Aguado v. XL Insurance America

District Court, D. Arizona·Decided March 5, 2024·No. 2:23-cv-02528·Unknown

Opinion

WO

Sergio Mireles Aguado, No. CV-23-02528-PHX-DGC

Plaintiff, ORDER

v.

XL Insurance America; Intercare Holdings, Inc.; Maria E. Flores; and Saul Rodriguez, Defendants.

Plaintiff Sergio Mireles Aguado asserts a bad faith tort claim against Defendant XL Insurance America (“XL Insurance”) and aiding and abetting claims against Defendants Intercare Holdings, Inc. (“Intercare”), Maria Flores, and Saul Rodriguez. Intercare has filed a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6). Doc. 13. The motion is fully briefed and no party requests oral argument. For reasons stated below, the Court will grant the motion.1 I. Background. Plaintiff’s complaint contains the following allegations. See Doc. 1-1 at 2-15. XL Insurance provides employees in Arizona with coverage under the Arizona Workers’ Compensation Act. Intercare is the third-party administrator that processes insurance

1 XL Insurance has filed an answer to the complaint, and takes no position on Intercare’s motion. Docs. 6, 16. Flores and Rodriguez waived service of process and have until March 8, 2024 to answer or otherwise respond to the complaint. Docs. 21, 22. claims on behalf of XL Insurance. Flores and Rodriquez are employees of Intercare. Id. ¶¶ 3-6, 30, 38. Plaintiff filed a workers’ compensation claim after suffering an injury while working for D & J Packing on January 9, 2021. Id. ¶ 9. Defendants accepted the claim on April 7, 2021. On May 19, 2022, Defendants issued a notice terminating Plaintiff’s benefits based on the assertion that he had left the state without the permission of the Industrial Commission of Arizona (“ICA”). On June 10, 2022, Defendants rescinded the notice but suspended Plaintiff’s benefits for same reason. Id. ¶ 10. Plaintiff was forced to hire an attorney and obtain a hearing before the ICA, at which Defendants failed to appear. Plaintiff testified that he did not leave Arizona for a continuous two-week period. The ICA found Plaintiff’s testimony to be credible and awarded payment of all benefits. Id. ¶¶ 12-13. Defendants then assigned a new adjuster to the claim and disputed the benefits owed to Plaintiff by requiring him to undergo an independent medical exam. The sole purpose of the exam was to manufacture a new reason to delay and deny payment of benefits. Id. ¶ 14. Plaintiff claims that Defendants chose to discontinue payment of benefits without an adequate investigation or a reasonable basis and otherwise acted in bad faith in processing the claim. Id. ¶¶ 11, 15-16. II. Rule 12(b)(6) Standard. A successful motion to dismiss under Rule 12(b)(6) must show that the complaint lacks a cognizable legal theory or fails to allege facts sufficient to support its theory. Balistreri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 1990). A complaint that sets forth a cognizable legal theory will survive a motion to dismiss if it contains “sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 554, 570 (2007)). While a complaint’s factual allegations need not be detailed, surviving a motion to dismiss “requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Twombly, 550 U.S. at 555; see Iqbal, 556 U.S. at 678 (“Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.”). III. Discussion. “Arizona law implies a covenant of good faith and fair dealing in every contract.” Wells Fargo Bank v. Ariz. Laborers, Teamsters & Cement Masons Loc. No. 395 Pension Tr. Fund, 38 P.3d 12, 28 (Ariz. 2002). The duty imposed by the implied covenant “prohibits a party from doing anything to prevent other parties to the contract from receiving the benefits and entitlements of the agreement. The duty arises by operation of law but exists by virtue of a contractual relationship.” Id. (citing Rawlings v. Apodaca, 726 P.2d 565, 569-70 (Ariz. 1986)). An insured may seek damages for the insurer’s breach of the duty by asserting a claim for the tort of bad faith. See Rawlings, 726 P.2d at 574. In this context, “[t]he tort of bad faith arises when the insurer ‘intentionally denies, fails to process or pay a claim without a reasonable basis.’” Zilisch v. State Farm Mut. Auto. Ins., 995 P.2d 276, 279 (Ariz. 2000) (quoting Noble v. Nat’l Am. Life Ins., 624 P.2d 866, 868 (Ariz. 1981)). Plaintiff alleges in count one that XL Insurance committed the tort of bad faith by refusing to properly investigate and promptly pay Plaintiff’s workers’ compensation claim. Doc. 1-1 at 2-15, ¶ 20. Plaintiff alleges in count two that Intercare is liable for the tort of aiding and abetting because it substantially assisted or encouraged XL Insurance in delaying and denying the claim. Id. ¶ 27. Intercare argues that count two fails to state a claim for relief because it alleges nothing more than the same conduct underpinning the bad faith claim asserted against XL Insurance. Doc. 13 at 2. In support, Intercare relies on several decisions from courts in this District dismissing aiding and abetting claims against individual adjusters or third- party administrators where the claims allege no action separate from the conduct giving rise to the bad faith claim against the insurer. Id. at 2, 8-10 (citing Young v. Liberty Mut. Grp., No. CV-12-2302-PHX-JAT, 2013 WL 840618, at *3 (D. Ariz. Mar. 6, 2013); Ortiz v. Zurich Am. Ins., No. CV-13-02097-PHX-JAT, 2014 WL 1410433, at *3 (D. Ariz. Apr. 11, 2014); Lambert v. Liberty Mut. Fire Ins., No. 2:14-CV-00521-JWS, 2014 WL 5432154, at *2 (D. Ariz. Oct. 24, 2014); Rosso v. Liberty Ins., No. CV-16-00860-PHX- DLR, 2016 WL 4013614, at *2-3 (D. Ariz. July 27, 2016); Centeno v. Am. Liberty Ins., No. CV-18-01059-PHX-SMB, 2019 WL 568926, at *3 (D. Ariz. Feb. 12, 2019); Garibaldi v. Everest Nat’l Ins., No. CV-19-02558-DLR, 2019 WL 12287472, at *1 (D. Ariz. Oct. 7, 2019)). Plaintiff counters with other decisions from courts in this District, including decisions from the undersigned judge, that denied dismissal of aiding and abetting claims in this context. Doc. 14 at 2, 5-9 (citing Morrow v. Bos. Mut. Life Ins., No. CIV. 06-2635- PHX-SMM, 2007 WL 3287585, at *5 (D. Ariz. Nov. 5, 2007); Pimal Prop. v. Cap. Ins. Grp., No. CV11-02323-PHX-DGC, 2012 WL 608392, at *6 (D. Ariz. Feb. 27, 2012); Inman v. Wesco Ins., No. CV-12-02518-PHX-GMS, 2013 WL 2635603, at *3-4 (D. Ariz. June 12, 2013); Miller v. York Risk Servs., No. 2:13-CV-1419 JWS, 2013 WL 6442764, at *5 (D. Ariz. Dec. 9, 2013); Wilson v. Accident Fund Gen. Ins., No. 2:13-CV-2012-HRH, 2013 WL 6670330, at *1-3 (D. Ariz. Dec. 18, 2013); Haney v. ACE Am. Ins., No. CV-13- 02429-PHX-DGC, 2014 WL 1230503, at *4-5 (D. Ariz. Mar. 25, 2014); Temple v. Hartford Ins. Co. of Midwest, 40 F. Supp. 3d 1156, 1170 (D. Ariz. Aug. 26, 2014); Gastelo v. Wesco Ins., No. CV-18-02659-PHX-MTL, 2020 WL 1285912, at *3 (D. Ariz. Mar. 18, 2020); Hoffman v. Cincinnati Ins., No. CV-21-00106-TUC-JCH, 2021 WL 4962648, at *3 (D. Ariz. Oct. 26, 2021)). Having carefully considered the relevant legal authority and the complaint’s allegations, the Court concludes that Plaintiff has failed to state a viable aiding and abettin

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