causal connection between the injury and the use of the vehicle, though it is a more liberal application of cause than a traditional proximate cause analysis.
Cross Reference: Coverage of proximate causation principles are located in Section 44.03 above.
In the "use" context, there are several recurring fact patterns. Courts generally hold that road rage injuries, in which one motorist gets out of a vehicle and assaults another because of a dispute, do not arise out of the "use" of a vehicle. Most courts also hold that loading and unloading a car with goods and exiting and entering a car both do qualify as use. A split of authority exists regarding when the act of loading or unloading is complete. Cases involving the discharge of a gun or a dog bite are handled according to the general rule. Courts analyze whether there was a causal relationship between the automobile and the injury. Common exclusions to liability coverage are for intentional acts, business purposes, and non-permissive users.
Cross Reference: Automobile liability insurance is thoroughly covered in Chapter 63 below.
Section 61.03 covers uninsured and underinsured motorist coverage. The essence of uninsured motorist coverage ("UM") is that an insured can recover from the insured's own insurer if the insured proves liability on the part of a third party who is "uninsured." UM is a hybrid of first-party and third-party insurance. It is first-party insurance to the extent it is purchased for the protection of the insured and the insured's family, but it is third-party insurance in the sense that coverage is triggered by proving the liability of a third party. UM is mandatory in 20 jurisdictions; in nearly all other jurisdictions, it is mandatory that insurers offer it for purchase. UM is generally subject to a right of subrogation on behalf of the UM insurer.
Two significant issues in UM coverage are: (1) what is an "uninsured vehicle"? (see Section 61.03[a][ii]); and (2) when is an insured "legally entitled to recover"? (see Section 61.03[a][iii]). In general, a vehicle is uninsured not only if the owner did not carry insurance, but also if the coverage is below the jurisdiction's minimum limits, the insurance carrier insuring the vehicle becomes insolvent, the insurer has denied coverage of the claim, or the insured vehicle is the victim of a hit-and-run. Regarding hit-and-runs, there is a jurisdictional split over whether actual physical contact is required in order to recover. Some states require physical contact by statute. Many states require coverage of hit-and-run incidents without addressing physical contact. In these jurisdictions, courts split over whether an insurer's requirement of physical contact in the policy is contrary to public policy. The majority rule, by a slim margin, in states without explicit statutory language in support of physical contact appears to be that physical contact cannot be required by a policy provision.
In general, an insured is legally entitled to recover if the uninsured driver was at fault in causing damages to the insured. The insurer is allowed to assert substantive, but not procedural, defenses that the uninsured motorist would have had against the insured. Distinguishing between the two can be surprisingly tricky. Comparative and contributory negligence and various types of immunity, including the workers' compensation bar, are generally regarded as substantive defenses, but the cases provide counterexamples. Common exclusions from UM include government vehicles, off-road vehicles, non-permissive users, and cases in which the covered vehicle is being used as a public or livery conveyance.
Underinsured motorist coverage ("UIM"), discussed in Section 61.03[b], covers the insured if the tortfeasor purchased insurance, often at low limits, but does not have enough coverage to pay all damages incurred. Eight jurisdictions require insureds to purchase UIM. There are two major types of UIM coverage. Pursuant to "gap" coverage, if the insured's UIM coverage exceeds the tortfeasor's liability limits, UIM provides the difference between the tortfeasor's limits and the amount of the insured's UM/UIM limits. On the other hand, "excess" UIM simply adds coverage if the insured's damages exceed the tortfeasor's liability limits.
One of the most significant issues regarding UM and UIM coverage is whether "stacking" is permitted. Section 61.03[c] covers stacking, which can be defined as aggregating multiple sources of insurance coverage to apply to a single loss. Stacking comes in two major varieties. Inter-policy stacking involves aggregating coverage under more than one policy; intra-policy stacking involves aggregating the limits of liability for each vehicle covered under a single policy. The jurisdictions are heavily splintered on whether stacking is permitted. A number of jurisdictions have passed anti-stacking statutes. In inter-policy stacking disputes, the crucial factors tend to be the existence of a statute in the jurisdiction and the existence of policy provisions addressing stacking. The same factors-statutes and provisions-are relevant in intra-policy stacking disputes, but courts also analyze whether multiple premiums were paid, and whether contra proferentem (the principle of construing provisions against the drafter of the instrument, here the insurer) applies.
