Haynes v. Allstate Fire & Casualty Insurance

CourtDistrict Court, D. Colorado
DecidedFebruary 18, 2020
Docket1:19-cv-02397
StatusUnknown

This text of Haynes v. Allstate Fire & Casualty Insurance (Haynes v. Allstate Fire & Casualty Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Haynes v. Allstate Fire & Casualty Insurance, (D. Colo. 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO

Civil Action No. 19-cv-02397-STV

JACQUELINE HAYNES,

Plaintiff,

v.

ALLSTATE FIRE & CASUALTY INSURANCE,

Defendant.

______________________________________________________________________

ORDER ______________________________________________________________________

Entered by Magistrate Judge Scott T. Varholak This matter is before the Court on the Motion to Dismiss or, Alternatively, Motion to Strike Pursuant to Fed. R. Civ. P. 12(f) (the “Motion”), filed by Defendant Allstate Fire & Casualty Insurance (“Allstate”). [#12] The parties have consented to proceed before the undersigned United States Magistrate Judge for all proceedings, including entry of a final judgment. [#18, 23] The Court has carefully considered the Motion and related briefing, the entire case file, and the applicable case law, and has determined that oral argument would not materially assist in the disposition of the Motion. For the following reasons, the Motion is DENIED. I. FACTUAL BACKGROUND1 Plaintiff Jacqueline Haynes entered into an automobile insurance policy (the “Policy”) with Allstate, which includes coverage for claims involving underinsured motorists. [#3 at ¶¶ 11, 169] At all times relevant to the Policy, Plaintiff paid the insurance

premiums required under the Policy. [Id. at ¶ 169] Pursuant to the Policy, Allstate is required to pay its insured “reasonable” medical expenses for covered expenses. [Id. at ¶ 38] On November 3, 2018, Plaintiff was involved in a motor vehicle accident when another driver ran a stop sign and hit her. [Id. at ¶ 14] The other driver, who was under the influence of drugs and/or alcohol at the time he ran the stop sign, was negligent and caused the collision. [Id. at ¶¶ 15, 16] Plaintiff was injured as a result of the collision. [Id. at ¶ 19] The negligent driver who caused the collision was insured for up to $25,000 per person. [Id. at ¶ 21] Allstate gave Plaintiff permission to settle with the negligent driver’s insurer for the policy limit of $25,000. [Id. at ¶¶ 21, 22, 24]

Plaintiff contends that her injuries, damages, and losses resulting from the motor vehicle accident exceeded the $25,000 limit of the negligent driver’s policy. [Id. at ¶ 23] Plaintiff submitted a claim to Allstate for underinsured motorist (“UIM”) benefits. [Id. at ¶ 27] In February 2019, Plaintiff requested that Allstate pay her underinsured motorist benefits, but Allstate did not pay benefits in response to that request. [Id. at ¶¶ 28, 29]

1 The facts are drawn from the allegations in Plaintiffs’ Complaint for Damages and Jury Demand (the “Complaint”) [#3], which must be taken as true when considering a motion to dismiss. Wilson v. Montano, 715 F.3d 847, 850 n.1 (10th Cir. 2013) (citing Brown v. Montoya, 662 F.3d 1152, 1162 (10th Cir. 2011)). On June 11, 2019, Plaintiff sent Allstate a second request to pay benefits under her Policy (the “June 11 Letter”). [Id. at ¶ 36; see also #12-1]2 On July 10, 2019, Brittney Montoya, the Allstate adjuster handling Plaintiff’s claim, responded to Plaintiff’s claim (the “July 10 Letter”). [#3 at ¶¶ 3, 4, 77; see also #12-3]3 Ms. Montoya informed Plaintiff that

