Aguado v. XL Insurance America

CourtDistrict Court, D. Arizona
DecidedMarch 5, 2024
Docket2:23-cv-02528
StatusUnknown

This text of Aguado v. XL Insurance America (Aguado v. XL Insurance America) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aguado v. XL Insurance America, (D. Ariz. 2024).

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9

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

11 Plaintiff, ORDER

12 v.

13 XL Insurance America; Intercare Holdings, Inc.; Maria E. Flores; and Saul Rodriguez, 14 Defendants.

16 17 Plaintiff Sergio Mireles Aguado asserts a bad faith tort claim against Defendant XL 18 Insurance America (“XL Insurance”) and aiding and abetting claims against Defendants 19 Intercare Holdings, Inc. (“Intercare”), Maria Flores, and Saul Rodriguez. Intercare has 20 filed a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6). Doc. 13. 21 The motion is fully briefed and no party requests oral argument. For reasons stated below, 22 the Court will grant the motion.1 23 I. Background. 24 Plaintiff’s complaint contains the following allegations. See Doc. 1-1 at 2-15. XL 25 Insurance provides employees in Arizona with coverage under the Arizona Workers’ 26 Compensation Act. Intercare is the third-party administrator that processes insurance

27 1 XL Insurance has filed an answer to the complaint, and takes no position on 28 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. 1 claims on behalf of XL Insurance. Flores and Rodriquez are employees of Intercare. Id. 2 ¶¶ 3-6, 30, 38. 3 Plaintiff filed a workers’ compensation claim after suffering an injury while 4 working for D & J Packing on January 9, 2021. Id. ¶ 9. Defendants accepted the claim on 5 April 7, 2021. On May 19, 2022, Defendants issued a notice terminating Plaintiff’s 6 benefits based on the assertion that he had left the state without the permission of the 7 Industrial Commission of Arizona (“ICA”). On June 10, 2022, Defendants rescinded the 8 notice but suspended Plaintiff’s benefits for same reason. Id. ¶ 10. 9 Plaintiff was forced to hire an attorney and obtain a hearing before the ICA, at 10 which Defendants failed to appear. Plaintiff testified that he did not leave Arizona for a 11 continuous two-week period. The ICA found Plaintiff’s testimony to be credible and 12 awarded payment of all benefits. Id. ¶¶ 12-13. 13 Defendants then assigned a new adjuster to the claim and disputed the benefits owed 14 to Plaintiff by requiring him to undergo an independent medical exam. The sole purpose 15 of the exam was to manufacture a new reason to delay and deny payment of benefits. Id. 16 ¶ 14. 17 Plaintiff claims that Defendants chose to discontinue payment of benefits without 18 an adequate investigation or a reasonable basis and otherwise acted in bad faith in 19 processing the claim. Id. ¶¶ 11, 15-16. 20 II. Rule 12(b)(6) Standard. 21 A successful motion to dismiss under Rule 12(b)(6) must show that the complaint 22 lacks a cognizable legal theory or fails to allege facts sufficient to support its theory. 23 Balistreri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 1990). A complaint that 24 sets forth a cognizable legal theory will survive a motion to dismiss if it contains “sufficient 25 factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” 26 Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 27 554, 570 (2007)). While a complaint’s factual allegations need not be detailed, surviving 28 a motion to dismiss “requires more than labels and conclusions, and a formulaic recitation 1 of the elements of a cause of action will not do.” Twombly, 550 U.S. at 555; see Iqbal, 556 2 U.S. at 678 (“Threadbare recitals of the elements of a cause of action, supported by mere 3 conclusory statements, do not suffice.”). 4 III. Discussion. 5 “Arizona law implies a covenant of good faith and fair dealing in every contract.” 