Irby v. Jefferson Insurance Company

CourtDistrict Court, D. New Mexico
DecidedJuly 1, 2024
Docket2:24-cv-00094
StatusUnknown

This text of Irby v. Jefferson Insurance Company (Irby v. Jefferson Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Irby v. Jefferson Insurance Company, (D.N.M. 2024).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW MEXICO

ANGELA IRBY, individually and on behalf of her minor daughters, K.I. and K.I., LAZHANTE ANDERSON, and TODD LOPEZ, as wrongful death personal representative for the Estate of William Irby, deceased,

Plaintiffs, Case No. 2:24-cv-00094-MIS-JHR v.

JEFFERSON INSURANCE COMPANY, and AGA SERVICE COMPANY d/b/a Allianz Global Assistance,

Defendants.

ORDER DENYING DEFENDANTS’ CONSTRUED PARTIAL MOTION FOR JUDGMENT ON THE PLEADINGS

THIS MATTER is before the Court on Defendants Jefferson Insurance Company and AGA Service Company d/b/a Allianz Global Assistance’s (“Defendants”) Partial Motion to Dismiss per Fed. R. Civ. P. 12(b)(6), filed February 6, 2024, ECF No. 10, which the Court construes as a Motion for Judgment on the Pleadings. Plaintiffs Angela Irby, individually and on behalf of her minor daughters, K.I. and K.I., LaZhante Anderson,1 and Todd Lopez, as wrongful death personal representative for the Estate of William Irby, deceased (“Plaintiffs”), filed a Response on March 19, 2024, ECF No. 18, to which Defendants filed a Reply on April 22, 2024, ECF No. 21. Upon review of the Parties’ submissions and the relevant law, the Court will DENY the Motion.

1 Mr. Anderson’s first name is spelled “LaZhante” in the case caption of all of Plaintiffs’ filings and in the “Parties, Jurisdiction, and Venue” section of the Complaint, but is spelled “LaZhonte” in in other sections of the Complaint. The Court will utilize the “LaZhante” spelling unless and until Plaintiffs ask the Clerk’s Office to amend the case caption. I. Background2 In early 2015, Decedent William Irby (“William”) was diagnosed with heart failure due to viral myocarditis. ECF No. 1-2 ¶ 29. The same year, William married Plaintiff Angela Irby (“Angela”). Id. ¶ 31. Angela had a son from a prior relationship, Plaintiff LaZhante Anderson, “who William became very close with, loved dearly, and raised as his own, both before and after Angela and William married.” Id. ¶ 28. In 2016, William received a heart transplant. Id. ¶ 32. He initially struggled with organ

rejection but later stabilized and had no further incidents after 2017. Id. ¶ 33. In 2019, William and Angela had twin daughters, Plaintiffs K.I. and K.I. Id. ¶ 36. William, Angela, LaZhante, and the twins lived together as a family unit in New Mexico. Id. ¶ 37. After the onset of the COVID-19 pandemic, Defendants began advertising Travel Insurance Policies with an “Epidemic Coverage Endorsement” that provided COVID-related coverage.3 Id. ¶ 44. One of Defendants’ advertisements touted how the benefit for Emergency Medical Transportation may apply if the insured was diagnosed with COVID-19 while travelling. See id. ¶ 45. It stated, in part: If you’re diagnosed with an epidemic disease such as COVID-19 while you’re traveling and you require an emergency medical evacuation, then your Emergency Transportation benefit can help. Our medical team will consult with the local doctor. If they determine that the local medical facilities are unable to provide adequate treatment, then our team can arrange and pay for emergency medical transportation to the nearest appropriate hospital.

2 The Court accepts the truth of all well-pleaded factual allegations in Plaintiffs’ Complaint and draws all reasonable inference in Plaintiffs’ favor.

