JEROME B. SIMANDLE, Chief District Judge.
This case arose out of an insurance coverage dispute between Plaintiff Steven Breitman and Defendant National Surety Corporation, after Defendant denied Plaintiff's claim for loss and damage to Plaintiff's property caused by flood, not wind, as a result of Superstorm Sandy. Plaintiff asserts that the full amount of loss and damages was $711,798,55.00, but Defendant only paid $114,181.06, and he alleges that Defendant conducted an improper adjustment, wrongfully denied his claim, and delayed payment. Plaintiff's original Complaint brought claims for breach of contract (Count One), breach of the duty of good faith and fair dealing (Count Two), bad faith (Count Three), and violations of the New Jersey Consumer Fraud Act ("NJCFA"), N.J. Stat. Ann. § 56:8-2 (Count Four).
Defendant moved for partial dismissal of Plaintiff's Complaint, and Plaintiff opposed and cross-moved to amend his Complaint. The revised Complaint contains additional factual allegations and three claims: breach of contract (Count One), breach of the duty of good faith and fair dealing/bad faith (Count Two), and violation of the NJCFA (Count Three). In reply, Defendants seek the dismissal of Count Three and to strike the request for attorney's fees from Count Two. The only questions before the Court are whether the Proposed Amended Complaint plausibly alleges a violation of the Consumer Fraud Act, and whether Plaintiff may request attorney's fees as part of consequential damages to a claim of bad faith.
Because Defendant has argued only for the dismissal of one claim in the revised Complaint and because the additional factual allegations are helpful to Plaintiff's other claims, the Court will permit Plaintiff's Proposed Amended Complaint to be filed. However, because Plaintiff has not stated a plausible claim for fraud under the NJCFA, the Court will dismiss Count Three without prejudice. At this time, the Court will not strike Plaintiff's demand for attorney's fees. The Court finds as follows:
1. Plaintiff Steven Breitman's property, a home located at 12 Broadmoor Drive in Monmouth, New Jersey, was insured by Defendant National Surety Corporation, a company that advertises itself as a leader in providing high net worth personal insurance. Plaintiff alleges that after the home suffered substantial damage from Hurricane Sandy in October of 2012, Defendant conducted an improper adjustment and underpaid Plaintiff's insurance claim; misrepresented what damage was covered under the policy; and failed to conduct a reasonable investigation after improperly denying Plaintiff's claim. (Compl. [Docket Item 1-1] ¶¶ 14-15, 22.) He additionally alleges that Defendant improperly delayed making a final decision on Plaintiff's insurance claim for nearly two years, forcing Plaintiff to file a bare bones complaint within days of receiving the decision in order to preserve his claims and prevent them from being time-barred. (Am. Compl. [Docket Item 9-1] ¶¶ 65-66.)
2. Plaintiff's original Complaint contained four counts: breach of contract (Count One); breach of the duty of good faith and fair dealing (Count Two); bad faith (Count Three); and violations of the NJCFA (Count Four). On January 21, 2015, Defendant filed a partial Motion to Dismiss [Docket Item 7-1] Count Three of the Complaint as duplicative of Count Two, to dismiss Plaintiff's claim under the NJCFA, and to strike Plaintiff's request for attorney's fees. With respect to Plaintiff's NJCFA claim, Defendant argued that the Complaint lacked specific allegations to put Defendant on notice of the precise fraudulent and deceptive acts it was charged to have committed, and did not meet the heightened pleading standard under Fed. R. Civ. P. 9(b). (Def. Mot. to Dismiss at 7-9.)
3. On February 17, 2015, 27 days later, Plaintiff filed an opposition together with a Cross-Motion to Amend [Docket Item 9] and a Proposed Amended Complaint which fleshes out the original Complaint by setting forth in much greater detail the factual allegations underlying the suit. [Docket Item 9-1.]
