RAMOS v. PROGRESSIVE SPECIALTY INSURANCE COMPANY

CourtDistrict Court, E.D. Pennsylvania
DecidedJuly 31, 2024
Docket2:24-cv-00816
StatusUnknown

This text of RAMOS v. PROGRESSIVE SPECIALTY INSURANCE COMPANY (RAMOS v. PROGRESSIVE SPECIALTY INSURANCE COMPANY) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
RAMOS v. PROGRESSIVE SPECIALTY INSURANCE COMPANY, (E.D. Pa. 2024).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA

LUIS RAMOS : CIVIL ACTION Plaintiff : : NO. 24-0816 v. : : PROGRESSIVE SPECIALTY : INSURANCE COMPANY : Defendant

NITZA I. QUIÑONES ALEJANDRO, J. JULY 31, 2024

MEMORANDUM OPINION

INTRODUCTION This civil action involves a dispute over automobile insurance policy coverage and an underlying state court action which involves a claim for personal injuries that occurred in a work- related fall during the course of employment at a construction site. In the case sub judice, Plaintiff Luis Ramos (“Ramos” or “Plaintiff”) filed an amended operative complaint against Defendant Progressive Specialty Insurance Company (“Progressive”) asserting a declaratory relief claim, (Count I), and a bad faith claim, (Count II), premised on Ramos’ assertion that Progressive has an obligation to defend him, consistent with an automobile insurance policy, in the underlying state court case styled De Leon v. Schweiger, Inc., Philadelphia County Court of Common Pleas, October Term, 2023, No. 02183 (the “Underlying State Court Action).1 Presently, before the Court is Progressive’s motion to dismiss the amended complaint filed pursuant to Federal Rule of Civil Procedure (“Rule”) 12(b)(6), (ECF 9), which Ramos opposes,

1 Progressive removed this action from the Philadelphia County Court of Common Pleas pursuant to 28 U.S.C. §1441 on the basis of diversity jurisdiction. There is no dispute that the requirements for diversity jurisdiction, 28 U.S.C. § 1332, are met: Ramos is a citizen of Pennsylvania, Progressive is a citizen of Ohio, and the alleged amount in controversy exceeds $75,000. (Am. Compl., ECF 7, at ¶¶ 1-2, 8). (ECF 12). The issues raised in the motion have been fully briefed and are ripe for disposition.2 For the reasons set forth, Progressive’s motion is granted, and this matter is dismissed.

BACKGROUND When ruling on a motion to dismiss, this Court must accept as true the well-pleaded allegations in the operative complaint. Fowler v. UPMC Shadyside, 578 F.3d 203, 210 (3d. Cir. 2009). Here, the facts relevant to the motion to dismiss are summarized as follows:3 A. Allegations in the Underlying State Court Action Olvin Guerra De Leon (“De Leon”) and Hilda Hernandes, husband and wife, filed a complaint in the Underlying State Court Action against Schweiger, Inc., Soft Contractor Corp., Ryan Homes, NVR, Inc., and Luis Ramos (Plaintiff here) claiming severe and permanent injuries and damages suffered when DeLeon fell at his workplace. (State Court Complaint, ECF 7-1, Ex. B). De Leon alleges therein that while in the course of his employment, he was working on the construction of a housing development (the “Construction Project”). (Id. at ¶ 25). While performing work-related duties on a surface without protected edges and without proper fall prevention measures, De Leon fell approximately thirty feet to the ground. (Id. at ¶¶ 26-28). Rather than calling 9-1-1 for an ambulance, Ramos, a worksite supervisor, instead, drove De Leon approximately fifty miles to Einstein Medical Center in North Philadelphia, allegedly “dumped” De Leon at the hospital entrance, and left. (Id. at ¶¶ 31-34).

