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Zimmerman v. Allstate Property and Casualty Ins.

Summarized by: 

Date Filed: 10-03-2013
Case #: S060011
Landau, J., for the Court.
Full Text Opinion: http://www.publications.ojd.state.or.us/docs/S060011.pdf

Insurance Law: Determining if notice of “proof-of-loss” of a UIM claim is sufficient is a pragmatic and functional inquiry that must be satisfied by the record. Additionally, a letter accepting coverage and offering arbitration is sufficient to trigger the "safe harbor" of ORS 742.061(3).

Allstate Property and Casualty Ins. (“Allstate”) appealed the Court of Appeal’s ruling that Sarah Zimmerman’s (“Zimmerman”) initial report to Allstate showed “proof-of-loss” of Under Insured Motorist (UIM) benefits. Zimmerman was injured in an automobile accident on December 22, 2006 caused by Louis Alvis (“Alvis”). Zimmerman reported the accident to Allstate, but the record is unclear whether she disclosed the insurance status of Alvis. In September 2008, Allstate was informed Zimmerman would pursue a UIM claim against Allstate, subsequently Allstate informed Zimmerman it accepted coverage and would consent to arbitration if they could not reach an agreement of benefits provided by the claim. Zimmerman received the policy limits from Alvis’s insurance. Allstate refused to pay Zimmerman’s $75,000 UIM claim. The claim went to trial and Zimmerman won. Subsequently her attorney was awarded fees pursuant to ORS 742.061(1).  Allstate argues that Zimmerman’s initial request for PIP coverage did not contain adequate information to trigger an investigation for UIM claims and in October of 2008, they accepted coverage and offered to arbitrate damages. Zimmerman argues that the accident report in 2006 included information adequate enough to suffice as “proof-of-loss” of a UIM claim, and the October 2008 letter from Allstate was insufficient to provide the “safe harbor” of ORS 742.061(3). The Supreme Court held that Zimmerman’s initial report was not a sufficient “proof-of-loss” of a UIM claim because nothing in the record indicated Zimmerman required a UIM claim until 2008. Determining if a notice of “proof-of-loss” of a UIM claim was sufficient is a pragmatic and functional inquiry that was not satisfied. Additionally the Court held Allstate’s letter accepting coverage and offering arbitration was sufficient to trigger the “safe harbor” of ORS 742.061(3). Reversed and remanded.