ORDER DENYING ALLIED'S MOTION TO DISMISS

[Re: ECF No. 17]

LAUREL BEELER, Magistrate Judge.

INTRODUCTION

The plaintiffs EYEXAM of California, Inc. and Luxottica Retail North America, Inc. ("LRNA") sued the defendants Allied World Surplus Lines Insurance Co. and Darwin Select Insurance Co. for Darwin's failure to defend them in two underlying lawsuits. Allied, as Darwin's successor, moves to dismiss the claims arising from one lawsuit (Altair Eyewear, Inc. v. Luxottica Retail North America, Inc., et al.), on the ground that the lawsuit was not covered under the insurance policy's definition of "Claim." The court denies Allied's motion.

STATEMENT

1. The Parties

EYEXAM is a health care service plan under the Knox-Keene Health Care Service Plan Act of 1975, Cal. Health & Safety Code § 1340 et seq., and is licensed by the California Department of Managed Healthcare. (Complaint, ECF No. 1, ¶ 10.) EYEXAM employs practicing optometrists who are licensed by the California Board of Optometry. (Id.) LRNA is a dispensing optician registered with the Division of Licensing of the California Medical Board. (Id. ¶ 11.) LRNA owns and operates LensCrafters, which has over 100 retail locations in California. (Id.) LRNA and EYEXAM have adopted business practices at LensCrafters retail locations to provide consumers with a "one-stop shopping" experience in which they can (i) obtain their eyeglass prescription from a licensed optometrist employed by EYEXAM, (ii) purchase frames and eyewear accessories, and (iii) have their lenses and frames fitted by a trained optician. (Id. ¶ 12.)

Darwin issued the insurance policy at issue in this litigation to EYEXAM and LRNA. (Id. ¶ 13.) Allied is the successor to Darwin. (Id. ¶ 6.)

2. The Insurance Policy

Darwin issued a Managed Care Organization Errors and Omissions Liability Insurance Policy No. 0303-7769, effective March 15, 2013 to March 15, 2014 (the "Policy"), to Luxottica U.S. Holdings Corp. (Id. ¶ 13; Policy, ECF No. 18-1, Policy Declarations.1) EYEXAM was named as an "Insured Entity," and LRNA was named as an "Additional Insured," pursuant to an endorsement. (Complaint, ECF No. 1, ¶ 13; Policy, ECF No. 18-1, Endorsement No. 17.)

The Policy covers "any Insured Loss which the Insured is legally obligated to pay as a result of a Claim that is first made against the Insured during the Policy Period . . . ." (Complaint, ECF No. 1, ¶ 14; Policy, ECF No. 18-1, Insuring Agreement, § I, Definitions, § IV(J) (bolding in original).) The policy has the following relevant definitions:

3. The Altair Action

EYEXAM and LRNA were named as defendants in two lawsuits: (1) Altair Eyewear, Inc. v. Luxottica Retail North America, Inc., et al., Superior Court of California, County of Sacramento, Case No. 34-2014-00156471; and (2) Smith v. Luxottica Retail North America, et al., United States District Court, Southern District of California, Case No. 14-cv-0366 JAH (BLM). (Complaint, ECF No. 1, ¶ 2.) Allied moves to dismiss the claims challenging its alleged failure to defend in the Altair lawsuit. Altair filed is complaint on January 10, 2014 against LRNA and EYEXAM in Sacramento County Superior Court. (Id. ¶ 20; see also Altair Complaint, ECF No. 1-1.) Relevant allegations from that complaint are as follows.