Cross References: UM and UIM are thoroughly covered in Chapter 65 below. The doctrine of Contra Proferentem is discussed in Chapter 5 in Section 5.02 above.
Medical payments, covered in Section 61.03, is first-party, no-fault coverage of medical expenses, typically in modest amounts of a few thousand dollars. Coverage applies to the insured and the insured's family members while occupying, or as pedestrians when struck by, a motor vehicle, and to any other person while occupying the insured motor vehicle.
Cross Reference: Medical payments are thoroughly covered in Chapter 64.
No-fault automobile insurance, which was designed to improve the efficiency and timeliness of automobile accident compensation and lower insurance costs, can be divided into four types: pure, hybrid, add-on, and choice. "Pure no-fault," which has not been adopted in any American jurisdiction, would completely abolish tort law for automobile accidents. Under a pure no-fault system, no-fault insurance would be compulsory, recovery for economic losses would be compensable through first-party coverage, and pain and suffering would never be compensable.
Nine states and Puerto Rico adopted a hybrid no-fault system. In a "hybrid no-fault" jurisdiction, tort law is not entirely abolished. Someone injured in an automobile accident will recover economic losses, but not pain and suffering, from first-party no-fault insurance. However, if the injured meets a certain threshold, then the injured is eligible to sue in tort, meaning that pain and suffering becomes available. There are two types of thresholds: monetary and verbal. Monetary thresholds are based on a specific amount of damages. If the damages suffered by the injured exceed the monetary threshold, the injured may sue in tort. Verbal thresholds require the injured to meet a verbal formulation of injury, which is often some version of "serious" injury, prior to being able to sue in tort. Many jurisdictions use mixed thresholds, which involve being able to meet either a monetary or a verbal threshold.
"Add-on no-fault" is the most common, and least significant, type of no-fault. It is simply modest, additional first-party coverage of economic loss, similar to medical payments with additional wage coverage. Add-on, adopted by 11 jurisdictions, does not restrict access to tort law in any way.
"Choice no-fault" allows motorists to elect to be insured under either the traditional tort system or a no-fault system. Motorists who choose the traditional tort system retain all those rights and liabilities, including the right to sue and be sued for pain and suffering. Motorists who elect no-fault cannot sue, or be sued, for pain and suffering for minor or modest injuries arising out of automobile accidents. Though no jurisdiction has adopted a robust choice plan, Kentucky, New Jersey, and Pennsylvania have adopted a modest version of choice no-fault. Many insureds in those jurisdictions choose the no-fault option.
Cross Reference: No-fault is thoroughly covered in Chapter 66 below.
Section 61.04 discusses the process of obtaining automobile insurance. Automobile insurance is overwhelmingly sold in individual, not group, policies. In essence, each consumer has to seek automobile insurance on the consumer's own behalf. Several options are available to consumers. Many major automobile insurers are direct writers, meaning the insurer markets insurance directly to consumers through the insurer's own sales representatives or through exclusive agents, representing only that insurer. Direct writers control approximately two-thirds of the private passenger automobile insurance market. Consumers may also use an intermediary to select automobile insurance. Insurance law features two major types of intermediaries: agents and brokers. In general, agents represent insurers, at least for most purposes. Agents can be either exclusive, representing a direct writer, or independent, representing multiple insurers. Brokers represent consumers, at least for many purposes.
The residual market, covered in Section 61.04, provides insurance to consumers who cannot obtain it through the primary market. The risk posed by some drivers may be too high for an insurer to voluntarily bear, even with high premiums. However, the consumer must purchase automobile insurance to comply with compulsory automobile insurance laws. Every jurisdiction has created a residual market for those unable to obtain insurance from any insurer. The vast majority of jurisdictions have created an assigned risk plan. Pursuant to an assigned risk plan, a jurisdiction creates an office governed by a board representing insurance companies licensed in the jurisdiction. When a motorist cannot obtain any insurance, the motorist can apply to the assigned risk plan, which will assign the motorist to one of the insurers writing policies in the jurisdiction. Applicant motorists are assigned to insurers in proportion to the amount of their voluntary business in the jurisdiction.
