Dameron Hospital Assoc. v. GEICO Indemnity Co.

District Court, E.D. California·Decided June 24, 2025·No. 2:24-cv-00934·Unknown

Opinion

DAMERON HOSPITAL ASSOCIATION No. 2:24-cv-00934-DJC-AC Plaintiff, v. Defendant. ___________________________________

DAMERON HOSPITAL ASSOCIATION No. 2:24-cv-01379-DJC-AC Plaintiff, v. ORDER COMPANY Defendant. Before the Court are two related cases involving functionally identical claims, 2:24-cv-00934-DJC-AC and 2:24-cv-01379-DJC-AC, concerning Plaintiff Dameron Hospital and Defendants Geico General Insurance Company and Geico Indemnity Company (“Geico” or “Defendant(s)”).1 Dameron alleges that Geico is responsible for additional financial costs related to Dameron’s medical treatment of five patients injured in automobile accidents. Dameron’s claims are that the patients assigned their payment rights under various Geico policies to Plaintiff as a condition of their medical treatment, that Defendants’ failure to pay violates the Unfair Competition Law, and that that there is a live question as to payment order between three patients with Geico insurance and Medicaid. Most of these claims were previously dismissed by Judge John A. Mendez with leave to amend. (ECF No. 19;) Dameron Hosp. Ass'n v. Geico Gen. Ins. Co. (“Dameron”), No. 2:24-CV-00934-JAM-AC, 2024 WL 4581685 (E.D. Cal. Oct. 25, 2024). For the reasons discussed below, the Court finds that Plaintiff’s amended pleading does not remedy some of the original complaint’s fatal flaws: that the patients’ assignments of rights to Dameron were done under an impermissible contract of adhesion for four of the five patients, and that there is no viable Unfair Competition Law violation as alleged. Accordingly, the Court finds that the agreements between Dameron and four patients to assign those patients’ rights are unenforceable. Also in agreement with the previous Order, the Court finds that, at this initial phase of the litigation, Plaintiff has a plausible claim that the sole uninsured patient may have validly assigned the payment rights to Plaintiff. However, the Court finds Plaintiff’s UCL claims unavailing and will dismiss those claims with leave to amend. The Court further finds that Plaintiff states a claim under the federal Medicare Secondary Payer Act. Defendant’s Motion to Dismiss (ECF No. 26, hereinafter “Mot.”) is GRANTED in part and DENIED in part with prejudice. Plaintiff Dameron Hospital is non-profit health services provider in Stockton, California. (ECF No. 25, First Amended Complaint, ¶ 5.) Dameron treated patients 1 Due to the nearly identical language between the complaints, the Court addresses them both in a single Order. All docket citations pertain to case No. 2:24-cv-00934-DJC-AC. D.S., X.K., M.A., and A.G., who are Medicare Beneficiaries or have Veterans Administration healthcare, and J.M., who is a Self-Pay patient with no other applicable insurance. (Id. ¶ 6.) All unspecified hospital services and patient accounts implicated in this case arise from emergency room and ongoing medical care provided to injury victims by Dameron. (Id. ¶ 5.) As a Condition for Admission (“COA”) for medical care at the hospital, Dameron required the patients to sign an Assignment of Benefits (“AOB”) contract. (Id. ¶ 15.) The COAs signed by the patients include a clause specifically assigning all insurance benefits under Med-Pay (medical payment coverage; “MP”) and Uninsured Motorist (“UM”) policies to Dameron that might provide coverage for the treatment provided. (Id. ¶ 17; see id. ¶ 30.) Dameron alleges that the patients hold automobile, liability, or no-fault insurance policies provided by Geico. (Id. ¶¶ 2, 9.) However, Defendants apparently provided reimbursement under the insurance policies to either the patients directly or a separate third party, rather than Plaintiff, against the terms of the AOB. (Id. ¶ 24.) Plaintiff alleges three causes of action.2 First, Plaintiff demands injunctive relief under California’s Unfair Competition Law, Business and Professions Code section 17200 (“UCL”), stemming from Defendants’ alleged breach of contract. (Id. ¶¶ 53–57.) Second, Plaintiff seeks general damages from Defendants’ failure to honor the patients’ AOBs. (Id. ¶¶ 58–66.) And third, Plaintiff argues that Defendants violated the Medicare Secondary Payer Act by refusing to pay Plaintiff directly for the costs associated with the care of patients covered by Medicare. (Id. ¶¶ 67–75.) A. Federal Rule of Procedure 12(b)(1) A party may move to dismiss a complaint for “lack of subject matter jurisdiction” under Federal Rule of Civil Procedure 12(b)(1). Challenges to a plaintiff’s Article III standing are properly raised under a 12(b)(1) motion as standing is required for a 2 The Court discusses these out of order below, as an analysis of the AOBs is necessary before moving to the UCL claim. federal court to exercise jurisdiction. Chandler v. State Farm Mut. Auto. Ins. Co., 598 F.3d 1115, 1122 (9th Cir. 2010); see, e.g., Nat'l Fed'n of the Blind of Cal. v. Uber Techs., Inc., 103 F. Supp. 3d 1073, 1078 (N.D. Cal. 2015). Taking the allegations in the complaint as true, “the court must determine whether a lack of federal jurisdiction appears from the face of the complaint itself.” Nat'l Fed'n of the Blind, 103 F. Supp. 3d at 1078. The “party invoking the federal court's jurisdiction has the burden of proving the actual existence of subject matter jurisdiction.” Thompson v. McCombe, 99 F.3d 352, 353 (9th Cir.1996); Chandler, 598 F.3d at 1122. B. Federal Rule of Procedure 12(b)(6) A party may move to dismiss for “failure to state a claim upon which relief can be granted.” Fed. R. Civ. P. 12(b)(6). The motion may be granted only if the complaint lacks a “cognizable legal theory or sufficient facts to support a cognizable legal theory.” Mendiondo v. Centinela Hosp. Med. Ctr., 521 F.3d 1097, 1104 (9th Cir. 2008). While the Court assumes all factual allegations are true and construes “them in the light most favorable to the nonmoving party,” Parks Sch. of Bus., Inc. v. Symington, 51 F.3d 1480, 1484 (9th Cir. 1995), if the complaint's allegations do not “plausibly give rise to an entitlement to relief” the motion must be granted, Ashcroft v. Iqbal (“Iqbal”), 556 U.S. 662, 679 (2009). A complaint need contain only a “short and plain statement of the claim showing that the pleader is entitled to relief,” Fed. R. Civ. P. 8(a)(2), not “detailed factual allegations,” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007). However, this rule demands more than unadorned accusations; “sufficient factual matter” must make the claim at least plausible. Iqbal, 556 U.S. at 678. In the same vein, conclusory or formulaic recitations of elements do not alone suffice. Id. “A claim has facial plausibility 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. This evaluation of plausibility is a context-specific task drawing on “judicial experience and common sense.” Id. at 679. Plaintiff has plausibly alleged facts that would confer federal court standing. However, on the merits, Plaintiff is unable to show that the AOBs were valid for four of the five patients, nor does Plaintiff advance a viable UCL claim. However, Plaintiff properly invokes the federal Medicare Secondary Payer Act, and its claim under that statute may proceed. A. Plaintiff Has Article III Standing A plai

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Dameron Hospital Assoc. v. GEICO Indemnity Co., (E.D. Cal. 2025).

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