At all relevant times, Altair was in the commercial business of selling eyeglass frames as retail fashion accessories and was a competitor of LRNA. (Complaint, ECF No. 1, ¶ 21; Altair Complaint, ECF No. 1-1, ¶ 2.) Altair alleged that it lost business because LRNA and EYEXAM unlawfully provided consumers with a "one-stop shopping" experience. (Complaint, ECF No. 1, ¶ 21; Altair Complaint, ECF No. 1-1, ¶¶ 18-19, 42-45.) To create this experience:

Altair alleged that LRNA's and EYEXAM's business practices do not comply with several California statutes regulating licensed optometrists and dispensing opticians. (Complaint, ECF No. 1, ¶¶ 21-22; Altair Complaint, ECF No. 1-1, ¶¶ 7-17, 34-40.) Altair thus sued LRNA and EYEXAM for unfair competition in violation of California Business and Professions Code § 17200 et seq. (Complaint, ECF No. 1, ¶ 21; Altair Complaint, ECF No. 1-1, ¶¶ 33-45.) Altair sought injunctive relief, private attorney general attorneys' fees, and costs. (Complaint, ECF No. 1, ¶ 21; Altair Complaint, ECF No. 1-1 at 13-14.)

LRNA and EYEXAM provided timely notice and asked Darwin to pay for defense costs incurred in defending the Altair Action. (Complaint, ECF No. 1, ¶ 23.) Darwin denied coverage and refused to pay such expenses. (Id.) LRNA and EYEXAM subsequently explained to Darwin why its coverage position was incorrect and provided further information demonstrating that the Altair Action was covered under the Policy. (Id.) More than once, LRNA and EYEXAM asked Darwin to reconsider its position, but Darwin responded by confirming its denial of coverage. (Id.)

The Superior Court dismissed the Altair Action on December 5, 2014. (Complaint, ECF No. 1, ¶ 20.)

4. Relevant Procedural History

On August 10, 2015, the plaintiffs LRNA and EYEXAM filed this lawsuit against the defendants Darwin and Allied for wrongfully denying coverage and refusing to pay the defense expenses incurred for the Altair Action and the Smith Action. (See generally Complaint, ECF No. 1.) Allied moved to dismiss the claims relating to the Altair Action on the ground that the Altair Action was not a "Claim" covered under the Policy. (See Motion, ECF No. 17.) The claims relating to the Altair Action are claims one, two, and five: 1) claim one is for declaratory relief to establish the duty to pay; 2) claim two is for breach of contract for failing to pay defense expenses; and 3) claim five is for breach of the covenant of good faith and fair dealing. (Id. ¶¶ 36-56.)

The court held a hearing on the motion on November 12, 2015. (Minute Order, ECF No. 37.)

GOVERNING LAW

1. Rule 12(b)(6)

A complaint must contain a "short and plain statement of the claim showing that the pleader is entitled to relief" to give the defendant "fair notice" of what the claims are and the grounds upon which they rest. See Fed. R. Civ. P. 8(a)(2); Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007)." A complaint does not need detailed factual allegations, but "a plaintiff's obligation to provide the `grounds' of his `entitlement to relief' requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do. Factual allegations must be enough to raise a claim for relief above the speculative level. . . ." Id. (internal citations omitted).

To survive a motion to dismiss, a complaint must contain sufficient factual allegations, accepted as true, "`to state a claim to relief that is plausible on its face.'" Ashcroft v. Iqbal, 556 U.S. 662,678 (2009) (quoting Twombly, 550 U.S. at 570). "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." Id. "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." Id. (quoting Twombly, 550 U.S. at 557). "Where a complaint pleads facts that are `merely consistent with' a defendant's liability, it `stops short of the line between possibility and plausibility of "entitlement to relief."'" Id. (quoting Twombly, 550 U.S. at 557).

If a court dismisses a complaint, it should give leave to amend unless the "the pleading could not possibly be cured by the allegation of other facts." Cook, Perkiss and Liehe, Inc. v. Northern California Collection Serv. Inc., 911 F.2d 242, 247 (9th Cir. 1990).