The application, which seeks information the insurer will use to gauge the risk posed by the applicant, is regarded as an offer by the applicant to the insurer to form a contract of insurance. To properly underwrite, insurers need to be able to rely on the assertions in the application. In earlier cases, courts construed assertions in applications as warranties or representations. A warranty was considered a part of the insurance contract; it had to be literally true and its materiality was irrelevant to the right of the insurer to void the contract. By contrast, a representation was considered collateral to an insurance contract; it need only be substantially true, and representations that were not material did not invalidate the contract. Section 61.04[c] covers the modern treatment of warranty and representation, which, in essence, is to treat warranties as representations.
The general thrust of the law has moved from a warranty/representation distinction to a focus on misrepresentation as the dominant approach to assertions by applicants or insureds in insurance contracts. Section 61.04[d] details the elements of misrepresentation-falsity, materiality, and justifiable reliance-and how those elements tend to be applied by courts. Jurisdictions are particularly reluctant to rescind an automobile insurance policy because of compulsory automobile insurance laws and the goal of protecting accident victims. Regarding falsity, the general rule is that a statement need not be absolutely true in all respects; substantial truth is sufficient for a statement not to be false. Materiality-whether the representation would matter to an insurer that was considering issuing a contract of insurance to the potential insured-is subject to a jurisdiction split regarding whether it should be evaluated objectively or subjectively. The majority of jurisdictions use an objective test. The general rule, and perhaps the best guidance available on the fact-specific issue of materiality, is that a representation is material if an insurer would still have issued a policy to the insured, but would have charged a higher premium. Courts have held that representations as to accident history and license revocation are material. Misrepresentations as to the identity of the owner of the vehicle are generally seen as material. Justifiable reliance is intertwined with materiality, and will necessarily involve a subjective demonstration of the insurer's behavior and preferences. An insurer cannot justifiably rely on a representation if the insurer knows the truth in spite of the representation.
Waiver and estoppel, covered in Section 61.04, are two defenses commonly used by insureds in response to insurer claims of misrepresentation or breach of warranty. Courts use the doctrines to achieve equity in individual cases, adding flexibility, but also enhancing uncertainty. Waiver is the voluntary relinquishment of a known right. An insurer waives the defense of misrepresentation or breach of warranty if, after knowledge of the misrepresentation or breach, the insurer treats the policy as valid and retains the premium as earned. Waivers may be express, but are often implied. As examples, insurers can waive an insured's failure to disclose:
• A child living at home who would be a youthful or underage driver as defined by the insurance policy;
• An insured's erroneous assertion that a vehicle is principally used in a city as opposed to being used for long-distance hauling;
• An insured's failure to pay premiums on time; and
• An insured's failure to meet a notice-of-claim deadline.
An estoppel occurs when the insurer, often through an agent, makes a representation to the insured, and the insured relies upon that representation to the insured's detriment. If these elements are proved, the insurer is estopped from asserting a claim of misrepresentation or breach of warranty. Where an applicant provides truthful answers to an insurance agent during the application process, but the agent records the answers incorrectly, the insurer cannot rely on the falsity of the answers as a defense. The same is true if the agent willfully includes a falsehood in the application. However, if the applicant knows the agent is answering falsely, courts are generally not willing to uphold the insurance contract. Consistent with compulsory automobile insurance laws, some courts have held that estoppel may not be effective on behalf of the insured, but may be effective on behalf of innocent tort victims.
An automobile insurance policy is generally effective during the time period described in the "policy period" section of the Declarations page, which lists a beginning and an end date. If the insured acquires a new vehicle during the policy period, the modern trend is to immediately cover any "newly acquired auto," and provide such insurance for a short grace period during which the insured can request that the insurer cover the vehicle.