4. According to the Amended Complaint, Plaintiff insured his property with Defendant for $2,658,000 in dwelling coverage; $531,600 for other structures coverage, and $1,329,000 for personal property coverage. (Am. Compl. ¶ 16.)
5. On November 18, 2012, shortly after Plaintiff's property was hit by Hurricane Sandy, Defendant's claim adjuster informed Plaintiff that "the loss [to Plaintiff's property] includes water damage . . . as well as damage separately caused by wind"; that the insurance policy covered damage "that was caused directly by wind"; and that "we will determine the full extent of damage caused by wind and will adjust and pay that portion of your claim." (Am. Compl. ¶ 44.)
6. In December of 2012 and June of 2013, Defendant paid two invoices totaling $43,274.21 for certain repairs and services on Plaintiff's property, which included mold remediation, water extraction, drying equipment, dehumidifiers, and air handlers and scrubbers. (
7. In June of 2014, Defendant issued a check to Plaintiff in the amount of $114,181.06, stating that the payment was "in no way . . . considered any type of final payment" and that the check was an advance only, based on the calculated repair cost. (
8. By letter dated October 20, 2014, nearly two years after Hurricane Sandy, Defendant denied Plaintiff's claim for $711,798,55 and stated that the $114,181.06 represented the "undisputed building amount." The letter also stated that the interior demolition of Plaintiff's home had prejudiced its ability to investigate Plaintiff's claim. (
9. Plaintiff asserts in his Amended Complaint that Defendant violated the NJCFA by "knowingly and intentionally making false and misleading statements, representations and assurances to Plaintiff as to the type, scope and coverage of the insurance and as to the method and manner of claim adjustment and settlement." (
10. In addition to revising the NJCFA claim, the Amended Complaint merges Counts Two and Three into one count (Count Two — breach of duty of good faith and fair dealing/bad faith). Plaintiff acknowledged that attorney's fees were not recoverable in a suit against the insurer to compel or enforce coverage and dropped the demand for attorney's fees from Count One (breach of contract). However, the Complaint continues to seek attorney's fees in Count Two under the theory that they are part of the consequential damages resulting from Defendant's bad faith denial of Plaintiff's claim. (Pl. Mot. to Amend [Docket Item 9-2] at 13-14.)
11. Defendant opposes the motion to amend but challenges only the viability of Plaintiff's NJCFA claim in Count Three. Defendant argues that Plaintiff has not plausibly stated a claim for fraud, and that NJCFA does not apply to individual denial of benefits under an insurance policy. (Def. Reply [Docket Item 11] at 7-11.) Defendant also seeks to strike from the Amended Complaint Plaintiff's request for attorneys' fees as consequential damages in Count Two. (
12. Federal Rule of Civil Procedure 15(a) permits a party to amend his pleading before trial as a matter of course in limited circumstances, or otherwise with the consent of the opposing party or the court's leave. Plaintiff filed his Motion to Amend 27 days after Defendant's Motion to Dismiss, and was therefore not within the 21-day window to amend as of right under Federal Rule of Civil Procedure 15(a)(1). Rule 15(a)(2) permits Plaintiff to amend "only with the opposing party's written consent or the court's leave." Fed. R. Civ. P. 15(a)(2). Although "[t]he court should freely give leave when justice so requires,"
13. While the new allegations in the Proposed Amended Complaint provide more detail about the submission and handling of Plaintiff's insurance claim, they boil down to a claim for wrongful denial of insurance benefits and do not make out a claim of fraud under the NJCFA. The New Jersey Consumer Fraud Act, N.J. Stat. Ann. § 56:8-2, is designed to address "sharp practices and dealings in the marketing of merchandise and real estate whereby the consumer could be victimized by being lured into a purchase through fraudulent, deceptive or other similar kind of selling or advertising practices."
N.J.S.A. 56:8-2. Unlawful practices fall into three general categories: (1) an affirmative misrepresentation, "even if unaccompanied by knowledge of its falsity or an intention to deceive"; (2) an omission or failure to disclose a material fact, if accompanied by knowledge and intent; and (3) and violations of specific regulations under the NJCFA, which are reviewed under strict liability.
