Petruzzo v. National Union Fire Insurance

124 F. Supp. 3d 642, 2015 U.S. Dist. LEXIS 113489, 2015 WL 5042874
CourtDistrict Court, E.D. North Carolina
DecidedMay 22, 2015
DocketNo. 5:12-CV-113-FL
StatusPublished
Cited by6 cases

This text of 124 F. Supp. 3d 642 (Petruzzo v. National Union Fire Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Petruzzo v. National Union Fire Insurance, 124 F. Supp. 3d 642, 2015 U.S. Dist. LEXIS 113489, 2015 WL 5042874 (E.D.N.C. 2015).

Opinion

ORDER

LOUISE W. FLANAGAN, District Judge.

This matter comes before the court on motion of defendant Virginia Surety Company, Inc. (“Virginia Surety”) to dismiss the complaint for lack of standing and failure to state a claim upon which relief can be granted, pursuant to Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6). (DE 146). For reasons stated herein, defendant’s motion is granted.

STATEMENT OF THE CASE

On March 6, 2012, plaintiff Mario Petruzzo (“Petruzzo”), a resident of North Carolina, filed complaint on behalf of himself and all similarly situated North Carolina residents concerning allegedly fraudulent insurance practices. Claims were asserted against three categories of defendants: 1) alleged scheme architects; 2) insurance brokers; and 3) underwriters. The matter was styled as a putative class action. Plaintiff invoked this court’s subject matter jurisdiction under the Class Action Fairness Act, 28 U.S.C. § 1332(d), alleging a class of more than 100 members with an aggregate amount in controversy in excess of $5,000,000.00.

[645]*645Plaintiff alleged that the policies issued pursuant to the disputed insurance program were illegal and void ab initio, where they failed to comply with N.C. Gen.Stat. §§ 58-51-75 and 58-51-95. Plaintiff sought to recover compensatory and punitive damages under the North Carolina Unfair and Deceptive Trade Practices Act (“UDTPA”), N.C. GemStat. § 75-1.1 et seq., as well as under common law claims for breach of the duty of good faith and fair dealing, unjust enrichment, and civil conspiracy.

In August 2013, the court took up and considered three separate motions to dismiss under Rule 12(b)(6), all of which were denied.1 Later, plaintiff made a motion to amend his complaint, which in large part was allowed. In the similarly styled amended complaint, filed September 12, 2014, (DE 123), which is the operative pleading in this case, plaintiffs substantive claims remain the same, but plaintiff, for the first time, alleged the existence of a second insurance policy providing additional benefits under the disputed insurance program. Plaintiff was permitted to add as defendant the underwriter of that policy, Virginia Surety, movant herein, a corporation organized under the laws of Illinois with its principal place of business in that state. Plaintiff also was permitted to add as defendant another alleged scheme architect, HealthExtras, LLC (“New HealthExtras”), a limited liability company organized and existing under the laws of the state of Delaware.2 Jeffrey Bush and Kimberly Bush (collectively the “Bush Plaintiffs” or the “Bushes”), residents of North Carolina from and after July 21, 2005, also were added as plaintiffs. The Bushes were living in Pennsylvania at the time of their enrollment in the insurance program.3

In response to the amended complaint, on November 14, 2014, defendant Virginia Surety filed the instant motion to dismiss, raising new argument that plaintiffs lack standing to sue, grounded on N.C. Gen. Stat. § 58-50-15(b), which provides in part that “[a] policy delivered or issued for delivery to any person in this State in violation of Articles 50 through 55 of [Chapter 58] shall be held valid but shall be construed as provided in Articles 50 through 55 of this Chapter.”4

[646]*646Defendant Virginia Surety seeks the court to examine the disputed insurance program as a whole, and evaluate plaintiffs’. standing to sue any defendant under plaintiffs’ theory that the policies issued pursuant to the insurance program are void ab initio and that plaintiffs were damaged by paying the premiums or fees for such policies.

BACKGROUND

A. Background of the Alleged Scheme

As derived from the amended complaint, in 1997, David Blair, then Chief Executive Officer of defendant HealthExtras, Inc. (“HealthExtras”), along with others,5 conceived of the alleged disability insurance scheme at issue, with the intent of defrauding consumers, avoiding state insurance regulations,' and gaining an unfair and illegal advantage in the disability insurance market. (Am. Compl., DE 123, ¶¶ 6-7, 84, 86, 95). Defendant HealthExtras developed a program whereby enrollees would pay a single payment or premium for two types of benefits: Accidental Permanent and Total Disability benefit (“Disability Benefit”), and Emergency Accident and Sickness Medical Expense benefit (“Health Benefit”).6 (See id. ¶¶ 84-88). The Disability Benefit and- Health Benefit afforded enrollees benefits accruing from two insurance policies, issued to a trust, which was denominated as the policy holder for both policies. (Id. ¶¶ 84, 89, 186— 88).. The trust held the policies for the benefit of the group of enrollees, where the only unifying characteristic of the group members was a desire to enroll in the program offered, by defendant. HealthExtras. (See id. ¶ 173).

To market its plan, defendant HealthExtras established marketing partnerships with the nation’s largest VISA, Master[647]*647Card, and American Express issuing banks, as well as other entities supplying “branded credit cards,” such as Sears and Conoco Phillips. (Id. ¶ 88). Defendant HealthExtras used these partnerships to send to all cardholders flyers bearing the likeness of late-Superman actor, Christopher Reeve, and applications for enrollment into the insurance program. (Id.).

B. The Alleged Scheme in Operation

As detailed in the amended complaint, defendant HealthExtras entered into contracts with the underwriters, defendants National Union Fire Insurance Company (“National Union”) and Virginia Surety,licensed insurance carriers, who applied to the insurance department of the state or states in which they were licensed to do business for approval of a blanket policy,' gained approval for such policy, and subsequently underwrote the policy, knowing that these policies did not and could not comply with the law. (Id. ¶¶ 88, 95). In order to obtain approval for such policies, these underwriters misrepresented to state insurance regulators that the policies would be issued for the benefit of a valid blanket group, as defined under state law. (Id. ¶ 88). However, plaintiffs allege that in some instances the underwriters failed to apply for approval at all. (Id.). The alleged complicity of these underwriters was critical to the success of the scheme, because defendant HealthExtras is not a licensed insurance company or licensed insurance underwriter. (Id. ¶ 105).

Defendant HealthExtras sold the policies to insurance “trusts,” which defendant HealthExtras allegedly controls, and allowed individuals seeking benefits under the Disability Benefit and Health Benefit to enroll in the program as “members” of the “group” for whose benefit the trust held the policies. (Id. ¶¶ 107, 174). Thus, the “trust” serves as policy holder, while the individuals, such as plaintiffs, are “members” or “certificate holders” of policies issued directly to the trust. (Id. ¶¶ 107,186-88).

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124 F. Supp. 3d 642, 2015 U.S. Dist. LEXIS 113489, 2015 WL 5042874, Counsel Stack Legal Research, https://law.counselstack.com/opinion/petruzzo-v-national-union-fire-insurance-nced-2015.