3 The Complaint alleges: “Jefferson and Allianz were engaged in a joint venture with respect to the sale and administration of the insurance policy at issue in this case. Jefferson and Allianz are sister corporations, both owned by parent company Allianz Worldwide Partners. Jefferson underwrote and issued the policy, while Allianz was both the selling ‘producer’ of the Policy and the third-party administrator of the policy’s claims. Both Jefferson and Allianz had a financial interest in the sale and administration of the Policy at issue in this case, both had joint control over the single business undertaking, and both shared profits and losses from the sale and administration of the Policy.” ECF No. 1-2 ¶ 22. Id. William and Angela (hereafter, “the Irbys”) purchased a Travel Insurance Policy from Defendants in New Mexico to cover a November 2021 vacation to Turks and Caicos. Id. ¶¶ 1, 16- 17, 43, 46. The Policy provided, inter alia, $250,000 of coverage for Emergency Transportation, including for what the Policy refers to as “Emergency Evacuation” to the nearest appropriate hospital in the event an insured becomes seriously ill and the local medical facilities are unable to provide appropriate medical treatment. Id. ¶ 47. The Policy also included $50,000 for Emergency Medical Coverage, $10,000 for Travel Accident Coverage, and a provision for repatriation of remains under which Defendants would arrange and pay to transport the insured’s remains to a funeral home near the insured’s primary residence or another funeral home located in the United States. Id. ¶ 48. The Irby’s fully paid the Policy’s premiums. Id. ¶¶ 18, 171. On November 2, 2021, William and Angela flew from El Paso International Airport to

Miami where they spent the night. Id. ¶¶ 49, 51. On November 3, 2021—the day the Policy went into effect—they flew from Miami to Turks and Caicos. Id. ¶¶ 50-51. William and Angela both were fully vaccinated against COVID-19 and both tested negative for COVID-19 immediately prior to boarding the flight in Miami to Turks and Caicos. Id. ¶¶ 52-53. On November 5, 2021, William began to feel ill and developed a fever, so the Irbys went to a hospital in Turks and Caicos. Id. ¶¶ 54-55. At approximately 1:00 a.m. on Saturday, November 6, 2021, William tested positive for COVID-19 at the hospital. Id. ¶ 57. Dr. Natasha Farnum advised William to “get off the island as soon as possible” due to inadequate hospital facilities to treat William’s unique condition as a post-transplant COVID-positive patient. Id. ¶ 58.

“The worry was that if William’s illness were to worsen, he could die due to the hospital’s inadequate staffing, medicines, and equipment.” Id. Dr. Farnum’s treatment note from November 6, 2021 states, in part: Case discussed with Dr. Davis (Locum Internist on call) Likely mild case of Covid as he is fully vaccinated Due to previous viral myocarditis best to medevac back to USA

* * *

Patient and his wife advised that they are to isolate in their hotel room and advise all persons who have been near them to call the Covid Hotline for testing today.

Advised to call their private insurance company to arrange for Medical Evacuation to the USA as soon as possible. Informed that there are no cardiologists or cardiothoracic surgeons in TCI [Turks and Caicos Island] to assist in an acute cardiac event.

Id. ¶ 59. The hospital told the Irbys that there was nothing the doctors could do for William if his condition worsened and instructed them to quarantine. Id. ¶¶ 60-61. The hospital provided William acetaminophen, and an ambulance transported the Irbys back to their hotel. Id. ¶¶ 63-64. Because William had tested positive for COVID-19, the Irbys could not leave Turks and Caicos on a commercial flight. Id. ¶ 62. Shortly after returning from the hospital on November 6, 2021, William and Angela called Defendants to open a claim for emergency medical evacuation coverage. Id. ¶ 65. They spoke with a representative who was located in Virginia. Id. ¶ 67. William explained to the representative that he received a heart transplant in 2016, that he was ill with COVID-19, and that the doctors had instructed him to evacuate as soon as possible because they did not have the ability to treat his condition. Id. ¶ 69. The representative asked the Irbys to email William’s medical records to him, which Angela did shortly after the call. Id. ¶¶ 71, 76.

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Irby v. Jefferson Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/irby-v-jefferson-insurance-company-nmd-2024.