14. The "prime ingredient" of all types of consumer fraud is the capacity to mislead,
15. Although Plaintiff insists that Defendant made false and misleading statements about the insurance coverage, Plaintiff's legal conclusions are not entitled to an assumption of truth.
16. Plaintiff alleges that he took out an insurance policy with Defendant expecting better coverage than what he ultimately received because Defendant held itself out as an "industry leader that affords his clients with superior claims and risk services." (Am. Compl. ¶ 8). But nothing in the Amended Complaint suggests that Defendant misrepresented the terms of the insurance policy Plaintiff purchased. Plaintiff's house suffered both wind and water damage, but the insurance policy itself states that water damage would not be covered, and indeed, Plaintiff admits in the Amended Complaint that shortly after Hurricane Sandy, a claims adjuster told Plaintiff that Defendant would cover only the portion of the claim related to wind damage. (Am. Comp ¶ 44.) Defendant ultimately paid invoices for repairs totaling $43,274.21 before issuing Plaintiff a check for $114,181.06, and Plaintiff has not alleged with any of the specificity required under Rule 9(b) how or why Defendant's payment did not meet the terms of the insurance policy. While Plaintiff alleges generally that Defendant's denial of the $711,798.55 claim was improper, he makes no specific assertions about what types of repairs or services were included in his own $711,798.55 estimate, how the damage was caused by the wind event rather than flood, or why they should have been covered under the policy. Most critically, the Complaint is devoid of any allegations that Defendant made false statements or assertions about the policy leading Plaintiff to believe that the repairs or services Defendant denied were included in Plaintiff's coverage when Plaintiff purchased it.
17. Nor are there facts in the Amended Complaint to suggest that Defendant told Plaintiff he would be fully compensated for the claims he submitted. Defendant's response to Plaintiff's first estimate of $223,804.72 was that "many of the items will be covered under your policy, but there are several items that will not." (Am. Compl. ¶ 51.) Thus, it made clear that not all of the damage to Plaintiff's property would fall under Plaintiff's insurance coverage. Defendant ultimately issued Plaintiff a check for $114,181.06, or roughly half of Plaintiff's initial estimate. Although Defendant first stated that the check was not a final payment and later revised its statement, nothing in the Amended Complaint suggests that Defendant misrepresented to Plaintiff that it would be issuing additional checks. The mere fact that Plaintiff revised his estimate of loss and damage upward to $711,798.55 and Defendant declined to pay that amount is not enough to create a plausible inference that Defendant engaged in an "unlawful practice."
18. Defendant may have underpaid Plaintiff's claim,
19. Because the facts in the Proposed Amended Complaint still do not yield a plausible claim for fraud, permitting the amendment on Plaintiff's NJCFA claim in its current state would be futile. Accordingly, the Court will dismiss the claim under the NJCFA.
20. The Court will not at this time strike Plaintiff's request for attorney's fees as part of his claim for breach of the duty of good faith (Count Two). Under New Jersey law, attorney's fees are recoverable where provided for under a court rule or statute, pursuant to a contract, or "where counsel fees are a traditional element of damages in a particular cause of action."
21. Because the rest of Plaintiff's Proposed Amended Complaint contains additional factual allegations relating to the other counts and Defendant has not sought dismissal of those counts, because Plaintiff filed his Amended Complaint just six days after the deadline for amending as of right, and because there is no indication of Plaintiff's bad faith or prejudice to Defendant, the Court will grant the rest of Plaintiff's Motion to Amend and permit the Amended Complaint to be filed without Count Three. Accordingly, the Court will grant in part Plaintiff's Cross-Motion to Amend and deny Defendant's Motion to Dismiss as moot. Plaintiff shall file the Amended Complaint within five (5) days from entry of this Order. An accompanying order will be entered.
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