Allstate Insurance Company v. 411 Help, LLC

CourtDistrict Court, E.D. Michigan
DecidedSeptember 30, 2021
Docket2:20-cv-12939
StatusUnknown

This text of Allstate Insurance Company v. 411 Help, LLC (Allstate Insurance Company v. 411 Help, LLC) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allstate Insurance Company v. 411 Help, LLC, (E.D. Mich. 2021).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION

ALLSTATE INSURANCE CO., ALLSTATE FIRE AND CASUALTY INSURANCE CO., ALLSTATE PROPERTY AND CASUALTY INSURANCE CO., ESURANCE INSURANCE CO., and ESURANCE PROPERTY AND CASUALTY INSURANCE CO.,

Plaintiffs, Civil Case No. 20-12939 v. Honorable Linda V. Parker

411 HELP, LLC, 4 UR RECOVERY THERAPY LLC, A1 OCCUPATIONAL THERAPY LLC, GRAVITY IMAGING, LLC, 4 TRANSPORT INC., NEW HORIZON CHIROPRACTIC PLLC, SPINE & HEALTH PLLC, FIRST MEDICAL GROUP, PLLC, UNIQUE LAB SOLUTIONS LLC, 4 HEALTH MANAGEMENT LLC, VELOCITY MRS – FUND IV, LLC, VELOCITY MRS – FUND V, LLC, HMRF – FUND III, LLC, NATIONAL HEALTH FINANCE DM, LLC, HASSAN FAYAD, MIRNA FAYAD, WILLIAM GONTE, M.D., GEOFFREY KEMOLI SAGALA, D.C., and ERNESTO CARULLA, P.T.

Defendants. __________________________________/

OPINION AND ORDER

This dispute arises from no-fault insurance benefits Plaintiffs paid to Defendants. Plaintiffs are insurance companies providing no-fault insurance coverage in Michigan. In a Complaint filed November 2, 2020, Plaintiffs allege that Defendants engaged in a scheme to defraud Plaintiffs by submitting and causing to be submitted false and fraudulent medical records, bills, and invoices

through interstate wires and the U.S. mail in violation of the federal Racketeer Influenced Corrupt Organizations Act (“RICO”), 18 U.S.C. § 1962(c) and (d), and state law. Counter-Complaints have been filed by various Defendants, alleging

that Plaintiffs breached insurance contracts by failing to pay no-fault benefits due to Defendants’ patients and Plaintiffs’ insureds. The Counter-Complaint also seeks a declaration that the unpaid benefits are owed. Presently before the Court are the following motions:

• A Motion for More Definite Statement or, in the Alternative, to Dismiss filed by Defendants HMRF Fund – III, LLC and Velocity MRS – Fund IV, LLC (ECF No. 91);

• A Motion to Dismiss Counterclaim filed by Plaintiffs (ECF No. 100); and

• A Motion to Dismiss filed by 411 Help, LLC, UR Recovery Therapy LLC, A1 Occupational Therapy LLC, Gravity Imaging, LLC, 4 Transportation, Spine & Health PLLC, First Medical Group, PLLC, 4 Health Management LLC, Hassan Fayad, and Mirna Fayad (collectively “Fayad Defendants”) (ECF No. 110).

The motions have been fully briefed. Finding the legal arguments sufficiently presented in the parties’ briefs, the Court is dispensing with oral argument pursuant to Eastern District of Michigan Local Rule 7.1(f). 2 I. Standard of Review The Federal Rules of Civil Procedure require that a plaintiff’s complaint

contain only “a short and plain statement” showing the court’s jurisdiction, entitlement to relief, and the relief sought. Fed. R. Civ. P. 8(a). “To survive a motion to dismiss, a complaint must contain 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 Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007)). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable

for the misconduct alleged.” Id. (citing Twombly, 550 U.S. at 556.) The plausibility standard “does not impose a probability requirement at the pleadings stage; it simply calls for enough facts to raise a reasonable expectation that

discovery will reveal evidence of illegal [conduct].” Twombly, 550 U.S. at 556. Where a pleading alleges fraud, the Federal Rules of Civil Procedure impose a heightened pleading requirement. See Fed. R. Civ. P. 9(b) (providing that “[i]n alleging fraud or mistake, a party must state with particularity the circumstances

constituting fraud or mistake.”). To meet Rule 9(b)’s particularity requirement, a complaint must “(1) specify the statements that the plaintiff contends were fraudulent, (2) identify the speaker, (3) state where and when the statements were

3 made, and (4) explain why the statements were fraudulent.” Frank v. Dana Corp., 547 F.3d 564, 570 (6th Cir. 2008) (internal quotations and citations omitted).

In deciding whether the plaintiff has set forth a “plausible” claim, the court must accept the factual allegations in the complaint as true. Erickson v. Pardus, 551 U.S. 89, 94 (2007). This presumption, however, is not applicable to legal

conclusions. Iqbal, 556 U.S. at 668. Therefore, “[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.” Id. (citing Twombly, 550 U.S. at 555). Rule 12(e) of the Federal Rules of Civil Procedure allows a party to move

for a more definite statement before responding to the pleading when the pleading “is so vague or ambiguous that a party cannot reasonably be required to frame a responsive pleading[.]” The motion is “ordinarily restricted to situations where a

pleading suffers from unintelligibility rather than want of detail, and if the requirements of the general rule as to pleadings are satisfied and the opposing party is fairly notified of the nature of the claim such motion is inappropriate.” Sheffield v. Orius Corp., 211 F.R.D. 411, 414-15 (D. Or. 2002) (quoting Tilley v. Allstate

Ins. Co., 40 F. Supp. 2d 809, 814 (S.D. W. Va. 1999)); see also Resolution Trust Corp. v. Gershman, 829 F. Supp. 1095, 1103 (E.D. Mo. 1993) (“Rule 12(e) provides a remedy for unintelligible pleadings; it is not intended to correct a

claimed lack of detail.”). 4 “A motion for a more definite statement is generally left to the district court’s discretion.” Sheffield, 211 F.R.D. at 414 (citing Tilley, 40 F. Supp. 2d at

814). Rule 12(e) motions “are not favored by the courts ‘since pleadings in the federal courts are only required to fairly notify the opposing party of the nature of the claim.’” Resolution Trust Corp. v. Dean, 854 F. Supp. 626, 649 (D. Ariz.

1994) (quoting A.G. Edwards & Sons, Inc. v. Smith, 736 F. Supp. 1030, 1032 (D. Ariz. 1989)). “If the moving party could obtain the missing detail through discovery, the motion should be denied.” Davison v. Santa Barbara High Sch. Dist., 48 F. Supp. 2d 1225, 1228 (C.D. Cal. 1998) (citing Beery v. Hitachi Home

Elec. (America), Inc., 157 F.R.D. 477, 480 (C.D. Cal. 1993)); see also Becker v. Clermont Cnty. Prosecutor, No. 1:07cv511, 2008 WL 2230178, at *2 (S.D. Ohio 2008) (“Motions for a more definite statement are not favored by the courts in light

of the availability of pretrial discovery procedures.”) Plaintiffs’ motion to dismiss challenges, in part, the Fayad Defendants’ standing to assert their counterclaims. Such a challenge is asserted under Federal Rule of Civil Procedure 12(b)(1). Rule 12(b)(1) motions “generally come in two

varieties: a facial attack or a factual attack.” Gentek Bldg. Prods., Inc. v.

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