BLACKBURN, J.
The matter before me is
I have subject matter jurisdiction pursuant to 28 U.S.C. § 1332 (diversity of citizenship).
When ruling on a motion to dismiss pursuant to Fed.R.Civ.P. 12(b)(6), I must determine whether the allegations of the complaint are sufficient to state a claim within the meaning of Fed.R.Civ.P. 8(a). For many years, "courts followed the axiom that dismissal is only appropriate where `it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.'" Kansas Penn Gaming, LLC v. Collins, 656 F.3d 1210, 1214 (10th Cir. 2011) (quoting Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 102, 2 L.Ed.2d 80 (1957)). Noting that this standard "has been questioned, criticized, and explained away long enough," the Supreme Court supplanted it in Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 562, 127 S.Ct. 1955, 1969, 167 L.Ed.2d 929 (2007). Pursuant to the dictates of Twombly, I now review the complaint to determine whether it "`contains enough facts to state a claim to relief that is plausible on its face.'" Ridge at Red Hawk, L.L.C. v. Schneider, 493 F.3d 1174, 1177 (10th Cir.2007) (quoting Twombly, 127 S.Ct. at 1974). "This pleading requirement serves two purposes: to ensure that a defendant is placed on notice of his or her alleged misconduct sufficient to prepare an appropriate defense, and to avoid ginning up the costly machinery associated with our civil discovery regime on the basis of a largely groundless claim." Kansas Penn Gaming, 656 F.3d at 1215 (citation and internal quotation marks omitted).
As previously, I must accept all well-pleaded factual allegations of the complaint as true. McDonald v. Kinder-Morgan, Inc., 287 F.3d 992, 997 (10th Cir.2002). Contrastingly, mere "labels and conclusions or a formulaic recitation of the elements of a cause of action" will not be sufficient to defeat a motion to dismiss. Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 1949, 173 L.Ed.2d 868 (2009) (citations and internal quotation marks omitted). See also Robbins v. Oklahoma, 519 F.3d 1242, 1247-48 (10th Cir.2008) ("Without some factual allegation in the complaint, it is hard to see how a claimant could satisfy the requirement of providing not only `fair notice' of the nature of the claim, but also `grounds' on which the claim rests.") (quoting Twombly, 127 S.Ct. at 1974) (internal citations and footnote omitted). Moreover, to meet the plausibility standard, the complaint must suggest "more than a sheer possibility that a defendant has acted unlawfully." Iqbal, 129 S.Ct. at 1949. See also Ridge at Red Hawk, 493 F.3d at 1177 ("[T]he mere metaphysical possibility that some plaintiff could prove some set of facts in support of the pleaded claims is insufficient; the complaint must give the court reason to believe that this plaintiff has a reasonable likelihood of mustering factual support for these claims.") (emphases in original). For this reason, the complaint must allege facts sufficient to "raise a right to relief above the speculative level." Kansas Penn Gaming, 656 F.3d at 1214 (quoting Twombly, 127 S.Ct. at 1965). The standard will not be met where the allegations of the complaint are "so general that they
The nature and specificity of the allegations required to state a plausible claim will vary based on context and will "require[] the reviewing court to draw on its judicial experience and common sense." Iqbal, 129 S.Ct. at 1950; see also Kansas Penn Gaming, 656 F.3d at 1215. Nevertheless, the standard remains a liberal one, and "a well-pleaded complaint may proceed even if it strikes a savvy judge that actual proof of those facts is improbable, and that a recovery is very remote and unlikely." Dias v. City and County of Denver, 567 F.3d 1169, 1178 (10th Cir. 2009) (quoting Twombly, 127 S.Ct. at 1965) (internal quotation marks omitted).
This is a putative class action for breach of insurance contract and related causes of action. Defendants issued automobile insurance policies to plaintiff and other similarly situated individuals in Colorado, which policies provide coverage for "reasonable and customary expense[s] for necessary medical services furnished within two years from the date of the accident, because of bodily injury sustained by an insured person." Plaintiff claims that this limitation is void and unenforceable and thus seeks to represent, inter alia, a subclass of individuals defined as
This subclass is referred to as the "two-year limitation subclass."
