Springstone, Inc. v. Hiscox Insurance Company, Inc.

CourtDistrict Court, W.D. Kentucky
DecidedAugust 5, 2020
Docket3:19-cv-00821
StatusUnknown

This text of Springstone, Inc. v. Hiscox Insurance Company, Inc. (Springstone, Inc. v. Hiscox Insurance Company, Inc.) is published on Counsel Stack Legal Research, covering District Court, W.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Springstone, Inc. v. Hiscox Insurance Company, Inc., (W.D. Ky. 2020).

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF KENTUCKY LOUISVILLE DIVISION

SPRINGSTONE, INC., ) ) Plaintiff, ) Civil Action No. 3:19-CV-821-CHB ) v. ) ) MEMORANDUM OPINION AND HISCOX INSURANCE COMPANY ) ORDER INC., ) ) Defendant. *** *** *** *** This matter is before the Court on Defendant Hiscox Insurance Company, Inc.’s Motion to Dismiss. [R. 4] Plaintiff has responded [R. 8], and Defendant filed a brief in reply [R. 11]. Therefore, this matter is ripe for review. For the following reasons, Defendant’s Motion is granted, and Plaintiff’s claims are dismissed pursuant to Fed. R. Civ. P. 12(b)(6). I. Background Facts1 Plaintiff Springstone, Inc. (“Springstone”), through its wholly owned subsidiaries, is a behavioral health provider with several facilities, headquartered in Louisville. [R. 1-2 p. 4 ¶¶ 6– 7] Hiscox Insurance Company, Inc. (“Hiscox”) is an insurance provider. [Id. ¶ 8] In January, 2017, Springstone obtained an insurance policy from Hiscox, Policy Number UVA1490983.17 (the “Policy”), which included a Directors & Officers Liability Coverage Part (“D&O Coverage”). [Id. p. 5 ¶¶ 9–10] The Policy included two agreements relevant here.2 First, the Policy includes Company Reimbursement Coverage (“Coverage B”), which covers:

1 Because this action is before the Court on a Motion to Dismiss under Federal Rule of Civil Procedure 12(b)(6), the Court takes all facts in the light most favorable to the Plaintiff, and all following factual allegations are taken from the Complaint or are undisputed. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). 2 The Court may consider the attachments to Plaintiff’s Complaint without converting the Motion to Dismiss as one for summary judgment, particularly given that they are referred to in the Complaint and are central to its claim. Amini v. Oberlin College, 259 F.3d 493, 502 (6th Cir. 2001). The Loss of a Company arising from a Claim first made against an Individual Insured during the Policy Period or the Discovery Period (if applicable) for any actual or alleged Wrongful Act of such Individual Insured, but only when and to the extent that such Company has indemnified such Individual Insured for such Loss. [R. 1-2 p. 28] Second, the Policy includes Company Coverage (“Coverage C”), which covers: The Loss of a Company arising from a Claim first made against a Company during the Policy Period or the Discovery Period (if applicable) for any actual or alleged Wrongful Act of a Company. [Id.] The Policy also has the following Exclusion in the D&O Coverage in Section IV: The Insurer shall not be liable to make any payment for Loss in connection with any Claim made against any Insured: Q. with respect to Coverage C only: (vi) seeking fines or penalties or non-monetary relief against the Company; provided, however, that this exclusion shall not apply to any Securities Claim. [Id. pp. 35, 38–39] The Policy Period ran from January 13, 2017 to October 8, 2017. [Id. p. 7 ¶ 19] On July 25, 2016, a qui tam lawsuit was filed under seal against Springstone in the Southern District of Ohio (the “Qui Tam Complaint”). [Id. p. 7 ¶ 20; see also id. pp. 132–160 (the Qui Tam Complaint)] The Qui Tam Complaint claimed that Springstone had violated the False Claims Act by obtaining reimbursement from Medicare and Medicaid for medically unnecessary services that it provided to patients. [Id. p. 8 ¶ 21] On July 25, 2017, the Office of the Inspector General for the Department of Health and Human Services (“OIG”) issued a subpoena (the “Subpoena”) to Springstone as part of its investigation of the qui tam action filed against Springstone. [Id. ¶¶ 23−25; see also id. pp. 161−92 (the Subpoena)] The Subpoena requested documentation regarding Springstone’s patient treatment and management practices. [Id. p. 8 ¶ 24] On October 6, 2017, Springstone notified Hiscox of the Subpoena, seeking coverage for its response to the Subpoena under the D&O Coverage. [Id. p. 9 ¶ 26; R. 8 p. 4] Hiscox denied coverage for Springstone’s response to the OIG Subpoena, noting that there was no “Claim” as defined by the Policy, nor did the Subpoena allege a “Wrongful Act.” [R. 1-2 p. 9 ¶ 27; id. pp. 193−96] Springstone obtained services from the law firm Alston & Bird to assist in responding

to the Subpoena and incurred substantial costs. [Id. ¶¶ 29−30] On January 21, 2019, the qui tam lawsuit was dismissed, and the Qui Tam Complaint was unsealed. [Id. pp. 9−10 ¶ 32] On January 22, 2019, Springstone again sought coverage for its expenditures made responding to the Subpoena. [Id. p. 9 ¶ 31; id. pp. 198−215] After receiving notice of the Qui Tam Complaint, Springstone notified Hiscox of its existence [Id. p. 10 ¶ 33; id. pp. 218−21] Hiscox again denied coverage. [Id. p. 10 ¶ 34]

On October 9, 2019, Springstone filed the present action against Hiscox in Jefferson Circuit Court. [R. 1-2] Springstone alleges breach of contract, seeks a declaration of rights under the insurance agreement, claims common law bad faith, violations of the Kentucky Unfair Claims Settlement Practices Act and Kentucky Consumer Protection Act, unjust enrichment, and seeks punitive damages. [R. 1-2 pp. 12−17] Hiscox timely removed the action to this Court, and filed its Motion to Dismiss. [R. 1; R. 4] Hiscox argues that neither Coverage C nor Coverage B covers Springstone’s costs relating to the Subpoena, and that Coverage C specifically excludes non-monetary relief. It further argues that Springstone’s statutory and common law claims fail because it was justified in denying Springstone’s claim.

II. Legal Standard Federal Rule of Civil Procedure 12(b)(6) provides for dismissal of an action if the Complaint fails to state a claim upon which relief can be granted. Fed. R. Civ. P. 12(b)(6). The moving party has the burden of proving that no claim exists. Total Benefits Plan. Agency Inc. v. Anthem Blue Cross and Blue Shield, 552 F.3d 430, 434 (6th Cir. 2008). While the Complaint must be liberally construed in favor of the non-moving party, “it is still necessary that the Complaint contain more than bare assertions or legal conclusions.” Id. (citing In re Delorean Motor Co., 991 F.2d 1236, 1240 (6th Cir. 1993)) (other citations omitted). Moreover, the Court

need not accept unwarranted factual inferences. Morgan v. Church’s Fried Chicken, 829 F.2d 10, 12 (6th Cir. 1987). “To survive a 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, 556 U.S. 662, 678 (2009). A claim is factually plausible if the Complaint contains factual allegations that “allow the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. This does not require a showing that the defendant is probably liable, but “it asks for more than a sheer possibility that a defendant has acted unlawfully.” Id.

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Bluebook (online)
Springstone, Inc. v. Hiscox Insurance Company, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/springstone-inc-v-hiscox-insurance-company-inc-kywd-2020.