RISK v. LM GENERAL INSURANCE COMPANY

CourtDistrict Court, E.D. Pennsylvania
DecidedMarch 14, 2024
Docket2:23-cv-00041
StatusUnknown

This text of RISK v. LM GENERAL INSURANCE COMPANY (RISK v. LM GENERAL 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
RISK v. LM GENERAL INSURANCE COMPANY, (E.D. Pa. 2024).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA MARCIE RISK, and CIVIL ACTION TIMOTHY RISK, Plaintiffs, v. NO. 23-41 LM GENERAL INSURANCE COMPANY, Defendant. MEMORANDUM HODGE, J. March 14, 2024 I. INTRODUCTION Marcieand Timothy Risk(“Plaintiffs” or “the Risks”) brought this lawsuitasserting claims of insurance bad faith (Count I),breach of contract (Count II), loss of consortium (Count III), and violations of the Unfair Trade Practices and Consumer Protection Law (“UTPCPL”) (Count IV) against LM General Insurance Company (“Defendant” or “LM”) for denying their underinsured motorist (“UIM”) claim without conducting an investigation into the basis for the claim or providingarationale for its denial. (ECF No. 1-3.) The Risks sued LM in the Philadelphia County Court of Common Pleas on December 2, 2022, and LM removed the case to federal court on January 5, 2023. (ECF No. 1.) This case is presently before the Court on LM’s Motion to Dismiss Counts I and IV of the Complaint, and to Strike Allegations of Bad Faith, Statutory Violations, and Demands for Extra- Contractual Damages from Counts II and III of the Complaint (ECF No. 13) (“MTD”); and on Plaintiffs’Motion to Compel Depositions of Danielle Helfer and aCorporate Designee (ECF No. 16) (“MTC”). For the reasons discussed herein, the Court will grant in part and deny in part Defendant’s MTD. The Court will dismiss Plaintiff’s MTC as Moot without prejudice and with the right to refile, taking into consideration the Court’s decision on the MTD. II. FACTUAL BACKGROUND1 This case arises from Defendant’s administration of the Risks’ UIM claim arising from a motor vehicle accident onMay 6, 2019,in which Ms. Risk’s vehicle was rearended while stopped

for traffic on Lancaster Avenue in Montgomery County, Pennsylvania. (ECF No. 1-3 at ¶¶ 6-7.) Ms. Risk’s vehicle was struck at a high rate of speed by another vehicle owned and operated by a third-party, John Maisey (“tortfeasor”). (Id. at ¶¶ 7-8.) The tortfeasor was thereafter charged by police for failure to maintain safe speed and distance. (Id.at ¶9.) As a result of the accident, Ms. Risk allegedly sustained “serious, disabling and permanent personal injuries.” (Id. at ¶ 11) (detailing diagnoses and treatment.) Ms. Risk resolved her claims with the tortfeasor for $92,000 of the tortfeasor’s $100,000 third-party liability limit, with permission from Defendant LM. (Id.at ¶10.) At all relevant times, Ms. Risk was insured under an insurance policy (the “Policy”)

provided by LM, policy number AOS-288-501225-4093. (Id. at ¶ 25.) The Policy provided UIM coverage with full tort coverage up to $250,000. (Id. at¶ 25-28.) The Complaint alleges that on April 13, 2022, Plaintiffs’ Counsel sent correspondence to Danielle Helfer, a Senior Claim Resolution Specialist for Defendant LM, providing a detailed explanation of Ms. Risk’s extensive injuriesandsubsequent medical treatment,and requesting LM tender the policy limits of $250,000 in UIM benefits. (Id. at ¶ 14.) Along with the correspondence, Plaintiffs provided fourteen separate sets of voluminous medical records along with other documents supporting her claim. (Id.) According to the Complaint, on July 12, 2022, Ms. Helfer contacted Plaintiffs’Counsel and