De Leon alleges that, as a result of his fall, he suffered severe, debilitating, and life-threatening injuries, including, inter alia: “intracranial epidural hemorrhage requiring complex craniectomy surgery to evacuate the bleeding and allow the brain to swell; [a] medically induced coma for twenty-one days; . . . multiple orbital fractures; . . . post-traumatic stress; . . . chronic physical pain; suffering and loss of life’s pleasures, past, present, and future.” (Id. at ¶ 35). De Leon also alleges that his medical condition “substantially worsened” “during” the fifty-mile drive to the hospital. (Id. at ¶ 33).

2 This Court also considered Progressive’s reply. (ECF 13).

3 These facts are gleaned from the amended complaint in this matter, (ECF 7), the complaint filed in the Underlying State Court Action, (ECF 7-1, Ex. B), and the automobile insurance policy at issue, (ECF 7-1, Ex. A). See Donegal Mut. Ins. Co. v. Baumhammers, 938 A.2d 286, 290 (Pa. 2007) (explaining that when determining whether an insurance company has a duty to defend, the court must look to the allegations in the underlying complaint and the insurance policy at issue). In the State Court Complaint, De Leon asserts a single claim for negligence against Ramos, (Id. at ¶¶ 106-116), specifying, thirty-nine instances in which Ramos was negligent. (Id. at ¶ 114(a)-(mm)). Notably, none of these contentions include Ramos’ use of a vehicle. (Id.).

B. The Insurance Policy There is no dispute that Ramos drove De Leon to the hospital in a vehicle that belonged to Mirayada Morales Alicea, (“Alicea”), and that Ramos had Alicea’s permission to drive the vehicle. Also, there is no dispute that at all relevant times, the vehicle was covered by an automobile insurance policy (the “Policy”) issued by Progressive.

The Policy, in its pertinent provisions, provides:

Part I—Liability To Others of the Policy provides, in part:

“If you pay the premium for this coverage, we will pay damages for bodily injury and property damage for which an insured person becomes legally responsible because of an accident. We will settle or defend, at our option, any claim for damages covered by this Part I.” (Policy, ECF 7-1, Ex. A, at p. 3).4 The Policy defines each of the bolded terms as follows:

“[Y]ou” refers to “(a) a person shown as a named insured on the declarations page; and (b) the spouse of a named insured if residing in the same household at the time of the loss.” (Id. at p. 3, General Definitions ¶ 17).

“[W]e” and “our” mean “the underwriting company providing the insurance, as shown on the declarations page.” (Id. at General Definitions ¶ 16).

“‘Bodily injury’ means bodily harm, sickness, or disease, including death that results from bodily harm, sickness, or disease.” (Id. at p. 1, General Definitions ¶ 4).

“‘Property damage’ means physical damage to, destruction of, or loss of use of, tangible property.” (Id. at p. 2, General Definitions ¶ 9).

“Insured person” means, in relevant part, “(b) any person with respect to an accident arising out of that person’s use of a covered auto with the

4 All bolded terms appear as such in the Policy. permission of you. . . .” (Id. at p. 3, Part I—Liability To Others, Additional Definition.5

LEGAL STANDARD Rule 12(b)(6) provides for the dismissal of a complaint, in whole or in part, if the plaintiff fails to state a claim upon which relief can be granted. Fed. R. Civ. P. 12(b)(6); Bell Atlantic Corp v. Twombly, 550 U.S. 544, 552 (2007). When considering a motion to dismiss for failure to state a claim pursuant to Rule 12(b)(6), the court “must accept all of the complaint’s well-pleaded facts as true, but may disregard any legal conclusions.” Fowler, 578 F.3d at 210-11. The court must determine “whether the facts alleged in the complaint are sufficient to show that the plaintiff has a ‘plausible claim for relief.’” Id. at 211 (quoting Ashcroft v. Iqbal, 556 U.S. 662, 679 (2009)).

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RAMOS v. PROGRESSIVE SPECIALTY INSURANCE COMPANY, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ramos-v-progressive-specialty-insurance-company-paed-2024.