City of Escondido v. General Reinsurance Corporation

District Court, S.D. California·Decided December 18, 2019·No. 3:19-cv-00868·Unknown

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 SOUTHERN DISTRICT OF CALIFORNIA 10 11 CITY OF ESCONDIDO, Case No. 19cv868-MMA (BGS)

12 Plaintiff, ORDER GRANTING GENESIS 13 v. MANAGEMENT AND INSURANCE SERVICES CORPORATION’S 14 GENERAL REINSURANCE MOTION TO DISMISS CORPORATION and GENESIS 15 MANAGEMENT AND INSURANCE 16 SERVICES CORPORATION, [Doc. No. 18] 17 Defendants. 18

19 GENERAL REINSURANCE CORPORATION, 20 Counter Claimant, 21 v. 22 CITY OF ESCONDIDO, 23 Counter Defendant. 24

25 26 On April 4, 2019, Plaintiff City of Escondido (“Plaintiff” or “City”) filed a 27 Complaint for breach of contract, breach of the implied covenant of good faith and fair 28 dealing, and declaratory relief in San Diego County Superior Court against Defendants 1 General Reinsurance Corporation (“GRC”) and Genesis Management and Insurance 2 Services Corporation (“Genesis”). Doc. No. 1-2.1 Defendants removed the action to this 3 Court on May 9, 2019. Doc. No. 1. 4 On May 23, 2019, Plaintiff filed the First Amended Complaint (“FAC”), adding 5 causes of action for concealment and negligent misrepresentation. Doc. No. 8 (“FAC”). 6 Genesis then moved to dismiss the FAC pursuant to Federal Rule of Civil Procedure 7 12(b)(6). Doc. No. 10-1. On August 29, 2019, the Court granted Genesis’s motion to 8 dismiss without prejudice and with leave to amend. Doc. No. 16 at 15. 9 On September 3, 2019, Plaintiff filed the operative Second Amended Complaint 10 (“SAC”) asserting causes of action for (1) breach of contract; (2) breach of the implied 11 covenant of good faith and fair dealing; (3) concealment; (4) negligent misrepresentation; 12 (5) false promise; and (6) declaratory relief. Doc. No. 17 (“SAC”). Genesis now moves 13 to dismiss Plaintiff’s claims pursuant to Federal Rule of Civil Procedure 12(b)(6). Doc. 14 No. 18. For the following reasons, the Court GRANTS Genesis’s motion. 15 I. BACKGROUND2 16 GRC is an insurance company and Genesis is a wholly owned subsidiary of GRC. 17 SAC ¶¶ 1–2. From February 1, 1990 to May 15, 1994, Defendants insured Plaintiff “for 18 workers’ compensation payments to Plaintiff’s covered employees and allocated 19 investigation, adjustment[,] and legal expenses . . . .” Id. ¶ 8. Plaintiff alleges that the 20 insurance policy was issued by GRC, but that it “was directed by [D]efendants solely to 21 Genesis with respect to claims, questions[,] and reimbursement requests involving the 22 policy,” and “was directed by [D]efendants to submit all its claims status reports solely to 23

24 25 1 All citations refer to the pagination assigned by the CM/ECF system.