Section 61.04 covers proof of insurance. Due to compulsory insurance and financial responsibility laws, insureds need to maintain proof of insurance. The best way to prove insurance coverage is with a copy of the policy or the proof of insurance card provided by the insurer. However, if the insured has not yet received physical possession of the policy, the issue is whether the insurer has issued a policy to the insured. Issuance is usually interpreted to include delivery. Delivery, in turn, primarily concerns an insurer's intent; if the insurer has put the policy outside of its legal control, even if not outside its actual possession, delivery has occurred.
Another way to prove coverage is with a binder. A binder is a temporary insurance policy that is in place from the time an application is filed until the applicant is declined or the permanent insurance policy is effective. Binders are usually issued only once the insured has paid the first premium. Binders are used frequently in the automobile insurance context. Most jurisdictions explicitly provide that the binder must contain the same terms as the policy applied for, in addition to any other addendums, conditions, or other provisions expressly contained in the binder itself. However, many jurisdictions also permit oral binders, meaning questions of interpretation can arise. Furthermore, oral binders are less valuable as proof of insurance.
Section 61.05 discusses who qualifies as an insured in an automobile insurance policy. The Named Insured, the person listed on the Declarations page, is covered. Furthermore, the policy covers the Named Insured's family members who reside in the Named Insured's household. One issue that arises often is whether a family member who is not presently living at the residence of the Named Insured is, nevertheless, still a member of the Named Insured's household. Children of the Named Insured who are away at college or in the military are common examples of the issue. In this context, membership in a group instead of attachment to a building is the issue; it is more a matter of intent and choice than location. The general rule is that a child away at college is still a member of the Named Insured's household; results are less consistent for children of the Named Insured who join the military.
Another common situation is when the spouse of the Named Insured is living in a separate location because of marital difficulties. Again, the crux of the matter is intent. There is a difference between a trial separation and a case in which the couple has no hope or plan to reconcile.
Automobile insurance covers any person driving a vehicle with the permission of the Named Insured. In the past, courts were divided among a conservative, liberal, and "minor deviation" approach to whether permission existed. The modern approach, discussed in Section 61.05[b], is to insure any person using the covered automobile, and exclude from coverage those without a "reasonable belief" that permission exists to use the vehicle. However, many policies cover a family member of the Named Insured even if the family member lacks a reasonable belief that permission exists to use the vehicle.
Section 61.06 covers what constitutes an automobile for purposes of automobile insurance. Cars are the quintessential automobile. Personal trucks and vans are considered automobiles. Trailers are also considered automobiles. In general, motorcycles and farm equipment are not considered automobiles.
Section 61.07 discusses how coverage is initiated under an automobile insurance policy. The insured is responsible for promptly reporting accidents or incidents that may require coverage to the insurer. Failure to do so has the potential to void coverage. However, the majority of jurisdictions require that the insurer prove not only a breach of the obligation to provide notice, but also prejudice to the insurer from the breach. Courts focus on whether late or nonexistent notice undermined a proper investigation or defense. Furthermore, some courts hold that compulsory automobile insurance laws trump the failure to notify because of the effect on injured accident victims.
Section 61.07 covers the insurer's duties once notice is received. The insurer has a duty to acknowledge receipt of the notice and keep the insured informed. One of the most significant issues is whether the insurer has a duty to defend the insured. One of the major benefits of liability insurance to the insured is that the insurer will pay the cost of defending the insured against lawsuits filed by third parties, as long as the lawsuit contains allegations that are potentially within the coverage of the policy. The focus is on the nature, not the veracity, of the allegations; the insurer has a duty to defend even if the allegations are groundless, false, or fraudulent. There is a jurisdictional split over whether to examine information beyond the allegations in the complaint when determining whether there is a duty to defend.
Cross References: Further coverage of the duty to defend is in Chapter 17 above and in New Appleman Insurance Law Library Edition Chapter 11A.
