Umbrella Policy
A Personal Umbrella Policy (PUP) is a necessary addition to insurance protection for most people. But how do you become aware of the importance of this valuable coverage? One of the best ways is to read about actual claim examples which demonstrate how an incident arising from normal daily activities can expose all of us to the potential for a large claims suit.
Listed below are actual Personal Umbrella Policy (PUP) claims. By reviewing the following claim scenarios, you will understand why a Personal Umbrella should be a vital part of your insurance portfolio.
Claim Scenario #1
On the date of loss, the son of our named insured joined a group of friends to play poker and watch the Olympic ceremonies on TV at a friend’s home. The parents were out of town but had given their child permission to have guests. Several individuals brought paintball guns and the teen host advised everyone to wear protective masks.
The teens went outside to shoot at trees. As the teens began shooting at each other, many ran into the house. Our insured’s son began shooting at one of the attendees. As that person ran into the house to avoid being hit, he ran past the claimant who then apparently opened the door and was struck in the eye with a paintball fired by the son of our insured.
There is conflicting testimony as to whether anyone was using protective eye gear. The claimant alleges he was not going outside to participate in the paintball fight, but only to see what was happening with all his friends outside.
The claimant suffered severe blunt trauma to his eye, was forced to have the lens of the eye removed, and as a result is legally blind due to his 20/200 vision in his other eye.
Suit was filed against our insured since his son is a member of the household. The host of the party was also named as a defendant.
After ten hours of mediation, the insurance company ultimately paid $500,000 from the $2 million Personal Umbrella Policy (PUP).
Claim Scenario #2
The plaintiff was a guest of the insured at his cabin primarily used when he went deer hunting. The guest suffered fatal injuries in a fall from a loft in the cabin. The main issue in the case was the configuration of the railing to this area at the time of the accident.
There is a loft sleeping area accessible by a “ship’s ladder”. The open side of this area was protected by a railing but there is a dispute as to what it looked like on the day of the accident.
The plaintiff experts maintain that the nail holes and finish marks indicate a system of just over 30″ was in place (i.e., 6″ below original code) which was not in keeping with either the insured’s or his son’s configurations. The plaintiff had been drinking heavily and was found on the floor during the night by another guest. It is not known whether he fell over the top of the rail, ro11ed under the rail or fell after he had already descended to the lower floor. Experts estimate his blood alcohol level at .20% at the time of the accident.
The defense expert opens that the plaintiff was already downstairs and fell from a standing position because there are no medical notes on lower body injuries - i.e., his legs would have to hit hard and be bruised as well. However, one witness heard a loud noise that sounded like something falling and plaintiff expert will state that the evidence indicates that plaintiff fell from the loft.
The plaintiff (age 45) was married and had three children and was employed making an average of $52,000 in earnings over the last five years for a loss of $1,040,000 to age sixty-five. He suffered massive head injuries and remained in a near-vegetative state until his death nine months later. His medical expenses were $425,000.
The insurance company ultimately paid $975,000 from the $5 million policy.
Claim Scenario #3
Mr. Insured (age 66) was backing 15 feet out of his driveway when he hit his Mrs. Neighbor, who was walking in the street. There were no obstructions to his view and his neighbor may have been wearing headphones.
Mrs. Neighbor fell to the ground and hit her head on the pavement and lost consciousness. She was transported to the hospital by ambulance. The police report indicates that unsafe backing was the cause of the accident.
No citations were issued. There are no witnesses to the accident.
Mrs. Neighbor (age 69) sustained a fractured skull. She also injured her right elbow and right knee. The extent of her lost wage claim is unknown.
Initially Mrs. Neighbor was awake and oriented in the hospital, but after three days her mental state worsened, she became agitated and non-responsive to commands. She was diagnosed with pneumonia and was intubated and placed on a feeding tube. She remained unresponsive for several days and was noted to have acute kidney insufficiency.
Limited medical records note that she improved and after two weeks in the hospital was transferred to a rehabilitation facility. The extent of her recovery is unknown at this time, but she reportedly continues to experience cognitive deficits, coordination problems and has lost the hearing in her left ear.
There is pure comparative liability in this state. Records indicate that Mrs. Neighbor was working parttime as a teacher at the time of the accident.
The Insurance Company ultimately paid the full $1 million Personal Umbrella Policy (PUP) limit.