26 2 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 27 (1976). Additionally, given the parallels between the FAC and the SAC, the Court repeats the background section provided in the Court’s previous dismissal order where appropriate. See Doc. No. 28 1 Genesis representatives . . . .” Id. ¶ 2. According to Plaintiff, it only communicated with 2 Genesis, who was the “sole decision maker and entirely controlled whether or not 3 reimbursements were to be issued to [Plaintiff] under the policy.” Id. “Over the course 4 of more than 15 years in dealing with [Plaintiff] concerning the policy, GRC and Genesis 5 acted jointly through Genesis, with Genesis conducting all the communications with 6 [Plaintiff] concerning the policy” such that “Genesis is the alter ego of GRC.” Id. ¶ 2, 3. 7 Plaintiff alleges that the policy requires Defendants to indemnify Plaintiff when its 8 expenditures on a worker’s compensation claim falling within the policy period exceed 9 the policy’s $250,000 self-insured retention. Id. ¶ 8. During the policy period, Plaintiff 10 “paid or incurred liability to pay workers’ compensation claims plus allocated 11 investigation, adjustment[,] and legal expenses in excess of $250,000” on three claims: 12 (1) GRC claim number 6040678 for claimant Paula Westenberger (“Westenberger 13 Claim”); (2) GRC claim number 6037896 for claimant Aida Faeldan (“Faeldan Claim”); 14 and (3) GRC claim number 6034852 for claimant Michael Gain (“Gain Claim”) 15 (collectively, the “Three Underlying Claims”). Id. ¶ 10. 16 Plaintiff timely submitted requests for indemnity to Defendants for amounts in 17 excess of $250,000 for each of the Three Underlying Claims. Id. ¶ 11. Each time, 18 Plaintiff alleges Defendants “refused to pay [Plaintiff] and . . . adopted a pattern and 19 practice of wrongful and bad faith claims evaluations, during which [D]efendants have 20 withheld benefits under the pretext of continuing to investigate while they assert a variety 21 of challenges and excuses . . . .” Id. Additionally, “[D]efendants have refused to 22 reasonably and timely investigate, refused to provide legitimate, reasonable[,] or accurate 23 reasons for their refusal to provide benefits owed, and have unreasonably withheld 24 benefits owed to Plaintiff.” Id. ¶ 12. 25 A. The Westenberger Claim 26 Mrs. Westernberger injured her low back on July 30, 1993, while working as an 27 employee of Plaintiff. Id. ¶ 16, 17. She became temporarily totally disabled due to 28 increased pain. Id. ¶ 17. When conservative treatment proved ineffective, Mrs. 1 Westenberger underwent several failed back surgeries. Id. ¶¶ 16–17. In December 1995, 2 Mrs. Westenberger began working at the City Heights Town Council (“CHTC”). Id. ¶ 3 19. When her pain increased, she was referred to a pain management specialist, which 4 included a series of back injections to alleviate back pain. Id. She also received a right 5 hip injection, which caused complications necessitating a right hip replacement. Id. ¶ 16. 6 As a result, Mrs. Westenberger developed a left foot deformity requiring multiple 7 surgeries. Id. “These surgeries were complicated by the development of reflex 8 sympathetic dystrophy (‘RSD’).” Id. ¶ 22. “[S]he was diagnosed with left foot 9 neurologic problems and complex regional pain syndrome (‘CRPS’). Id. ¶ 16. Mrs. 10 Westenberger’s worker’s compensation case determined that her “right hip replacement, 11 left foot deformity, left foot neurological problems, and CRPS were all causally related to 12 her industrial injury suffered while working [for Plaintiff].” Id. Thus, Plaintiff was 13 responsible for paying for Mrs. Westenberger’s treatment for these conditions. Id. 14 During the worker’s compensation proceeding, Plaintiff sought a right of 15 contribution against CHTC and its insurer for costs associated with Mrs. Westenberger’s 16 right hip problems and right hip replacement. Id. ¶ 34. Ultimately, 50% of Mrs. 17 Westenberger’s right hip problems were apportioned to the 1993 back injury, and 50% 18 were apportioned to her full-time work at CHTC. Id. ¶ 35. However, CHTC “is a non- 19 profit community advocacy group with no assets and it had no worker’s compensation 20 insurance” during the time Mrs. Westenberger was working full-time. Id. ¶ 37. Thus, 21 Plaintiff, with Defendants’ concurrence, abandoned the contribution claim. Id. As a 22 result, Defendants purportedly knew that Plaintiff faced “near certain joint and several 23 liability” for the costs of Mrs. Westenberger’s past and future treatment that would likely 24 exceed $1 million. Id. ¶ 31. 25 In 2011, Defendants authorized Plaintiff to offer a structured settlement of $1.25 26 million to Mrs. Westenberger. Id. The “Compromise and Release” would release 27 Plaintiff from further disability payments and any obligation to pay for Mrs. 28 Westenberger’s future medical care. Id.

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