2. The Interpretation of Insurance Agreements

In MacKinnon v. Truck Insurance Exchange, the California Supreme Court summarized the principles for interpreting insurance policies:

31 Cal.4th 635, 647-48 (Cal. 2003).

3. An Insurer's Duty to Defend

In Scottsdale Insurance Company v. MV Transportation, the California Supreme Court summarized the principles relating to an insurer's duty to defend as follows:

36 Cal.4th 643, 654-55 (Cal. 2005).

ANALYSIS

The issue is whether the Altair lawsuit is a "Claim" under the Policy. Allied makes several arguments that it is not. (Motion, ECF No. 17 at 6-8; Reply, ECF No. 23 at 4-9.)

First, Allied argues that the Altair Action does not meet the Policy's definition of a "Claim" because "Claims" can be brought only by healthcare providers or plan members, and Altair "is neither a member (i.e., an enrollee or subscriber) nor a provider (i.e., a professional or health facility licensed to deliver or furnish healthcare service) of EYEXAM's health care plan, but rather is alleged to be a competitor of [the p]laintiffs which has suffered economic harm as a result of [the p]laintiffs' business practices in the form of loss of market share and sales." (Motion, ECF No. 17 at 7-8.) But as the plaintiffs point out, nothing in the Policy says that "Claims" may be filed only by healthcare providers or plan members. Under the Policy, a "Claim" is "any written notice received by any Insured that a person or entity intends to hold an Insured responsible for a Wrongful Act . . . ." (Policy, ECF No. 18-1, Definitions, § IV(C) (emphasis added).) By its own terms, a "Claim" is not limited to claims brought by healthcare providers or plan members.

Second, Allied argues that the Altair Action is not a "Claim" because Altair did not try to hold the plaintiffs responsible for a "Wrongful Act." (Motion, ECF No. 17 at 7.) The plaintiffs' acts were not "Wrongful Acts," Allied argues, because the "acts, errors, and omissions" that Altair alleged in the Altair Action do not fall within the Policy's definition of "Managed Care Activity." (Id.)

Here, the Policy defines "Managed Care Activity," and the definition encompasses a wide range of conduct. It includes:

(Policy, ECF No. 18-1, Definitions, § IV(K).) It also includes "[c]onsumer directed health plans, prescription drug, behavioral health, dental, vision, long or short-term disability and automobile medical payment plans." (Policy, ECF No. 18-1, Endorsement No. 6.)

Allegations in the Altair Action fall within this definition. For example, Altair alleged that LRNA and EYEXAM actively pursued and retained doctors who understood that promoting LRNA's products to patients is an important part of their jobs, used "capture rates" to evaluate and decide whether to promote EYEXAM's doctors, and paid most of the doctors by the hour, which gave them the power to reduce or increase scheduled hours and compensation and to better control the doctors' professional judgment with punishments or rewards. (Altair Complaint, ECF No. 1-1, ¶¶ 18-19, 27-31.) These acts fall within the Policy's definition of "Provider Selection," which means "evaluating, selecting, credentialing, contracting with or performing peer review of any provider of Medical Services." (Policy, ECF No. 18-1, Definitions, § IV(P).) Altair also alleged that LRNA provided office space at its LensCrafters stores for EYEXAM's doctors and that LRNA and its LensCrafters employees actively advertised, scheduled, and furnished the services of EYEXAM optometrists through LRNA's LensCrafters website, other advertising, and signage in its retail stores. (Altair Complaint, ECF No. 1-1, ¶¶ 18-20, 22, 25-26.) These acts constitute "Managed Care Activity" because they constitute the "advertising, marketing, selling, or enrollment for health care or workers' compensation plans" and "services or activities performed in the administration or management of health care of workers' compensation plans." (Policy, ECF No. 18-1, Definitions, § IV(K).) (See Opposition, ECF No. 19 at 11-12, summarizing allegations in the Altair complaint relating to "Managed Care Activity," including design and implementation of financial incentive programs, development of clinical guidelines, practice parameters, and protocols, and services performed in the administration of health-care plans.)

