Southern Orthopaedic Specialists LLC v. State Farm Fire & Casualty Company

CourtDistrict Court, E.D. Louisiana
DecidedJanuary 25, 2022
Docket2:21-cv-00861
StatusUnknown

This text of Southern Orthopaedic Specialists LLC v. State Farm Fire & Casualty Company (Southern Orthopaedic Specialists LLC v. State Farm Fire & Casualty Company) is published on Counsel Stack Legal Research, covering District Court, E.D. Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Southern Orthopaedic Specialists LLC v. State Farm Fire & Casualty Company, (E.D. La. 2022).

Opinion

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF LOUISIANA

SOUTHERN ORTHOPAEDIC CIVIL ACTION SPECIALISTS LLC

VERSUS NO. 21-0861-WBV-DMD

STATE FARM FIRE AND CASUALTY SECTION: D (1) COMPANY

ORDER AND REASONS Before the Court is Defendant State Farm Fire and Casualty Company’s Rule 12(b)(6) Motion to Dismiss for Failure to State a Claim.1 Plaintiff Southern Orthopaedic Specialists LLC opposes the Motion.2 Defendant has filed a Reply.3 After careful consideration of the parties’ memoranda and the applicable law, the Motion is DENIED without prejudice. I. FACTUAL AND PROCEDURAL BACKGROUND This is an insurance coverage and bad faith suit to recover lost income and extra expenses incurred during the COVID-19 pandemic.4 On August 1, 2019, Plaintiff Southern Orthopaedic Specialists LLC (“Southern Orthopaedic”), a medical practice operating at three locations, entered into a contract for insurance with Defendant State Farm Fire and Casualty Company (“State Farm”).5 The insurance policy (“the policy”) included an eight page policy, a Business Owners Coverage Form,

1 R. Doc. 15. 2 R. Doc. 25. 3 R. Doc. 29. 4 R. Doc. 1-1. 5 R. Doc 1-1 at ¶6. and several policy endorsements, including “CMP 4218.2, Amendatory Endorsement (Louisiana),” “CMP 4705.2, Loss of Income and Extra Expense, and “CMP 4704.1, Dependent Property—Loss of Income.”6 Coverage under the CMP 4705.2, Loss of

Income and Extra Expense endorsement required that any loss be caused by “direct physical loss to” the covered property and the loss is caused by a “Covered Cause of Loss.”7 The same endorsement also provided coverage for losses caused by a civil authority prohibiting access to the covered property due to a “Covered Cause of Loss” to a non-covered property under certain circumstances.8 Plaintiff made a timely demand on State Farm for business interruption

coverage “caused by or resulting from the COVID-19 Pandemic; the suspension of surgeries and in-person medical visits; and/or the orders of the State of Louisiana, the Department of Health, the City of New Orleans, and or Jefferson Parish.”9 Plaintiff sought coverage for the business interruption loss under the “CMP 4705.2, Loss of Income and Extra Expense” endorsement which included Civil Authority coverage.10 Defendant denied coverage on June 24, 2020.11 Plaintiff then brought suit in Orleans Parish Civil District Court seeking

declaratory relief that coverage was provided for the claimed loss, payment for the claimed relief, and bad faith damages as provided by La. Rev. Stat. Ann. § 22:1892.12

6 R. Doc. 1-4. 7 Id. at 29. 8 Id. at 30. 9 R. Doc. 1-1 ¶ 39. 10 Id. at ¶¶ 10-15. 11 R. Doc. 1-1 ¶ 39, 45. 12 Id. at ¶¶ 47-52 Defendant timely removed the action to this Court pursuant to 28 U.S.C. §§ 1332, 1441 and 1446.13 Defendant moves for dismissal under Federal Rule of Civil Procedure 12(b)(6)

alleging that Plaintiff’s claims fail because: (1) the policy contains exclusions that preclude coverage; and (2) Plaintiff otherwise fails to plead sufficient facts to establish accidental direct physical loss to trigger coverage.14 Specifically, Defendant claims the presence of an exclusion clause removing coverage for loss caused by virus (the “Virus Exclusion Clause”) bars Plaintiff’s claims. Defendant also argues that any losses due to either government orders or the presence of a virus, fails to constitute

“direct physical loss” under Louisiana law. In response, Plaintiff concedes that coverage under the policy is triggered if there is “accidental direct physical loss” to covered property, but argues that “accidental direct physical loss” is not defined in the policy. Nevertheless, Plaintiff maintains that it has sufficiently pled loss of physical use of the insured property and uninhabitability.15 Further, Plaintiff argues that the policy’s virus exclusion does not bar coverage and, instead, the policy provides coverage though the Civil Authority

coverage endorsement.16

13 R. Doc. 1 at 1. 14 R. Doc. 15. 15 R. Doc. 25. 16 Id. In its Reply, Defendant reasserts that the exclusions listed in the insurance policy unambiguously apply to the endorsement and that Louisiana law does not recognize intangible loss as a “direct physical loss” to a property.17

II. LEGAL STANDARD A. Fed. R. Civ. P. 12(b)(6) Motion to Dismiss. Under Federal Rule of Civil Procedure 12(b)(6), a defendant can seek dismissal of a complaint, or any part of it, for failure to state a claim upon which relief may be granted.18 To survive a Rule 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.’”19 “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.”20 “The plausibility standard is not akin to a probability requirement, but it asks for more than a sheer possibility that a defendant has acted unlawfully.”21 A court must accept all well-pleaded facts as true, viewing them in the light most favorable to the plaintiff.22 The Court, however, is not bound to accept as true

conclusory allegations, unwarranted factual inferences, or legal conclusions.23

17 R. Doc. 29. 18 Fed. R. Civ. P. 12(b)(6). 19 Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). 20 Gentilello v. Rege, 627 F.3d 540, 544 (5th Cir. 2010) (quoting Ashcroft, 556 U.S. at 678) (quotation marks omitted). 21 Iqbal, 556 U.S. at 679 (quotation omitted). 22 Gines v. D.R. Horton, Inc., 699 F.3d 812, 816 (5th Cir. 2012) (quoting In re Katrina Canal Breaches Litig., 495 F.3d 191, 205 (5th Cir. 2007)). 23 Plotkin v. IP Axess Inc., 407 F.3d 690, 696 (5th Cir. 2005). “Dismissal is appropriate when the complaint on its face shows a bar to relief.”24 In deciding a Rule 12(b)(6) motion to dismiss, a court is generally prohibited from considering information outside the pleadings, but may consider documents outside

of the complaint when they are: (1) attached to the motion; (2) referenced in the complaint; and (3) central to the plaintiff’s claims.25 The Court can also take judicial notice of matters that are of public record, including pleadings that have been filed in a federal or state court.26 III. ANALYSIS A. Matters Considered by the Court in its Analysis and Applicable Law.

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Southern Orthopaedic Specialists LLC v. State Farm Fire & Casualty Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/southern-orthopaedic-specialists-llc-v-state-farm-fire-casualty-company-laed-2022.