Blue Cross & Blue Shield v. Halifax Insurance Plan, Inc.

961 F. Supp. 271, 1997 U.S. Dist. LEXIS 5167, 1997 WL 189089
CourtDistrict Court, M.D. Florida
DecidedApril 15, 1997
Docket96-1498-Civ-T-17
StatusPublished
Cited by2 cases

This text of 961 F. Supp. 271 (Blue Cross & Blue Shield v. Halifax Insurance Plan, Inc.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blue Cross & Blue Shield v. Halifax Insurance Plan, Inc., 961 F. Supp. 271, 1997 U.S. Dist. LEXIS 5167, 1997 WL 189089 (M.D. Fla. 1997).

Opinion

ORDER ON DEFENDANTS’ MOTIONS TO DISMISS AND FOR SANCTIONS

KOVACHEVICH, Chief Judge.

This cause is before the Court on the following motions and responses:

1. Defendant’s Motion to Dismiss Plaintiffs Amended Complaint (Docket No. 21).
2. Plaintiffs Reply to Defendant’s Motion to Dismiss Plaintiffs Amended Complaint (Docket No. 24).
3. Plaintiffs Motion for Leave to Amend (Docket No. 28).
4. Defendant’s Motion for Sanctions (Docket No. 29).
*273 5. Plaintiffs Reply to Defendant’s Motion for Sanctions (Docket No. 26).

I. Standard of Review

A complaint should not be dismissed for failure to state a claim unless it appears beyond a doubt that the plaintiff can prove no set of facts that support a claim for relief. Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 101-02, 2 L.Ed.2d 80 (1957). A trial court, in ruling on a motion to dismiss, is required to view the complaint in the light most favorable to the plaintiff. Scheuer v. Rhodes, 416 U.S. 232, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974). The allegations in the complaint should be taken as admitted by the defendants and liberally construed in favor of the plaintiff. Jenkins v. McKeithen, 395 U.S. 411, 421, 89 S.Ct. 1843, 1848-49, 23 L.Ed.2d 404 (1969).

In the Eleventh Circuit, three (3) types of conduct warrant Rule 11 sanctions: a party’s filing a pleading that has no reasonable factual basis; a party’s filing a pleading that is based on a legal theory that has no reasonable chance of success and that cannot be advanced as a reasonable argument to change existing law; and a party’s filing a pleading in bad faith or for improper purpose. Didie v. Howes, 988 F.2d 1097, 1104 (11th Cir.1993).

II. Background

Plaintiff in this case, Blue Cross and Blue Shield of Michigan, filed a diversity suit in this court on August 1, 1996, and filed an amended complaint on November 6, 1996. The following facts are asserted in the amended complaint and are relevant to the issues before this court. For purposes of these motions, all of these allegations are assumed to be admitted. Plaintiff was the health care insurance provider for Carol A. Levine. In August 1991, Levine visited Dr. Remigio G. Laesamana because she had found a lump in her right breast. Dr. Laesa-mana ordered a mammogram, but did not provide the follow-up care indicated by the results of the mammogram, instead telling Levine that she had nothing to worry about.

On April 1992, Levine consulted another doctor regarding the lump in her breast. That doctor diagnosed a carcinoma of the right breast requiring a modified radical mastectomy. Levine required extensive medical treatment up until the time of her death in March, 1994. Plaintiff paid $283,-126.78 in medical expenses related to Levine’s treatment for cancer.

The contract between Levine and Plaintiff included a subrogation provision allowing Plaintiff to seek recovery for medical expenses it had paid that should have been paid by another. The administrator of Levine’s estate settled a lawsuit with Dr. Laesamana. However, the settlement did not include Levine’s medical expenses. The defendant was the medical malpractice insurance provider for Dr. Laesamana. Plaintiff alleges that at the time of the settlement Defendant knew or should have known of the existence of Plaintiffs subrogation interest, the facts of the medical malpractice committed by its insured, and the likelihood that Defendant was legally responsible for the medical expenses paid by Plaintiff. Plaintiff alleges as well that Defendant negligently failed to properly investigate claims, failed to acknowledge and act promptly on claims, and denied claims without having first conducted a reasonable investigation, and that Defendant acted in such a manner as a general business practice.

III.Discussion

Defendant moves to dismiss the amended complaint on the grounds that it violates Florida’s nonjoinder statute, Florida Statutes § 627.4136, and that Plaintiff does not have standing to bring a suit under Florida Statutes § 624.155.

A Violation of Nonjoinder Statute

Florida’s nonjoinder statute requires as a condition precedent to a suit against a liability insurer by a third party, that is, a party other than the insured, that the third party must first obtain a settlement or judgment against the insured. Fla. Stat. § 627.4136(1). Likewise, that section also provides that no third party shall have an interest in a liability insurance policy without having first obtained *274 a settlement or judgment against the insured. Fla. Stat. § 627.4136(2). An insurer may also “insert in liability insurance policies contractual provisions that preclude” third parties “from joining a liability insurer as a party defendant with its insured” before a verdict has been rendered. Fla. Stat. § 627.4136(3).

Defendant argues that Plaintiff has not met the requirements of the nonjoinder statute, in that Plaintiff has not alleged that either Plaintiff or its subrogor has obtained a settlement or verdict against the insured, Dr. Laesamana, for Levine’s medical expenses.

Plaintiff argues that it has not violated the Florida nonjoinder statute. It argues that if the third party has obtained a settlement from the insured, it may sue the liability insurer, even if the settlement does not cover all pending claims.

The issue, therefore, is whether, under Florida law, the allegation that a third party has reached a settlement with the insured is sufficient to satisfy the requirements of Florida’s nonjoinder statute, even if that settlement does not include the particular claim under which the insured sues, but is a part of the same set of facts and circumstances.

As far as this Court can determine, this issue has not been addressed by a Florida court. However, the pertinent words of the statute state that a third party may not maintain a cause of action against an insurer unless the third party has “obtained a settlement or verdict against [the insured] under the terms of such policy for a cause of action which is covered by such policy.” Fla. Stat. § 627.4136 (emphasis added).

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Cite This Page — Counsel Stack

Bluebook (online)
961 F. Supp. 271, 1997 U.S. Dist. LEXIS 5167, 1997 WL 189089, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-blue-shield-v-halifax-insurance-plan-inc-flmd-1997.