Dameron Hospital Assoc. v. GEICO Indemnity Co.

CourtDistrict Court, E.D. California
DecidedOctober 25, 2024
Docket2:24-cv-00934
StatusUnknown

This text of Dameron Hospital Assoc. v. GEICO Indemnity Co. (Dameron Hospital Assoc. v. GEICO Indemnity Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dameron Hospital Assoc. v. GEICO Indemnity Co., (E.D. Cal. 2024).

Opinion

1 2 3 4 5 6 7 8 9 10 UNITED STATES DISTRICT COURT 11 EASTERN DISTRICT OF CALIFORNIA 12 13 DAMERON HOSPITAL ASSOCIATION, a ) Case No. 2:24-cv-01379-JAM-AC California Non-Profit ) 14 Association, ) ) 15 Plaintiff, ) ) 16 v. ) ) ORDER GRANTING IN PART 17 GEICO GENERAL INSURANCE COMPANY, ) DEFENDANTS’ MOTION TO DISMISS a Nebraska Corporation, ) 18 ) Defendant. ) 19 ) DAMERON HOSPITAL ASSOCIATION, a ) Case No. 2:24-cv-00934-JAM-AC 20 California Non-Profit ) Association, ) 21 ) Plaintiff, ) 22 ) v. ) 23 ) GEICO INDEMNITY COMPANY, a ) 24 Maryland Corporation, ) ) 25 Defendant. ) 26 INTRODUCTION OF CASE 27 Before the Court is two related cases involving Geico General 28 Insurance Company and Geico Indemnity Company (“Defendant(s)”), who 1 move to dismiss the Complaint by Dameron Hospital Association 2 (“Plaintiff”) for failure to state a claim. See Mot., ECF No. 12 3 and 10; Compl., ECF No. 1 (both). These cases involve nearly 4 identical claims and legal arguments and were related pursuant to 5 Local Rule 123. See ECF No. 9 (both). Plaintiff opposed the 6 motions. See Opp’n, ECF Nos. 14 and 12. Defendants filed replies. 7 See Reply, ECF Nos. 15 and 14. For the reasons below, Defendants’ 8 Motions are denied in part and granted in part with leave to 9 amend.1 10 I. FACTUAL ALLEGATIONS 11 Plaintiff Dameron Hospital operates an emergency room in 12 Stockton, California and seeks injunctive, declaratory, and 13 compensatory relief arising from Defendants’ Geico General 14 Insurance Company (“Geico General”) and Geico Indemnity Company 15 (“Geico Indemnity”) failure to pay Dameron Hospital certain 16 benefits due under various patients’ automobile policies. See 17 Compl. at 24-25 (both). Specifically, this case involves the 18 purported assignment of Med-Pay (“MP”) and Uninsured Motorist 19 (“UM”) benefits by five patients who were admitted and discharged 20 from Dameron Hospital. Dameron claims entitlement to these 21 benefits pursuant to the Assignment of Benefits (“AOB”) contained 22 in each patients’ respective Conditions of Admission (“COA”) 23 paperwork. Four of the patients have Medicare or Veterans 24 Administration healthcare as their medical insurance (D.S., X.K., 25 M.A., A.G.) and one individual (J.M.) is alleged to be a self-pay 26 patient with no other insurance. See Compl. ¶ 4 (both). Each of

