RENÉE MARIE BUMB, District Judge.
This matter is before the Court upon a motion by Defendant Certain Underwriters at Lloyds, London ("Underwriters") to dismiss Counts II and V of the Second Amended Complaint filed by Plaintiff New Jersey Schools Insurance Group ("NJSIG"). For the reasons set forth herein, the motion will be granted.
The following facts are taken from the Second Amended Complaint. (Compl. [ECF No. 26]). On June 1, 2011, Luis Rodriguez was struck by a school bus owned and operated by Jersey City Public Schools ("Jersey City"), resulting in personal injuries to Mr. Rodriguez. Mr. Rodriguez filed a personal injury action against Jersey City in the New Jersey Superior Court, Law Division, Union County (the "Rodriguez Action").
Jersey City was insured by Plaintiff NJSIG for the claims in the Rodriguez Action under a policy with a coverage limit of $500,000. Munich Insurance Company provided indemnity coverage for an additional $500,000. Defendant Star Insurance Company insured Jersey City under an Excess Liability policy with coverage in excess of the $1 million provided by NJSIG and Munich Insurance Company. Underwriters insured NJSIG under a Trustees Errors and Omissions Liability Insurance for Self Insured Funds policy bearing number LTEO-0006976 (the "Policy").
The Rodriguez Action settled at mediation on July 21, 2004. The settlement resulted in a General Release in which all claims by Mr. Rodriguez against Jersey City, NJSIG, and others were released in exchange for the settlement payment of $1.9 million. On September 29, 2014, over two months after the settlement, NJSIG notified Star and Meadowbrook of the settlement and requested payment of $900,000 under the Star policy.
On November 7, 2014, Brokers' Risk, on Underwriters' behalf, denied coverage to NJSIG under the Policy. In pertinent part, Underwriters denied coverage because no claim had been made against NJSIG as required under the Policy. Plaintiff alleges the denial was "based on a narrowly circumscribed and distorted interpretation of `claim' that purportedly required litigation against NJSIG in order to trigger coverage under the. . . Policy." (Compl. ¶ 33). NJSIG also alleges that the denial was made without conducting any investigation and that Brokers' Risk/Underwriters had no debatable reason to deny coverage under the Policy.
Underwriters contends that Counts II and V fail to state a claim because Underwriters had a legally permissible basis to deny coverage to NJSIG or, at a minimum, Underwriters' denial of coverage was debatable.
A Rule 12(b)(6) motion to dismiss for failure to state a claim upon which relief may be granted must be denied if the plaintiff's factual allegations are "enough to raise a right to relief above the speculative level, on the assumption that all the allegations in the complaint are true, (even if doubtful in fact)."
A district court must accept any and all reasonable inferences derived from those facts.
Therefore, in deciding a motion to dismiss, a court should look to the face of the complaint and decide whether, taking all of the allegations of fact as true and construing them in a light most favorable to the non-movant, the plaintiff has alleged "enough facts to state a claim for relief that is plausible on its face."
Count II alleges a breach of the implied covenant of good faith and fair dealing. Specifically, NJSIG alleges that Underwriters "breached the duty of good faith and fair dealing in its determination as to the liabilities due to NJSIG under [the Policy]." Count V alleges bad faith. Specifically, Plaintiff alleges that Underwriters "lacked any reasonable basis for denying coverage and/or knew or recklessly disregarded the lack of a reasonable basis for denying the claim."
Although this is a motion to dismiss and not a motion for summary judgment, the Court is permitted to rely upon facts if they are contained in documents that are integral to the Complaint.
(Pl.'s Opp. Br. Ex B at 23 [ECF No. 34-1].) Likewise, the Policy contains a notice of claim provision:
(
Most importantly, "Claim" is defined under the Policy:
(
Clearly, on the face of the Policy, the unambiguous definition of "Claim" requires that a written demand be made against the insured. NJSIG, however, has not alleged anywhere in the Second Amended Complaint that any third party made a demand, written or otherwise, against NJSIG based on the events of the settlement of the Rodriguez Action. Nor does NJSIG allege anywhere in the Second Amended Complaint that it advised Underwriters that it was under "threat of litigation" by Rodriguez. As Underwriters' letter makes clear, Underwriters expressly asked NJSIG to keep it advised as the matter developed. NJSIG does not allege that it ever provided such notice.
Accordingly, based on the pleadings, it cannot be said that Underwriters' denial of coverage was not fairly debatable. Accordingly, Counts II and V will be dismissed.