Forest Park Army Navy Store, Inc. v. Underwriting Management Experts, LLC, et al.

District Court, N.D. Georgia·Decided September 1, 2026·No. 1:25-cv-06642·Unknown

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF GEORGIA ATLANTA DIVISION FOREST PARK ARMY NAVY STORE, INC., Plaintiff, v. CIVIL ACTION FILE NO. 1:25-CV-6642-TWT UNDERWRITING MANAGEMENT EXPERTS, LLC, et al., Defendants. OPINION AND ORDER This is a breach of contract action. It is before the Court on the Defendant Underwriting Management Experts, LLC’s (“UME”) Motion to Dismiss [Doc. 33] and the Defendant Exemplar Health Benefits Administrator, LLC’s Motion to Dismiss [Doc. 34]. For the following reasons, Defendant UME’s Motion to Dismiss [Doc. 34] is GRANTED and Defendant Exemplar’s Motion to Dismiss [Doc. 33] is DENIED. I. Background1 In January 2024, Forest Park Army Navy Store, Inc. (“Forest Park”) entered into a contract with non-party Gerber Life Insurance Company for excess loss coverage (“excess loss policy”) for Forest Park’s employee healthcare coverage plan. (1st Am. Compl. ¶ 7). The excess loss policy came about after

1 The Court accepts the facts as alleged in the First Amended Complaint as true for purposes of the present Motion to Dismiss. , 941 F.3d 1116, 1122 (11th Cir. 2019). Forest Park submitted an application for coverage to Defendant UME, who served as Gerber Life’s underwriter. ( ¶ 8). To complete the application, Forest Park relied on information provided by Exemplar—its health benefits

administrator. ( ). UME underwrote the excess loss policy and approved the application, so Gerber then issued the policy to Forest Park. ( ¶ 9). During the application process, Forest Park completed a “Group Disclosure Form,” which asked for a list of participants “who have paid or pending claims in excess of 50% of the specific deductible, or excess of $10,000 in paid claims, during the past 12 months or could reasonably be expected to

have claims in excess of this amount.” ( ¶ 10). Forest Park responded to this question with the word “unknown.” ( ). Forest Park responded this way because it did not have an answer to the question, and was not in possession of the information required to answer it. ( ¶ 12). Forest Park believed Exemplar had the answer or was responsible for supplying Forest Park or UME with the information to answer the question. ( ¶ 13). The Group Disclosure Form was signed by a representative of Forest Park as well as the

CEO of Exemplar on December 26, 2023. ( ¶ 11). Exemplar did not provide any information that was requested on the Group Disclosure Form. ( ¶ 17). Forest Park has an administrative services agreement (“ASA”) with Exemplar, under which Exemplar agreed to advise Forest Park on the availability of insurance for it, purchase such insurance, and “provide for the

2 corresponding reporting requirements of the insurance carrier.” ( ¶ 14). In accordance with the ASA, Forest Park provided Exemplar with “a true and accurate accounting of all Participants,” and it relied on Exemplar to collect

and provide all participant claim information. ( ¶ 15). By failing to provide the information requested on the Group Disclosure Form and signing it anyway, Exemplar failed to provide for the reporting requirements of the insurance carrier as required under the ASA. ( ¶ 18). UME was on notice of the “unknown” answer, but never sought out any additional information from either Forest Park or Exemplar before, during, or

after issuing the excess loss policy. ( ¶ 19). On September 4, 2025, UME sent a letter to Exemplar denying claims totaling $182,218.95 and terminating the excess loss policy. ( ¶ 21). The denied claims related to a single plan participant’s heart condition and treatment. ( ¶ 21). UME explained that it was rescinding the policy due to a “lack of complete and accurate information during the underwriting process,” stating that “neither the disclosure statement, nor other information provided during underwriting, full disclosed

the nature and/or extent of the participant’s condition.” ( ¶ 22). UME further explained that, had it known of the participant’s medical condition at the time of underwriting, it would have either declined to quote Forest Park for coverage or would have quoted it at a significantly higher rate.” ( ¶ 23). However, UME also stated that it had received claim submissions from several dates

3 between September 2024 and May 2025, long before the September 4, 2025 recission date. ( ¶ 24). Forest Park alleges that the ASA requires Exemplar to process claims

timely and appropriately and arrange for the payment of all valid claims, so Exemplar is in breach for failing to ensure timely payment of valid claims of its employees. ( ¶ 25). It also alleges that UME and Exemplar’s combined failures have resulted in the wrongful denial of “hundreds of thousands of dollars of [Forest Park’s] employees’ health benefits claims, which otherwise should have been paid by the stop loss insurance.” ( ¶ 26). Forest Park

originally brought this action against Exemplar and UME in the Superior Court of Clayton County on October 13, 2025. It asserts one claim for breach of contract against Exemplar (Count I), and claims for negligence and negligent misrepresentation (Count II), estoppel (Count III), declaratory and injunctive relief (Count IV), and attorney’s fees (Count V) against UME. ( ¶¶ 27-53). The Defendants removed the action to this Court on November 19, 2025, and in December 2025, Forest Park filed an amended complaint. [Docs. 1, 27]. Both

Defendants moved to dismiss, and those motions are presently before the Court. [Docs. 33, 34]. II. Legal Standards A complaint should be dismissed under Rule 12(b)(6) only where it appears that the facts alleged fail to state a “plausible” claim for relief.

4 , 556 U.S. 662, 678 (2009); Fed. R. Civ. P. 12(b)(6). A complaint may survive a motion to dismiss for failure to state a claim, however, even if it is “improbable” that a plaintiff would be able to prove those facts; even if the

possibility of recovery is extremely “remote and unlikely.” , 550 U.S. 544, 556 (2007). In ruling on a motion to dismiss, the court must accept the facts pleaded in the complaint as true and construe them in the light most favorable to the plaintiff. , 711 F.2d 989, 994-95 (11th Cir. 1983); , 40 F.3d

247, 251 (7th Cir. 1994) (noting that at the pleading stage, the plaintiff “receives the benefit of imagination”). Generally, notice pleading is all that is required for a valid complaint. , 753 F.2d 974, 975 (11th Cir. 1985). Under notice pleading, the plaintiff need only give the defendant fair notice of the plaintiff’s claim and the grounds upon which it rests. , 551 U.S. 89, 93 (2007) (citing , 550 U.S. at 555).

III. Discussion A. Exemplar’s Motion to Dismiss [Doc. 34] a. Choice of Law Forest Park’s breach of contract claim centers on the ASA between it and Exemplar. Before addressing Exemplar’s arguments against a finding of

5 breach, the Court must determine which state’s law governs interpretation and enforcement of the agreement, which contains a North Carolina choice of law provision. [Doc. 9-2, (“ASA”), ¶ 8].2

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Forest Park Army Navy Store, Inc. v. Underwriting Management Experts, LLC, et al., (N.D. Ga. 2026).

Forest Park Army Navy Store, Inc. v. Underwriting Management Experts, LLC, et al. (Forest Park Army Navy Store, Inc. v. Underwriting Management Experts, LLC, et al.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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