Underinsured motorist benefits are designed to help pay for costs related to a car accident when the at-fault party’s insurance policy falls short. Underinsured coverage is generally elective, and several cases have looked at whether or not benefits were explicitly rejected. In Progressive Direct Ins. Co. v. Wilson (16-P-544), a mother and a son appealed a declaratory judgment entered in favor of the mother’s auto insurance company. The insurer claimed that the policy only provided underinsured benefits to members of the household, and the son was not a member of the household as defined by the policy.
The mother and son argued that the court erred by granting the insurer’s motion, and the insurer should be estopped from denying the son benefits based on a conversation the mother had with a representative. The appellate court looked first at the mother’s policy, which provides damages to “any household member…while occupying an auto not owned by you.” The household member must be related by blood, marriage, or adoption. To counter the mother and son’s claim, the insurer provided medical records, a driver’s license, and a lease to show that the son lived in Unit One of the building, rather than Unit Two, where his mother resided. The insurer also pointed to a conversation the mother held with an insurance representative prior to the purchase of her policy. In that conversation, the mother stressed that the son did not live in the unit with her and that he lived downstairs.
At the lower court, the mother and son insisted that they did live in the same household, pointing to all of the parties doing laundry in Unit One, the fact that both units were always accessible to the other members of the family through unlocked back doors, and the tradition of the mother cooking for the entire family. The mother viewed the conversation with the representative as proof that she relied on the representative in her understanding of the policy. The court disagreed, finding that estoppel was not applicable in this circumstance. For estoppel to occur, there must be a representation that is intended to induce reliance, an act or omission by the person because of the reliance, and a detriment as a consequence. The court did not think the mother could come away from the conversation with the mistaken understanding that her son was covered under the policy because the bulk of the conversation dealt with where he didn’t live. The representative did not make any statement or implication that the son did not need to be listed in order to receive underinsured benefits. There was no mention of underinsured motorist coverage. The lower court’s ruling was upheld, and the declaratory judgment against the insured and her son remained intact.
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