Section 61.08 covers the insured's duties at the scene of the accident and during the investigation and trial of the matter. At the scene of the accident, the insured's primary duty to the insurer is not to interfere with the insurer's subrogation right by releasing a person from whom the insurer could recover damages. During the investigation and trial, the insured must:
• Provide the insurer with any notices or legal papers the insured receives;
• Aid the insurer in securing witnesses;
• Provide the insurer with truthful information about the accident, and
• Appear for important procedures, such as interviews, depositions, and the trial.
The rules governing failure of an insured to cooperate parallel the rules governing failure to notify the insurer of a potential claim. Just as in the failure to notify context, a potential consequence of failure to cooperate is voidance of insurance coverage. Moreover, in the vast majority of jurisdictions, it is a two-step analysis. First, the insurer must prove a breach of the duty to cooperate, which is a based on the facts and circumstances of each case, and is generally an issue for the finder of fact. In addition to the issue of whether the duty to cooperate was breached, most jurisdictions also require a demonstration of prejudice to the insurer, though a few only require a material breach. Finally, as in failure to notify, many courts restrict the voiding of insurance based on failure to cooperate because of the compulsory nature of automobile insurance.
Section 61.09 discusses the related concepts of termination, cancellation, and renewal. "Cancellation" and "termination" are terms of art in insurance law. "Cancellation" means termination of the policy prior to the policy period by the act of the insurer or insured. By contrast, "termination" means the lapse of the policy under its own terms. "Renewal" means that insurer and insured agree to continue the insurance relationship for the duration of another policy period after the termination of a prior policy period. Typically, the insured has a contractual right to cancel the policy. Insurers also have the right to cancel the policy, but policies and statutes frequently restrict the right to cancel to reasons such as nonpayment of the premium, suspension or revocation of an insured's driver's license, or the policy being obtained through a material misrepresentation. Statutory and policy notice requirements limit the discretion of insurers.
Finally, Section 61.10 covers additional incentives to both insureds and insurers to conduct their relationship in good faith. Beyond the possible voiding of the insurance policy, insureds are potentially susceptible to criminal fraud charges for making false claims to obtain insurance coverage not due to the insured. Punishment includes fines and even incarceration in many jurisdictions.
Bad faith actions were created to provide incentives to insurers to properly consider the insured's interests in processing claims. Critics argued that if an insurer denied a claim, the worst thing that could happen to the insurer is that the insurer would later have to pay the claim. The incentive was to simply deny claims and see what would happen. Thus, if an insurer is held liable for bad faith, the insurer must pay the claim for the insured, including any amount over the policy limits. This is true regardless of whether contract or tort is the doctrinal basis for bad faith. A tort basis makes possible (though all tort-based jurisdictions do not necessarily adopt) remedies for noneconomic damages, such as emotional distress, and, if the specific standard is met, punitive damages. The biggest challenge in bad faith doctrine appears to be the vagueness of the concept itself; many jurisdictions rely on what is essentially a recklessness or "fairly debatable" standard.
Cross References: Further discussion of bad faith is in Chapter 23 above and Barker & Kent, New Appleman Insurance Bad Faith Litigation, Second Edition .
Christopher J. Robinette is Associate Professor at the Widener University School of Law. He is a graduate of the College of William & Mary (B.A., cum laude, 1993) and the University of Virginia School of Law (J.D., 1996). At Widener, he teaches Torts, Insurance, Contracts, Evidence, and Professional Responsibility. He is co-author, with Jeffrey O'Connell, of A RECIPE FOR BALANCED TORT REFORM (2008). He has authored or co-authored articles and essays in the University of Illinois Law Review, Northwestern University Law Review, George Mason Law Review, Connecticut Law Review, Tennessee Law Review, Northern Illinois University Law Review, and Brandeis Law Journal. In addition, he has written for symposia in the Charleston Law Review and Widener Law Journal. At Widener, he has won awards for both scholarship and teaching. He serves as an editor of TortsProf Blog: http://lawprofessors.typepad.com/tortsprof/. Ken Abraham, Jeffrey O'Connell, and Sheila Scheuerman provided valuable comments on a previous draft of this chapter. Stefanie Pitcavage, Tricia Lontz, Kari Panza, and Casey Welsh contributed excellent research assistance.
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