27 1 This motion was determined to be suitable for decision without 28 oral argument. E.D. Cal. L.R. 230(g). The hearing was scheduled 1 these individuals is alleged to maintain automobile coverage 2 through either Defendant Geico General Insurance Company or Geico 3 Indemnity Company. See Compl. ¶ 6-7 (both). 4 Dameron Hospital alleges three causes of action in its 5 Complaint. The First Cause of Action is a claim for injunctive 6 relief under California’s Unfair Competition Law, Business and 7 Professions Code § 17200 (“UCL”) stemming from a breach of 8 contract. The Second Cause of Action alleges breach of contract by 9 Defendants for failure to honor the assignment of MP or UM benefits 10 in Dameron Hospital’s COAs signed by the aforementioned emergency 11 room patients. The Third and final Cause of Action is a claim 12 under the Medicare Secondary Payer Act, U.S.C.A. § 1395y(b)(3)(A) 13 (“MSP Act”), alleging that Defendants have primary payer 14 responsibility for the services rendered by Plaintiff Dameron 15 Hospital. 16 II. OPINION 17 A. Legal Standard 18 A Rule 12(b)(6) motion challenges the sufficiency of a 19 complaint for “failure to state a claim upon which relief can be 20 granted.” Fed. R. Civ. P. 12(b)(6). Under the plausibility 21 pleading standard set forth in Bell Atlantic Corp. v. Twombly, 550 22 U.S. 544, 570 (2007), a plaintiff survives a motion to dismiss by 23 alleging “enough facts to state a claim to relief that is 24 plausible on its face.” The complaint must contain sufficient 25 “factual content that allows the court to draw the reasonable 26 inference that the defendant is liable for the misconduct 27 alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). At the 28 Rule 12(b)(6) stage, the Court must accept all nonconclusory 1 factual allegations of the complaint as true and construe those 2 facts and the reasonable inferences that follow in the light most 3 favorable to the Plaintiff. Id.; see also Knievel v. ESPN, 393 4 F.3d 1068, 1072 (9th Cir. 2005). 5 B. Analysis 6 1. Plaintiff Fails to State a Claim for Breach of 7 Contract 8 a. The COAs Are Unenforceable Adhesion Contracts Under 9 California Caselaw for Patients with Medical 10 Insurance 11 Defendants argue that the COAs and AOBs that Plaintiff 12 requires patients to sign upon admittance or discharge from 13 Dameron Hospital are adhesion contracts, thus there is no breach 14 of contract claim for such unenforceable contracts that defy the 15 reasonable expectations of the signatory. See Mot. at 9. 16 Plaintiff argues that an unpublished district court order in this 17 district, Dameron Hosp. Ass’n v. State Farm Mut. Auto. Ins. Co., 18 2018 WL 1425981, at *4 (E.D. Cal. Mar. 22, 2018) (hereinafter, 19 “State Farm 2018”) supports its position that the AOBs are valid 20 contracts. See Opp’n at 10; Exhibit 1. However, as Defendants 21 correctly point out in their Reply, State Farm 2018 did not 22 address arguments that AOBs are unenforceable as adhesion 23 contracts that defy reasonable expectations. See Reply at 6. 24 Importantly, unlike this Court, the State Farm 2018 district court 25 order did not have the benefit of the analysis in Dameron Hosp. 26 Assn. v. AAA N. California, Nevada & Utah Ins. Exch., 77 Cal. App. 27 5th 971 (2022)(“AAA”) – a recently decided case – which as 28 discussed below, deemed Dameron Hospital’s COAs unenforceable 1 adhesion contracts under California law. 2 The factual allegations and legal arguments in this case are 3 strikingly similar to those at issue in AAA: both involve Dameron 4 Hospital, automobile insurers, and questions surrounding the 5 assignment of MP and UM benefits. Plaintiff argues that AAA 6 disposes the contract issue in its favor, however, the Court finds 7 that AAA squarely holds that Dameron Hospital’s COAs are adhesion 8 contracts and are unenforceable if patients do not reasonably 9 expect such assignment of benefits to occur. Id. at 988, 994. 10 “The distinctive feature of a contract of adhesion is that 11 the weaker party has no realistic choice as to its terms.” AAA at 12 992, quoting Wheeler v. St. Joseph Hosp., 63 Cal. App. 3d 345, 356 13 (1976). There is arguably no weaker party than an individual 14 recently admitted to an emergency room for injuries sustained in 15 an accident or any individual under the care of medical 16 professionals and awaiting discharge from a hospital. As 17 Defendants persuasively point out, Dameron Hospital’s COAs possess 18 all the characteristics of a contract of adhesion because “[t]he 19 would-be patient is in no position to reject the proffered 20 agreement, to bargain with the hospital, or in lieu of agreement 21 to find another hospital.” AAA, at 992-93, quoting Wheeler, 63 22 Cal. App. 3d at 357. 23 The COAs Dameron Hospital requires are dense standardized 24 contract forms, which must be signed by or on behalf of all 25 patients receiving emergency medical services, before any patient 26 may be discharged. See Compl. Exhibit 1; ¶ 8. Patients in need 27 of emergency care like those in this case are in no position to 28 bargain with Dameron Hospital over the terms of the COA or refuse 1 to sign it and find another emergency room.

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Dameron Hospital Assoc. v. GEICO Indemnity Co., Counsel Stack Legal Research, https://law.counselstack.com/opinion/dameron-hospital-assoc-v-geico-indemnity-co-caed-2024.