1 The Court adopts the pagination supplied by the CM/ECF docketing system. requested a telephone call to discuss the UIM claim. (Id. at ¶18.) On July 15, 2022, Plaintiffs’ Counsel spoke with Ms. Helfer via telephone, at which time Ms. Helfer allegedly notified Plaintiffs that LM believed Ms. Risk had been fully compensated for her damages through her recovery in thecase with thethird-party tortfeasor. (Id.at ¶19.) The Risks allegethat in aJuly 21, 2022letter to Plaintiffs’counsel from the Defendant, Ms. Helfer failed to provide an explanation or rationale

for LM’s decision to deny the claim. (Id.at ¶20.) On August 10, 2023, the Risks sent another letter to Ms. Helfer notifying her that she had failed to provide a basis for her denial and that she had failed to conduct an independent medical examination or interview of Ms. Risk under oath. (Id.at ¶21.) Plaintiffs alsorenewedtheir request that LM tender the UIM policy limit of $250,000 for the UIM claim and notified LM that they would sue for bad faith under the UTPCPL §§201-1 - 201-9.2 and the Pennsylvania Unfair Insurance Practices Act 40 P.S. § 1171.1 et seq. and 73 P.S. § 201-1, et. seq.if LM failed to tender the policy limitsfor Ms. Risk’s claim. (Id.) On August 23, 2022, Ms. Helfer sent correspondence to Plaintiffs stating that she had reviewed all medical records and felt that Ms. Risk had been fully

compensated by the underlying policy limits of $100,000 and asking Ms. Risk for any additional medical records. (Id.at ¶22.) On September 12, 2022, Plaintiffs’ Counselsent Ms. Helfer acost report from a medical expert, estimating Ms. Risk would pay $285,111 in future medical costs arising from the accident. (Id. ¶23.) The Risks maintain that at no point did Ms. Helfer on behalf of LM provide an offer to settle Ms. Risk’s claim for UIM benefits. (Id.) The Risks then filed the instant lawsuit alleging that as a result of the car accident, they are entitled to the UIM benefits under the Policyas well as additional damages. (ECF No. 1-3.)In support oftheir bad faithclaim (Count I), the Risks allege that LM “failed to objectively and reasonably evaluate the plaintiff’s claims” by providing no basis for its decision to deny her claim moreover without any settlement offer, and by failing to request an independent medical examination (“IME”) or take Ms. Risk’s statement under oath before reaching its decision. (Id. at ¶ 38.) Plaintiffs further allege that Defendant systematically deprives its insureds of benefits and unreasonably delays the payment of full benefits to further its financial gains and interests. (Id. at ¶ 32.) In support of the UTPCL claim (Count IV), the Plaintiffs allege that LM falsely advertised their insurance benefits, and that

theyrelied on those advertisements when purchasing an insurance policy from Defendant. (Id.¶¶ 56-59.) III. LEGAL STANDARD A. MOTION TO DISMISS Defendant LM moves for dismissal under Federal Rule of Civil Procedure 12(b)(6). (ECF No. 13.) To survive a 12(b)(6) motion to dismiss, “a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” Ashcroft v. Iqbal, 566 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). A claim

is plausible when the plaintiff pleads “factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. Conclusory recitation of the elements of a cause of action is not sufficient. Phillips v. Cty. of Allegheny, 515 F. 3d 224, 233 (3d Cir. 2008). Rather, the plaintiff must allege facts necessary to make out each element. Id. at 234(quotingTwombly, 550 U.S. at 555). In other words, the complaint must contain facts which, if proven later, support a conclusion that a cause of action can be established. In considering a motion to dismiss under Rule 12(b)(6), the Courtfirst separatesthe factual and legal elements of a claim, accepting the well-plead facts as true and disregarding legal conclusions. Fowler v. UPMC Shadyside, 578 F. 3d 203, 210-11 (3d Cir. 2009). Then, the Court determines whether the alleged facts make out a “‘plausible claim for relief.’” Id. (quoting Iqbal, 556 U.S. at 679). All well-pleaded allegations in the complaint must be accepted as true and interpreted in the light most favorable to the plaintiffs, and all inferences must be drawn in the plaintiffs’ favor. See McTernan v. City of York, 577 F.3d521, 526 (3d. Cir. 2009).

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RISK v. LM GENERAL INSURANCE COMPANY, Counsel Stack Legal Research, https://law.counselstack.com/opinion/risk-v-lm-general-insurance-company-paed-2024.