6 Wells Fargo Bank v. Ariz. Laborers, Teamsters & Cement Masons Loc. No. 395 Pension 7 Tr. Fund, 38 P.3d 12, 28 (Ariz. 2002). The duty imposed by the implied covenant 8 “prohibits a party from doing anything to prevent other parties to the contract from 9 receiving the benefits and entitlements of the agreement. The duty arises by operation of 10 law but exists by virtue of a contractual relationship.” Id. (citing Rawlings v. Apodaca, 11 726 P.2d 565, 569-70 (Ariz. 1986)). 12 An insured may seek damages for the insurer’s breach of the duty by asserting a 13 claim for the tort of bad faith. See Rawlings, 726 P.2d at 574. In this context, “[t]he tort 14 of bad faith arises when the insurer ‘intentionally denies, fails to process or pay a claim 15 without a reasonable basis.’” Zilisch v. State Farm Mut. Auto. Ins., 995 P.2d 276, 279 16 (Ariz. 2000) (quoting Noble v. Nat’l Am. Life Ins., 624 P.2d 866, 868 (Ariz. 1981)). 17 Plaintiff alleges in count one that XL Insurance committed the tort of bad faith by 18 refusing to properly investigate and promptly pay Plaintiff’s workers’ compensation claim. 19 Doc. 1-1 at 2-15, ¶ 20. Plaintiff alleges in count two that Intercare is liable for the tort of 20 aiding and abetting because it substantially assisted or encouraged XL Insurance in 21 delaying and denying the claim. Id. ¶ 27. 22 Intercare argues that count two fails to state a claim for relief because it alleges 23 nothing more than the same conduct underpinning the bad faith claim asserted against XL 24 Insurance. Doc. 13 at 2. In support, Intercare relies on several decisions from courts in 25 this District dismissing aiding and abetting claims against individual adjusters or third- 26 party administrators where the claims allege no action separate from the conduct giving 27 rise to the bad faith claim against the insurer. Id. at 2, 8-10 (citing Young v. Liberty Mut. 28 Grp., No. CV-12-2302-PHX-JAT, 2013 WL 840618, at *3 (D. Ariz. Mar. 6, 2013); Ortiz 1 v. Zurich Am. Ins., No. CV-13-02097-PHX-JAT, 2014 WL 1410433, at *3 (D. Ariz. 2 Apr. 11, 2014); Lambert v. Liberty Mut. Fire Ins., No. 2:14-CV-00521-JWS, 2014 WL 3 5432154, at *2 (D. Ariz. Oct. 24, 2014); Rosso v. Liberty Ins., No. CV-16-00860-PHX- 4 DLR, 2016 WL 4013614, at *2-3 (D. Ariz. July 27, 2016); Centeno v. Am. Liberty Ins., 5 No. CV-18-01059-PHX-SMB, 2019 WL 568926, at *3 (D. Ariz. Feb. 12, 2019); Garibaldi 6 v. Everest Nat’l Ins., No. CV-19-02558-DLR, 2019 WL 12287472, at *1 (D. Ariz. Oct. 7, 7 2019)). 8 Plaintiff counters with other decisions from courts in this District, including 9 decisions from the undersigned judge, that denied dismissal of aiding and abetting claims 10 in this context. Doc. 14 at 2, 5-9 (citing Morrow v. Bos. Mut. Life Ins., No. CIV. 06-2635- 11 PHX-SMM, 2007 WL 3287585, at *5 (D. Ariz. Nov. 5, 2007); Pimal Prop. v. Cap. Ins. 12 Grp., No. CV11-02323-PHX-DGC, 2012 WL 608392, at *6 (D. Ariz. Feb. 27, 2012); 13 Inman v. Wesco Ins., No. CV-12-02518-PHX-GMS, 2013 WL 2635603, at *3-4 (D. Ariz. 14 June 12, 2013); Miller v. York Risk Servs., No. 2:13-CV-1419 JWS, 2013 WL 6442764, 15 at *5 (D. Ariz. Dec. 9, 2013); Wilson v. Accident Fund Gen. Ins., No. 2:13-CV-2012-HRH, 16 2013 WL 6670330, at *1-3 (D. Ariz. Dec. 18, 2013); Haney v. ACE Am. Ins., No. CV-13- 17 02429-PHX-DGC, 2014 WL 1230503, at *4-5 (D. Ariz. Mar. 25, 2014); Temple v. 18 Hartford Ins. Co. of Midwest, 40 F. Supp. 3d 1156, 1170 (D. Ariz. Aug. 26, 2014); Gastelo 19 v. Wesco Ins., No.

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Related

Watters v. Wachovia Bank, N. A.
550 U.S. 1 (Supreme Court, 2007)
Ashcroft v. Iqbal
556 U.S. 662 (Supreme Court, 2009)
Noble v. National American Life Insurance
624 P.2d 866 (Arizona Supreme Court, 1981)
Zilisch v. State Farm Mutual Automobile Insurance
995 P.2d 276 (Arizona Supreme Court, 2000)
Rawlings v. Apodaca
726 P.2d 565 (Arizona Supreme Court, 1986)
Temple v. Hartford Insurance
40 F. Supp. 3d 1156 (D. Arizona, 2014)

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Aguado v. XL Insurance America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aguado-v-xl-insurance-america-azd-2024.