Cozzone v. AXA Equitable Life Insurance Society of the United States

858 F. Supp. 2d 452, 2012 WL 871201, 2012 U.S. Dist. LEXIS 34526
CourtDistrict Court, M.D. Pennsylvania
DecidedMarch 14, 2012
DocketCivil Action No. 3:CV-10-2388
StatusPublished
Cited by11 cases

This text of 858 F. Supp. 2d 452 (Cozzone v. AXA Equitable Life Insurance Society of the United States) is published on Counsel Stack Legal Research, covering District Court, M.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cozzone v. AXA Equitable Life Insurance Society of the United States, 858 F. Supp. 2d 452, 2012 WL 871201, 2012 U.S. Dist. LEXIS 34526 (M.D. Pa. 2012).

Opinion

MEMORANDUM AND ORDER

THOMAS M. BLEWITT, United States Magistrate Judge.

I. Background.

On March 31, 2010, Plaintiff, Monica Cozzone, D.O., commenced this action against Defendants AXA Equitable Life Insurance Society of the United States (“AXA Equitable”), formerly the Equitable Life Assurance Society of the United States, and Disability Management Services, Inc. (“DMS”), via a Writ of Summons in the Court of Common Pleas of Luzerne County, Pennsylvania. On October 20, 2010, Plaintiff filed a two-count Complaint, Count I, breach of contract and Count II, bad faith pursuant to 42 Pa.C.S.A. § 8371, in Luzerne County. Plaintiff attached an Exhibit A to her [454]*454Complaint, namely, a copy of a disability insurance policy Defendant AXA Equitable issued to Plaintiff on November 27, 1991, providing coverage for loss that results from injury or sickness as defined in the policy. On November 18, 2010, Defendants removed this case to this Court based on diversity jurisdiction. 28 U.S.C. § 1332.1 (Doc. 1). Plaintiffs allegations all relate to the way in which Defendants processed Plaintiffs claim under her disability income overhead expense insurance policy Defendant AXA Equitable issued to her. Defendant DMS was Defendant AXA Equitable’s third-party administrator regarding Plaintiffs disability claim. Plaintiff essentially alleges that Defendant AXA Equitable breached its duties to provide her with coverage for disability benefits under her disability income insurance policy. Plaintiff seeks payment with respect to her supplemental application for overhead expense disability coverage as part of the insurance policy Defendant AXA Equitable issued to her. Plaintiff alleges that she was unable to perform her regular occupation as a physician in December of 2005 due to injury or sickness, and that she submitted an application for benefits under the insurance policy Defendant AXA Equitable issued to her. Plaintiff avers that Defendants made payments for some of the benefits due under the policy, but that Defendants failed to provide full payment of all benefits due to her under the policy. Defendants denied Plaintiffs claim with respect to some of the expenses (;’.e. insurance premiums to attach a Reporting Endorsement to her malpractice insurance) she submitted since they found that the Malpractice Tail Endorsement Premium expense was not a Covered Overhead Expense as defined by her policy. (Doc. 14, Ex. A).

On November 24, 2010, Defendants filed a Rule 12(b)(6) Motion to Dismiss Defendant DMS from this action, and to dismiss Plaintiffs bad faith claim. On April 12, 2011, 2011 WL 1375264, the Court denied Defendants’ Motion to Dismiss. (Doc. 7). Defendants then filed their Answer to Plaintiffs Complaint with Affirmative Defenses and attached Exhibits on April 27, 2011. (Doc.8).

After the discovery was completed, on June 27, 2011, Defendants filed a Motion for Judgment on the Pleadings, pursuant to Fed.R.Civ.P. 12(c), with respect to only Count II of the Complaint. (Doc. 13). Defendants also submitted Exhibits, Doc. 14, Exs. A-C. Defendants’ Motion has been briefed and it is ripe for disposition.2 (Docs. 14, 16 & 17).

II. Motion for Judgment on the Pleadings Standard.

In Faylor v. Szupper, 2009 WL 2982646, *4 (W.D.Pa.), the Court stated:

A motion for judgment on the pleadings is subject to the same standard as a Rule 12(b)(6) motion to dismiss. Mele, supra, 359 F.3d at 253. Thus, we will view all facts presented in the pleadings in a light most favorable to the nonmovant. Id. A motion for judgment on [455]*455the pleadings will not be granted “unless the moving party has established that there is no material issue of fact to resolve, and that [they are] entitled to judgment as a matter of law.” Id.

See also Sikirica v. Nationwide Ins. Co., 416 F.3d 214 (3d Cir.2005).

In Reisinger v. Luzerne County, 712 F.Supp.2d 332, 343-344 (M.D.Pa.2010), the Court stated:

The Third Circuit Court of Appeals recently set out the appropriate standard applicable to a motion to dismiss in light of the United States Supreme Court’s decisions Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007), and Ashcroft v. Iqbal, 556 U.S. 662, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). “[T]o survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true to ‘state a claim that relief is plausible on its face.’ ” Iqbal, 129 S.Ct. at 1949 (citing Twombly, 550 U.S. at 570, 127 S.Ct. 1955). The Court emphasized that “only a complaint that states a plausible claim for relief survives a motion to dismiss.” Id. at 1950. Moreover, it continued, “[djetermining whether a complaint states a plausible claim for relief will ... be a context-specific task that requires the reviewing court to draw on its judicial experience and common sense.” Id. (citation omitted). McTernan v. City of York, 577 F.3d 521, 530 (3d Cir.2009). The Circuit Court discussed the effects of Twombly and Iqbal in detail and provided a road map for district courts presented with a motion to dismiss for failure to state a claim in a case filed just a week before McTernan, Fowler v. UPMC Shadyside, 578 F.3d 203 (3d Cir.2009).
[District courts should conduct a two-part analysis. First, the factual and legal elements of a claim should be separated. The District Court must accept all of the complaint’s well-pleaded facts as true, but may disregard any legal conclusions. [Iqbal, 129 S.Ct. at, 1949.] Second, a District Court must then determine whether the facts alleged in the complaint are sufficient to show that the plaintiff has a “plausible claim for relief.” Id. at 1950. In other words, a complaint must do more than allege a plaintiffs entitlement to relief. A compilaint has to “show” such an entitlement with its facts. See Phillips [v. Co. of Allegheny], 515 F.3d [224,] 234-35 [ (3d Cir.2008) ]. As the Supreme Court instructed in Iqbal, “[w]here the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint has alleged-but it has not ‘show[n]’-‘that the pleader is entitled to relief.’ ” Iqbal, 129 S.Ct. at 1949. This “plausibility” determination will be “a context-specific task that requires the reviewing court to draw on its judicial experience and common sense.” Id. Fowler, 578 F.3d at 210-11.
The Circuit Court’s guidance makes clear that legal conclusions are not entitled to the same deference as well-pled facts. In other words, “the court is ‘not bound to accept as true a legal conclusion couched as a factual allegation.’ ” Guirguis v. Movers Specialty Services, Inc.,

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858 F. Supp. 2d 452, 2012 WL 871201, 2012 U.S. Dist. LEXIS 34526, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cozzone-v-axa-equitable-life-insurance-society-of-the-united-states-pamd-2012.