MARK A. KEARNEY, District Judge.
Our limited jurisdiction does not include resolving hypothetical disputes against insurance companies as a matter of public policy. We resolve claims of concrete injury filed by persons allegedly suffering an injury caused by the insurer. With proof, we allow injured persons to sell, or assign, their legal claims against their insurer to persons such as medical providers who are looking to be paid for their medical services from the patient's insurer. But the person filing the claim must still plead how the opposing party caused the injury. It cannot be a public policy hypothetical seeking to correct a pattern of conduct without an injured party. When, as here, a medical provider's amended complaint still fails to plead a fact of injury caused to one of its patients by the insurer's specific acts allegedly violating Delaware law, we cannot proceed. Otherwise, we would have spokespersons filing lawsuits seeking public policy changes. The medical provider needs to plead facts showing how their patient's insurer's specific conduct harmed the patient. As the medical provider has not yet done so, we grant the insurer's motion to dismiss the medical provider's amended complaint in the accompanying Order with one last leave to timely satisfy these rudimentary pleading obligations.
Delaware's General Assembly requires a minimum amount of automobile insurance maintained by an owner of a motor vehicle registered here.
Under the PIP mandate, insurers must pay or deny a PIP claim within thirty days of submission.
State Farm Mutual Automobile Insurance Company and State Farm Fire and Casualty Company (collectively, "State Farm") issue automobile insurance policies to owners of Delaware registered vehicles.
Without identifying an insured who suffered the specific harm, Spine Care alleges State Farm violates the PIP mandate and breaches its insurance contracts by: failing to pay the claims within the thirty-day statutory period;
By way of further example, Spine Care alleges after it operates on a patient, it submits two PIP claims to State Farm, one for anesthesia and one for the surgical bill.
Spine Care sued State Farm on behalf of itself and all others similarly situated, alleging violations of the PIP statute, breach of contract, bad faith breach of contract, and seeking injunctive relief.
After we dismissed its complaint, Spine Care amended its complaint to bring claims on behalf of 26 named patient-assignors identified in an Exhibit to the Amended Complaint. The list is helpful in part; but we still do not have a fact showing which, if any, of the identified patients suffered which of the alleged breaches or violations of the PIP mandate.
State Farm moves to dismiss Spine Care's Amended Complaint with prejudice arguing Spine Care: fails to sufficiently allege patients suffered harm and also fails to allege they assigned their right to bring their claim in Spine Care's name;
Spine Care argues we addressed all of State Farm's challenges in our February 9, 2018 Memorandum granting the motion to dismiss the Complaint because we "held that [Spine Care] could satisfy the pleading standard on its claims" and this is now "the law of the case."
State Farm argues Spine Care fails to sufficiently allege patients suffered harm and also fails to allege they assigned their right to bring their claim in Spine Care's name. This is not a new issue to either party. As outlined above, we dismissed Spine Care's complaint for threshold pleading deficiencies in its PIP and contract claims, the identity of the patient, the specific harm suffered by patient caused by State Farm, and the patient's assignment of rights to Spine Care. Spine Care needs to tie each of State Farm's alleged unlawful practices to facts showing a patient actually suffered harm caused by the unlawful practice.
As we held in our February 9, 2018 opinion, Spine Care's burden to identify a specific factual claim and claimant is not difficult. Spine Care, in its brief, agrees its burden is not difficult and for its PIP claim, it just needs to plead "[w]e are suing on patient Joe Doe's PIP claim . . ." and for its contractual claim, it must plead a specific patient suffered harm from State Farm and assigned the claim to Spine Care.
This list of 26 names untethered to facts does not cure Spine Care's pleadings deficiencies. We are not overly pedantic in our pleading requirements but Spine Care needs to pleads facts as to these patients and Spine Care does not dispute it has the information to do so. Spine Care argues it produced a chart with a patients' name, dates of services, damages, and "theory of case" five days before State Farm moved to dismiss and asks us to take judicial notice of the fact State Farm is on notice of the specific factual allegations.
On the same day Spine Care made this argument, it also sought leave to amend yet still does not include a single basic factual allegation, i.e. "John Doe is a patient at Spine Care where he had a bilateral spinal surgery and Spine Care submitted a PIP covered claim and State Farm only paid for half the surgery. John Doe alleges John Doe assigned his statutory and breach of contract claims to Spine Care to pursue."
Spine Care agrees it has facts to allege and admits to knowing exactly how to plead, yet does not seek include the allegations in its proposed Second Amended Complaint. While Spine Care may be correct in arguing State Farm is aware of the patient-specific facts through discovery, we review allegations to determine whether Spine Care survives a Rule 12 motion, and those allegations control the case going forward.
In a Rule 12(b)(6) motion, we assume the truth of "well-pleaded factual allegations . . . then determine whether they plausibly give rise to an entitlement for relief."
We decline to address Spine Care's separate request for injunctive relief. Injunctions are an equitable remedy and not a cause of action.
We grant State Farm's motion to dismiss without prejudice because Spine Care fails to plead facts of harm suffered by specific patients caused by a State Farm alleged unlawful practice and who assigned the right to pursue their claims to Spine Care. In a separate Order, we also deny Spine Care's pending motion for leave to amend because its proposed amendments fail to cure its pleading deficiencies.
Our court of appeals requires we apply a three-step analysis under a 12(b)(6) motion: (1) "it must `tak[e] note of the elements [the] plaintiff must plead to state a claim;'" (2) "it should identify allegations that, `because they are no more than conclusions, are not entitled to the assumption of truth;'" and, (3) "[w]hen there are well-pleaded factual allegations, [the] court should assume their veracity and then determine whether they plausibly give rise to an entitlement for relief." Connelly v. Lane Construction Corp., 809 F.3d 780, 787 (3d Cir. 2016) (quoting Iqbal, 556 U.S. at 675, 679); see also Burtch, 662 F.3d at 221; Malleus v. George, 641 F.3d 560, 563 (3d. Cir. 2011); Santiago v. Warminster Township, 629 F.3d 121, 130 (3d. Cir. 2010).