Allied does not explain how the Policy's definition of "Managed Care Activity" can be read to exclude conduct that Altair alleged in its complaint. Instead, Allied relies on the Policy "as a whole," arguing that it "is a Managed Care Errors & Omissions policy, not a business liability or Directors & Officers policy." (Reply, ECF No. 23 at 6-7.) "The risk insured is an error or omission in the insured's business as a managed care plan, not its anti-competitive activity as a purveyor of fashion eyewear." (Id.) In short, Allied asserts, coverage is limited to liability for services provided by the managed care plan. (Id. at 9.) That, it says, is not the liability faced by the plaintiffs in Altair action: their liability was "neither premised on their conduct in establishing healthcare plan networks (e.g., a provider suing for being unfairly denied entrance into a health care plan network) nor for functions that involve the typical administrative and sales activities needed to maintain a managed care organization." (Motion, ECF No. 17 at 8.) Instead, "Altair sued for unfair competition under Business & Professions Code § 17200, not for mismanagement of its own health care plan." (Reply, ECF No. 23 at 5-6, emphasizing that Altair did not claim that it was harmed "as a user of managed care services.")

This argument does not change the outcome. It is true that "[t]he terms in an insurance policy must be read in context and in reference to the policy as a whole, with each clause helping to interpret the other," Sony Computer Entm't Am. Inc. v. Am. Home Assurance Co., 532 F.3d 1007, 1012 (9th Cir. 2008) (citations omitted). But one cannot ignore the policy's definitions. "If contractual language is clear and explicit, it governs." Bank of the West v. Superior Ct., 2 Cal.4th 1254, 1264 (1992). The Policy's definition of "Managed Care Activity" covers allegations in the Altair complaint. Moreover, the Policy defines the risk that it is insuring, providing coverage for "any Insured Loss which the Insured is legally obligated to pay as a result of a Claim that is first made against the Insured during the Policy Period." (Policy, ECF No. 18-1, Insuring Agreement, § I.) A "Claim" is "any written notice received by any Insured that a person or entity intends to hold an Insured responsible for a Wrongful Act"; a "Wrongful Act," includes "any actual or alleged act, error or omission in the performance of, or any failure to perform, a Managed Care Activity by any Insured Entity." (Policy, ECF No. 18-1, Definitions, § IV(C), (W)(1).) And again, the Policy does not restrict coverage to "Claims" brought by healthcare providers or plan members.

Third, Allied suggests that "principles" articulated by the California Supreme Court in Bank of the West bar coverage under the Policy for the "types of allegedly anticompetitive practices" at issue in the Altair Action. (Reply, ECF No. 23 at 3, 4.) In Bank of the West, the California Supreme Court interpreted the scope of coverage in a comprehensive general liability insurance policy. See 2 Cal. 4th at 1258. The court addressed whether the policy covered the "damages" the insured had to pay because of "advertising injury." Id. at 1262. The policy defined "advertising injury" as a list of tort offenses arising in the course of advertising activities, one of which was "unfair competition," which the policy did not define. Id. The court applied general principles of contract interpretation and concluded that the undefined term "unfair competition" referred to the common-law tort and not the much broader statutory definition. Id. at 1262-73. But as the plaintiffs point out in their sur-reply, the policy here is markedly different. Coverage is not limited to common-law torts, and the issue is not about construing an undefined term (such as "unfair competition") in the context of other terms that give it meaning. Instead, this is a policy covering acts, errors, and omissions in the performance of "Managed Care Activity," a defined term that covers a broad range of advertising, marketing, and administrative activities in providing health services or managing a health-care plan. (See Sur-Reply, ECF No. 32-1 at 7.)

In sum, under the plain language of the Policy, and interpreting the Policy broadly to afford the greatest possible protection to the insured, the Altair Action is a covered "Claim." See MacKinnon, 31 Cal. 4th at 648.

CONCLUSION

IT IS SO ORDERED.