City of Escondido v. General Reinsurance Corporation

District Court, S.D. California·Decided August 20, 2019·No. 3:19-cv-00868·Unknown

Opinion

CITY OF ESCONDIDO, Case No.: 19cv868-MMA (BGS)

Plaintiff, ORDER GRANTING GENESIS v. MANAGEMENT AND INSURANCE SERVICES CORPORATION'S MOTION TO DISMISS CORPORATION and GENESIS MANAGEMENT AND INSURANCE SERVICES CORPORATION, [Doc. No. 10] Defendants.

CORPORATION, Counter Claimant, v. CITY OF ESCONDIDO, Counter Defendant. On April 4, 2019, Plaintiff City of Escondido (“Plaintiff”) filed a Complaint for breach of contract, breach of the implied covenant of good faith and fair dealing, and declaratory relief in San Diego County Superior Court against Defendants General Reinsurance Corporation (“GRC”) and Genesis Management and Insurance Services Corporation (“Genesis”). Doc. No. 1-2. Defendants removed the action to this Court on May 9, 2019. Doc. No. 1. On May 23, 2019, Plaintiff filed the operative First Amended Complaint (“FAC”). Doc. No. 8 (“FAC”). Genesis now moves to dismiss the causes of action against it pursuant to Federal Rule of Civil Procedure 12(b)(6). Doc. No. 10-1 (“MTD”). Plaintiff opposes dismissal [Doc. No. 13 (“Oppo.”)] and Genesis replied [Doc. No. 14 (“Reply”)]. The Court found the matter suitable for determination on the papers and without oral argument pursuant to Civil Local Rule 7.1.d.1. Doc. No. 4. For the following reasons, the Court GRANTS Genesis’ motion to dismiss. BACKGROUND1 GRC is an insurance company and Genesis is a wholly owned subsidiary of GRC. FAC ¶¶ 1-2. From February 1, 1990 to May 15, 1994, Defendants insured Plaintiff for workers’ compensation payments to Plaintiff’s covered employees and allocated investigation, adjustment, and legal expenses. FAC ¶ 8. Plaintiff alleges that the insurance policy was issued by GRC, but that it was directed by Defendants “solely to Genesis with respect to claims, questions and reimbursement requests involving the policy,” and “was directed by [D]efendants to submit all its claims status reports solely to Genesis representatives . . . .” FAC ¶ 2. According to Plaintiff, it only communicated with Genesis, who was the “sole decision maker and entirely controlled whether or not reimbursements were to be issued to [P]laintiff under the policy.” Id. “Over the course of more than 15 years in dealing with [P]laintiff concerning the policy, GRC and Genesis acted as a unitary entity with Genesis conducting all the communications with [P]laintiff concerning the policy” such that “Genesis is the alter ego of GRC.” Id. Plaintiff alleges that the policy requires Defendants to indemnify Plaintiff when its expenditures on a worker’s compensation claim falling within the policy period exceed 1 Because this matter is before the Court on a motion to dismiss, the Court must accept as true the allegations set forth in the complaint. See Hosp. Bldg. Co. v. Trs. of Rex Hosp., 425 U.S. 738, 740 the policy’s $250,000 self-insured retention. FAC ¶ 8. During the policy period, Plaintiff paid or incurred liability to pay workers’ compensation claims plus allocated investigation, adjustment, and legal expenses in excess of $250,000 on three claims: (1) GRC claim number 6040678 for claimant Paula Westenberger (the “Westenberger Claim”); (2) GRC claim number 6037896 for claimant Aida Faeldan (the “Faeldan Claim”); and (3) GRC claim number 6034852 for claimant Michael Gain (the “Gain Claim”) (collectively, the “Three Underlying Claims”). FAC ¶ 10. Plaintiff timely submitted requests for indemnity to Defendants for amounts in excess of $250,000 for each of the Three Underlying Claims. FAC ¶ 11. Each time, Plaintiff alleges Defendants refused “to pay Plaintiff and . . . adopted a pattern and practice of wrongful and bad faith claims evaluations, during which [D]efendants have withheld benefits under the pretext of continuing to investigate while they assert a variety of challenges and excuses . . . .” Id. Additionally, Defendants “have refused to reasonably and timely investigate, refused to provide