Lister v. Bankers Life & Casualty Co.

218 F. Supp. 2d 49, 2002 DNH 163, 2002 U.S. Dist. LEXIS 17446, 2002 WL 31041821
CourtDistrict Court, D. New Hampshire
DecidedSeptember 5, 2002
DocketCIV. 02-83-B
StatusPublished
Cited by2 cases

This text of 218 F. Supp. 2d 49 (Lister v. Bankers Life & Casualty Co.) is published on Counsel Stack Legal Research, covering District Court, D. New Hampshire primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lister v. Bankers Life & Casualty Co., 218 F. Supp. 2d 49, 2002 DNH 163, 2002 U.S. Dist. LEXIS 17446, 2002 WL 31041821 (D.N.H. 2002).

Opinion

MEMORANDUM AND ORDER

BARBADORO, Chief Judge.

The plaintiff, Althea Lister, filed suit against the defendant, Bankers Life and Casualty Company. Lister seeks a declaratory judgment (Count I) that she is entitled to coverage under the home health care insurance policy she purchased from Bankers. See Amend. Pet. (Doc. No. 9) ¶¶ 47-53. The plaintiff also seeks relief for bad faith breach of contract (Count II), intentional infliction of emotional distress (Count III), and consumer fraud under N.H.Rev.Stat. Ann. ch. 358-A (Count IV). See id. ¶¶ 54-86.

Bankers moves to dismiss Count II, arguing that it is “premature in light of the pendency of [Lister’s] declaratory judgment claim.” Def s. Mot. to Dismiss (Doc. No. 13) ¶ 6. It also moves to dismiss Counts III and TV pursuant to Federal Rule of Civil Procedure 12(b)(6). For the following reasons, I grant Bankers’ motion as it pertains to Count IV, and deny the motion as it pertains to Counts II and III.

I. STANDARD OF REVIEW

When ruling on a motion to dismiss under Fed.R.Civ.P. 12(b)(6), the court must “accept as true the well-pleaded factual allegations of the complaint, draw all reasonable inferences therefrom in the plaintiffs favor and determine whether the complaint, so read, sets forth facts sufficient to justify recovery on any cognizable theory.” Martin v. Applied Cellular Technology, Inc., 284 F.3d 1, 6 (1st Cir.2002). Dismissal is appropriate only if “it clearly appears, according to the facts alleged, that the plaintiff cannot recover on any viable theory.” Langadinos v. American Airlines, Inc., 199 F.3d 68, 69 (1st Cir.2000) (quotation omitted). The issue is not “what the plaintiff is required ultimately to prove in order to prevail on her claim, but rather what she is required to plead in order to be permitted to develop her case for eventual adjudication on the merits.” Gorski v. New Hampshire Dept. of Corrections, 290 F.3d 466, 472 (1st Cir.2002) (emphasis in original).

II. FACTS

Crediting the allegations set forth in Lister’s amended petition as true, and drawing all reasonable inferences there *51 from in the light most favorable to her, the pertinent facts appear as follows.

Lister, an elderly woman, discussed purchasing a home health care insurance policy with Bryan Clark, a representative of Bankers. Clark befriended her in order to obtain her business and to “create an impression that Bankers would be approachable and easy to work with if she ever had a claim.” Amend. Pet. ¶¶ 63-64. Because of his efforts to gain her trust, Lister looked upon him “as a personal and family friend.” Id. ¶ 26. In their discussions about home health care insurance, Clark told her that “she needed insurance coverage for medications, domestic care, and medical supplies so that if she were sick, she could continue to live at home and not ‘end up in a nursing home.’ ” Id. ¶ 5. He assured her that the policy would “cover whatever was needed,” and that “[everything would be taken care of.” Id. ¶¶ 6-7. Relying upon his representations and Bankers’ promotional materials, Lister purchased a home health care policy on March 30,1998.

On March 16, 2001, Lister was hospitalized because of severe coronary artery disease and angina. She 1 returned to the hospital on May 14, 2001 due to the same conditions. Upon release from her second hospital stay, her doctor, Dr. VanderLincle, certified that she was unable to perform some basic activities of daily living without assistance. The physician claim form and home health care plan, which Dr. Vander-Linde completed, stated that “[Lister] needs homemaking services as she is unable to perform these duties due to her heart disease.” Id. ¶ 17. Dr. Vander-Linde ordered her to obtain the home services of a registered nurse, occupational therapist, and physical therapist.

Based upon Dr. VanderLinde’s orders, Lister’s daughter, Cindy Addario, and granddaughter, Joyce Ninness, contacted Clark and his supervisor, Gary Asker, to make a claim for benefits under the policy. Initially, Clark told Ninness that Bankers “will pay for whatever the doctor deems medically necessary,” and instructed her to “[g]et grammy whatever services she needs and the policy is now active.” Id. ¶ 21. However, “[ijmmediately after [Lister] made a claim, the agents refused to assist her in processing it and actively avoided her.” Id. ¶ 65. During one of her attempts to seek assistance from Bankers on behalf of her grandmother, Ninness overheard Clark state “I don’t want to deal with those people.” Id. ¶ 24. The plaintiff was “shocked, hurt, and betrayed by [the agents’] conduct and thought she had done something wrong that offended [them] when she made a claim for coverage. This caused her substantial emotional distress at a time when she should have been focused on recovery.” Id. ¶ 27.

After repeated attempts to file her claim and receive coverage under her policy, Bankers denied Lister’s claim, alleging that she was not receiving personal care services under a doctor’s home health care plan. This decision was rendered despite Dr. VanderLinde’s certified home health care plan specifically ordering personal care services, which was filed with Lister’s claim. Lister suffered an angina attack due to Bankers’ denial of coverage.

Lister, with the assistance of counsel, asked Bankers to reconsider its decision. Bankers again denied coverage, this time on the grounds that she did not need assistance with two or more activities of daily living, as allegedly required by the policy. A new letter from Dr. Vander-Linde was submitted to Bankers, which stated that the Lister was unable to walk unassisted, bathe and wash her hair, or shop and prepare food. Bankers denied the claim for the third time, again claiming that she did not need assistance with two or more activities of daily living.

*52 III. DISCUSSION

A. Count II, Bad Faith Breach of Contract

Bankers argues that an insured may only bring a bad faith breach of contract claim after it has obtained a declaratory judgment in a separate action that the insured’s policy provides the coverage in dispute. In support of this contention, Bankers cites Jarvis v. Prudential Ins. Co., 122 N.H. 648, 653, 448 A.2d 407 (1982), which states:

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Wirth v. Domerson
S.D. New York, 2023
Lister v. Bankers Life
2002 DNH 163 (D. New Hampshire, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
218 F. Supp. 2d 49, 2002 DNH 163, 2002 U.S. Dist. LEXIS 17446, 2002 WL 31041821, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lister-v-bankers-life-casualty-co-nhd-2002.