Allstate accepted as reasonable $15,556 of the $18,312.25 in total medical expenses that Plaintiff had incurred up to that date. [#3 at ¶ 77; #12-3] Ms. Montoya further informed Plaintiff that Allstate evaluated Plaintiff’s general damages at $13,500. [#3 at ¶ 79; #12- 3] Ms. Montoya thus offered Plaintiff $4,056 to settle her underinsured motorist claim. [#3 at ¶ 62; see also #12-3] At the time of that offer, Allstate did not advise Plaintiff of any failure to meet the conditions precedent under the Policy or raise any other coverage defense. [#3 at ¶¶ 67, 68; see also #12-3] Although Allstate did not dispute that at least $4,056 in underinsured motorist benefits were owed to Plaintiff, no underinsured motorist benefits were actually paid to Plaintiff at that time. [#3 at ¶¶ 64, 65]

2 Both parties agree that the Court should consider the June 11 Letter in analyzing Allstate’s Motion. [#12 at 5; #17 at 9] The Court may consider the copy of the June 11 Letter submitted by Allstate as an exhibit to the Motion [#12-1] without converting the Motion into a motion for summary judgment. See GFF Corp. v. Associated Wholesale Grocers, Inc., 130 F.3d 1381, 1384 (10th Cir. 1997) (“[I]f a plaintiff does not incorporate by reference or attach a document to its complaint, but the document is referred to in the complaint and is central to the plaintiff’s claim, a defendant may submit an indisputably authentic copy to the court to be considered on a motion to dismiss.”); Tellabs, Inc. v. Makor Issues & Rights, Ltd., 551 U.S. 308, 322 (2007) (holding that court “must consider the complaint in its entirety . . . [and] documents incorporated into the complaint by reference”). 3 Allstate requests that the Court consider the July 10 Letter, in which Allstate provides an evaluation of Plaintiff’s UIM claim, in analyzing the Motion [#12 at 9], and Plaintiff does not object [#17]. The Court finds that the July 10 Letter [#12-3], like the June 11 Letter discussed above, was incorporated by reference in Plaintiff’s Complaint and thus may be considered by the Court without converting the Motion into a motion for summary judgment. [See supra note 2] Plaintiff contends that, in evaluating her medical expenses, Allstate utilized a software program called Mitchell Decision Point (“MDP”). [Id. at ¶¶ 41, 44, 50] According to Plaintiff, Allstate uses MDP “to artificially depress healthcare reimbursements” and used MDP to reduce her medical expenses. [Id. at ¶¶ 49, 51] According to the Complaint,

Allstate knows that its adjusters have used MDP “inappropriately or incorrectly in the past.” [Id. at ¶ 109] Plaintiff further contends that, in evaluating her general damages, Allstate utilized a software program called Colossus. [Id. at ¶¶ 52, 58] According to Plaintiff, “Allstate engages in the institutional practice of inappropriately using Colossus to lower insured’s general damages.” [Id. at ¶ 123] More specifically, Plaintiff contends that Colossus fails to take life expectancy into account and cannot evaluate damages for physical impairment or disfigurement. [Id. at ¶¶ 129, 130] The Complaint alleges that Allstate knows that its adjusters handling UIM claims have failed to enter full and correct information into Colossus for certain past claims and provides seven examples specifically identifying both the Allstate adjuster and the claimant involved. [Id. at ¶¶ 114-

121] On July 10, 2019, in response to Allstate’s offer, Plaintiff informed Ms. Montoya that she was aware that Allstate had entered information into Colossus incorrectly for other Allstate insureds. [Id. at ¶ 89] Although Ms. Montoya admitted that she had used MDP and Colossus to evaluate Plaintiff’s claim, she refused to provide Plaintiff with copies of the MDP and Colossus reports used to adjust her claim. [Id. at ¶¶ 78, 80, 82, 83] Following that exchange, Ms. Montoya discussed Allstate’s position regarding the production of MDP and Colossus reports with Allstate management. [Id. at ¶ 93] On July 16, 2019, Ms. Montoya advised Plaintiff that it was Allstate’s position that the MDP and Colossus reports are proprietary work product and thus would not be provided to the insured. [Id.

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Bluebook (online)
Haynes v. Allstate Fire & Casualty Insurance, Counsel Stack Legal Research, https://law.counselstack.com/opinion/haynes-v-allstate-fire-casualty-insurance-cod-2020.