legitimate, reasonable or accurate reasons for their refusal to provide benefits owed, and have unreasonably withheld benefits owed to Plaintiff.” FAC ¶ 12. With respect to the Westenberger Claim, Plaintiff alleges Defendants falsely represented that they would reimburse Plaintiff for future medical payments made pursuant to a settlement agreement. FAC ¶¶ 60-77. However, Defendants intended not to fully reimburse Plaintiff and intended to delay or avoid making reimbursement payments. Id. Accordingly, Plaintiff asserts causes of action for breach of contract, breach of the implied covenant of good faith and fair dealing, and declaratory relief with respect to each of the Three Underlying Claims. Additionally, Plaintiff asserts causes of action for concealment and negligent misrepresentation against Defendants with respect to the Westenberger Claim. A. The Westenberger Claim Mrs. Westernberger injured her low back on July 30, 1993, while working as an employee of Plaintiff. FAC ¶ 17. She became temporarily totally disabled due to increased pain. Id. When conservative treatment proved ineffective, Mrs. Westenberger underwent several failed back surgeries. FAC ¶¶ 16-17. In December 1995, Mrs. Westenberger began working at the City Heights Town Council (“CHTC”). FAC ¶ 19. When her pain increased, she was referred to a pain management specialist, which included a series of back injections to alleviate back pain. Id. She also received a right hip injection, which caused complications necessitating a right hip replacement. FAC ¶ 16. As a result, Mrs. Westenberger developed a left foot deformity requiring multiple surgeries. Id. “These surgeries were complicated by the development of reflex sympathetic dystrophy (“RSD”).” FAC ¶ 22. She was diagnosed with left foot neurologic problems and complex regional pain syndrome (“CRPS”). FAC ¶ 16. Mrs. Westenberger’s worker’s compensation case determined that her right hip replacement, left foot deformity, left foot neurological problems, and CRPS were all causally related to her industrial injury suffered while working for Plaintiff. Id. Thus, Plaintiff was responsible for paying for Mrs. Westenberger’s treatment for these conditions. Id. During the worker’s compensation proceeding, Plaintiff sought a right of contribution against CHTC and its insurer for costs associated with Mrs. Westenberger’s right hip problems and right hip replacement. FAC ¶ 34. Ultimately, 50% of Mrs. Westenberger’s right hip problems were apportioned to the 1993 back injury and 50% were apportioned to her full-time work at CHTC. FAC ¶ 35. However, CHTC “is a non- profit community advocacy group with no assets and it had no worker’s compensation insurance” during the time Mrs. Westenberger was working full-time. FAC ¶ 37. Thus, Plaintiff, with Defendants’ concurrence, abandoned the contribution claim. Id. As a result, Defendants purportedly knew that Plaintiff faced “near certain joint and several liability” for the costs of Mrs. Westenberger’s past and future treatment that would likely exceed $1 million. FAC ¶ 31. In 2011, Defendants’ authorized Plaintiff to offer a structured settlement of $1.25 million to Mrs. Westenberger. Id. The “Compromise and Release” would release Plaintiff from further disability payments and any obligation to pay for Mrs. Westenberger’s future medical care. Id. Genesis advised Plaintiff that it would initially fund all components of the settlement, but that Genesis would reimburse Plaintiff for each settlement payment. FAC ¶ 74. Mrs. Westenberger rejected the offer because she believed her future medical care would exceed the settlement amount. FAC ¶ 31. In May of 2012, Plaintiff and Mrs. Westenberger entered into a “Stipulation with Request for Award.” FAC ¶ 25. Defendants “authorized and approved of [Plaintiff’s] entering into [the] “Stipulation with Request for Award”

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City of Escondido v. General Reinsurance Corporation, (S.D. Cal. 2019).

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