Continental General Insurance Company v. Gardina

District Court, M.D. Florida·Decided March 27, 2025·No. 6:23-cv-02149·Unknown

Opinion

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA ORLANDO DIVISION

CONTINENTAL GENERAL INSURANCE COMPANY,

Plaintiff,

v. Case No: 6:23-cv-2149-PGB-DCI

CAROL GARDINA and GEORGE GARDINA, Defendants. / ORDER This cause comes before the Court on Defendants Carol Gardina (“Ms. Gardina”) and George Gardina’s (“Mr. Gardina”)1 Motion to Dismiss the Amended Complaint. (Doc. 39 (the “Motion”)). Plaintiff Continental General Insurance Company (“Plaintiff”) has responded in opposition. (Doc. 40 (the “Response”)). Further, Plaintiff and Defendants have each filed a Notice of Supplemental Authority. (Docs. 43, 44). Upon consideration, the Motion is due to be denied.

1 Collectively, Ms. Gardina and Mr. Gardina will be referred to as the “Defendants” or the “Gardinas.” I. BACKGROUND2 Through this action, the Plaintiff insurance company brings a series of claims related to what it describes as the Gardinas’ decades-long “brazen scheme

to collect more than $1.9 million in long-term care insurance benefits” to which they were not entitled. (Doc. 35, ¶ 1). Ms. Gardina purchased a long-term care insurance policy (the “Subject Policy”) from Plaintiff’s predecessor in interest in January 2002. (Id. ¶ 2). Less than three months later, Ms. Gardina allegedly suffered a subarachnoid hemorrhage. (Id.).

With Mr. Gardina’s assistance, in August 2002, Ms. Gardina submitted a claim for benefits under the Subject Policy. (Id.). Since the time Ms. Gardina submitted this claim, the Gardinas have “consistently . . . represented to [Plaintiff] that [Ms.] Gardina’s subarachnoid hemorrhage left her physically incapacitated, unable to perform typical activities of daily living, and cognitively impaired.” (Id. ¶ 4). As a result of these representations, Plaintiff found that Ms. Gardina was

entitled to benefits under the Subject Policy and continued to pay claims benefits to Ms. Gardina for the ensuing two decades. (Id. ¶¶ 4–5). However, in 2023, Plaintiff learned that a civil lawsuit, Prudential Insurance Co. of America v. Gardina, No. 6:23-cv-1125-JSS-DCI (filed June 14, 2023) (the “Prudential Suit”), had been filed against the Gardinas by another

insurance company. (Id. ¶¶ 71–72). Therein, Prudential Insurance Company of

2 This account of the facts comes from Plaintiff’s Amended Complaint. (Doc. 35 (the “FAC”)). The Court accepts well-pled factual allegations as true when considering motions to dismiss. Williams v. Bd. of Regents, 477 F.3d 1282, 1291 (11th Cir. 2007). America (“Prudential”) accused the Gardinas of fraudulently collecting benefits under a long-term care insurance policy that had been issued by Prudential in February 2002 (the “Prudential Policy”). (Id. ¶ 73). Specifically, Prudential

alleged that Ms. Gardina had been receiving claims payments under the Prudential Policy stemming from her April 2002 subarachnoid hemorrhage. (Id. ¶ 74). Since the time of the hemorrhage, the Gardinas represented to Prudential that this medical event had left Ms. Gardina “physically incapacitated and severely cognitively impaired.” (Id.). Notably, Prudential’s surveillance of Ms. Gardina

contradicted these representations, and found Ms. Gardina performing activities such as driving a large truck without assistance, securing a boat trailer, and carrying lumber. (See id. ¶ 77). As a result, Prudential brought claims against the Gardinas for fraudulent misrepresentation, fraudulent concealment, declaratory judgments, and civil conspiracy. Prudential Ins. Co. of Am. v. Gardina, No. 6:23- cv-1125-JSS-DCI, 2024 WL 2304572, at *1 (M.D. Fla. May 16, 2024).

Upon learning of the Prudential Suit, Plaintiff conducted its own investigation and determined that the Gardinas had made various misrepresentations to Plaintiff with regard to the Subject Policy.3 (See Doc. 35, ¶¶ 84–144). Plaintiff alleges these misrepresentations caused Ms. Gardina to receive benefits under the Subject Policy to which she was not entitled. (E.g., id. ¶¶ 3–6).

3 For example, Plaintiff asserts that Ms. Gardina has submitted fraudulent invoices to Plaintiff; has falsely presented herself as severely physically and mentally incapacitated during benefit eligibility assessments; has represented that she was receiving treatment from a third-party healthcare agency when the relevant entity is owned by Mr. Gardina; and has represented that she was receiving treatment in Canada when she was actually in Florida. (Doc. 35, ¶¶ 146, 149, 150–51). Accordingly, in the operative FAC, Plaintiff brings claims against the Gardinas for fraudulent misrepresentation (Count I), fraudulent concealment (Count II), unjust enrichment (Count III), declaratory judgments (Counts IV and V)4, and civil

conspiracy (Count VI). (Id. ¶¶ 145–95). Now, the Gardinas move to dismiss the FAC under Federal Rule of Civil Procedure 12(b)(6).5 (Doc. 39). II. LEGAL STANDARD A complaint must contain “a short and plain statement of the claim showing that the pleader is entitled to relief.” FED. R. CIV. P. 8(a)(2). Thus, to survive a

motion to dismiss made pursuant to Federal Rule of Civil Procedure 12(b)(6), the 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 Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). A claim is plausible on its face 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. The court must view the complaint in the light most favorable to the plaintiff and must resolve any doubts as to the sufficiency of the complaint in the plaintiff’s favor. Hunnings v. Texaco, Inc., 29 F.3d 1480, 1484

4 The Court notes that Plaintiff has brought each of these counts against both Ms. Gardina and Mr. Gardina except for Counts IV and V for declaratory judgments, which Plaintiff has brought against Ms. Gardina only.

5 The Gardinas also cite to Federal Rules of Civil Procedure 8(e)(1) and 10(b) as additional bases for their Motion. (Doc. 39, p. 1). However, Rule 8(e)(1) does not exist. See FED. R. CIV. P. 8(e). Further, the Gardinas fail to reference either of these provisions outside of the introductory paragraph of the Motion, and it is not clear to the Court how Rule 10(b) would apply to the arguments raised in the Motion. (See generally Doc. 39); FED. R. CIV. P. 10(b). As a result, the Court limits its analysis to the Gardinas’ arguments for dismissal of the FAC pursuant to Rule 12(b)(6). See F .R.C .P.12(b)(6). (11th Cir. 1994) (per curiam). However, though a complaint need not contain detailed factual allegations, pleading mere legal conclusions, or “a formulaic recitation of the elements of a cause of action,” is not enough to satisfy the

plausibility standard. Twombly, 550 U.S. at 555. “While legal conclusions can provide the framework of a complaint, they must be supported by factual allegations,” and the court is “not bound to accept as true a legal conclusion couched as a factual allegation.” Iqbal, 556 U.S. at 679; Papasan v. Allain, 478 U.S. 265, 286 (1986).

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