The substantive basis for all the various claims of the two-year subclass is section 10-4-635, C.R.S., which requires insurers to offer their insureds medical payment ("med-pay") benefits. The statute provides, in relevant part:
§ 10-4-635(1)(a), C.R.S. Because the statute itself does not limit the time in which such claims must be submitted, plaintiff concludes that the policies' restriction contravenes public policy as an attempt to "dilute, condition, or limit statutorily mandated coverage" and thus is unenforceable. See DeHerrera v. Sentry Insurance Co., 30 P.3d 167, 173 (Colo.2001) (citation and internal quotation marks omitted). All his claims for relief on behalf of this class are premised on this contention.
Defendants moved to dismiss the claims of the purported subclass on the ground, inter alia, that the limitation was not void as contrary to public policy. (See
A policy exclusion or limitation is not void simply because it narrows the circumstances under which coverage applies. Cruz v. Farmers Insurance Exchange, 12 P.3d 307, 312 (Colo.App.2000); Farmers Insurance Exchange v. Chacon, 939 P.2d 517, 520 (Colo.App.1997). "Even within the context of statutorily mandated insurance, insurers are free to include `conditions and exclusions that are not inconsistent with' Colorado's mandatory insurance laws." Bailey v. Lincoln General Insurance Co., 255 P.3d 1039, 1047 (Colo.2011) (quoting § 10-4-623(1), C.R.S.). That an exclusion or limitation may not further the legislative intent of a statute does not render the exclusion or limitation void; instead, the exclusion is void only if it contravenes public policy. See Principal Mutual Life Insurance Co. v. Progressive Mountain Insurance Co., 1 P.3d 250, 255 (Colo.App.1999). Moreover, given Colorado's strong commitment to the freedom of contract, Shelter Mutual Insurance Co. v. Mid-Century Insurance Co., 246 P.3d 651, 662 (Colo.2011), "[t]he principle that contracts in contravention of public policy are not enforceable should be applied with caution and only in cases plainly within the reason on which the doctrine rests," Bailey v. Lincoln General Insurance Co., 255 P.3d 1039, 1045 (Colo.2011).
Med-pay benefits are one of the new categories of coverage for economic losses that previously came under the umbrella of the personal injury protection ("PIP") coverages mandated by the Colorado Auto Accident Reparations Act ("CAARA"). After CAARA was allowed to sunset and Colorado moved to a tort-based system in 2004, med-pay coverage became wholly optional. However, this arrangement quickly became unworkable for first responders and emergency medical service providers, whose claims too often fell in the gap between automobile insurance and health insurance deductibles and coverages where med-pay coverage had not been elected. These providers frequently were forced to resort to the private pay market, where claims for emergency medical services tended to go unpaid.
In order "to try to keep our trauma system whole," Senate Bill 11 was introduced in 2008. (
Given this legislative intent and history, and having reviewed the arguments, authorities, and evidence submitted by the parties, I find nothing to suggest that a two-year limitation on the submission of med-pay claims would offend the intent of the statute or the public policy impelling it. "In the absence of statutory inhibition, an insurer may impose any terms and conditions consistent with public policy which it may see fit." Chacon v. American Family Mutual Insurance Co., 788 P.2d 748, 750 (Colo.1990). See also Bailey, 255 P.3d at 1047 ("Even within the context of statutorily mandated insurance, insurers are free to include `conditions and exclusions that are not inconsistent with'
All plaintiff's claims in this lawsuit hinge on the viability of its argument that any temporal limitation on the payment of med-pay benefits is void under Colorado law.
1. That
2. That plaintiff's claims implicating the two-year limitation subclass are
3. That at the time judgment enters, judgment
§§ 10-4-635(2)(b)(I)-(IV), C.R.S. The insurer must provide a reserve $5,000 of coverage for these claims for no more than thirty days after receipt of the accident notice. § 10-4-635(2)(c). Only after that thirty-day period ends may any remaining amounts be used to pay claims for reimbursement submitted by other providers. Id.