Filed: Mar. 04, 2019
Latest Update: Mar. 04, 2019
Summary: ORDER DENYING DEFENDANTS' MOTION TO DISMISS ROBERT S. LASNIK , District Judge . This matter comes before the Court on "Defendants' Motion to Dismiss." Dkt. # 12. 1 Plaintiff alleges that defendant United Services Automobile Association ("USAA") engaged in per se unfair acts in the business of insurance when it curtailed her benefits under the Personal Injury Protection ("PIP") provisions of her automobile policy. Plaintiff specifically alleges that USAA refused to pay medical provider bill
Summary: ORDER DENYING DEFENDANTS' MOTION TO DISMISS ROBERT S. LASNIK , District Judge . This matter comes before the Court on "Defendants' Motion to Dismiss." Dkt. # 12. 1 Plaintiff alleges that defendant United Services Automobile Association ("USAA") engaged in per se unfair acts in the business of insurance when it curtailed her benefits under the Personal Injury Protection ("PIP") provisions of her automobile policy. Plaintiff specifically alleges that USAA refused to pay medical provider bills..
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ORDER DENYING DEFENDANTS' MOTION TO DISMISS
ROBERT S. LASNIK, District Judge.
This matter comes before the Court on "Defendants' Motion to Dismiss." Dkt. # 12.1 Plaintiff alleges that defendant United Services Automobile Association ("USAA") engaged in per se unfair acts in the business of insurance when it curtailed her benefits under the Personal Injury Protection ("PIP") provisions of her automobile policy. Plaintiff specifically alleges that USAA refused to pay medical provider bills whenever a computerized review process indicated that the bill ran afoul of a pre-determined screen or limit. She alleges that the failure to investigate or otherwise make an individualized determination regarding the reasonableness or necessity of the provider's charges before denying payment violates Washington's insurance regulations. See Folweiler Chiropractic, PS v. Am. Family Ins. Co., 5 Wn.App. 1002, 2018 WL 4087573, * 3-4 (Aug. 27, 2018). Plaintiff filed this lawsuit on behalf of similarly situated insureds asserting a claim under the Washington Consumer Protection Act ("CPA").
Defendants seek dismissal of the CPA claim on the grounds that plaintiff has failed to allege (1) an injury to "business or property" that is cognizable under the statute, (2) an unfair or deceptive act or practice by defendants, (3) an act or practice that has the capacity to deceive a substantial portion of the public, or (4) a causal connection between defendants' acts and a legally cognizable injury. Only the unfair/deceptive act, public interest, and the causation issues are discussed below. The Court certified the injury to "business or property" issue to the Washington Supreme Court in a separate order.
For purposes of this motion, the Court will assume the truth of plaintiff's allegations and draw all reasonable inferences in her favor. Usher v. City of Los Angeles, 828 F.2d 556, 561 (9th Cir. 1987).2 The question for the Court is whether the facts in the complaint sufficiently state a "plausible" ground for relief. Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). The allegations must give rise to something more than mere speculation that plaintiff has a right to relief. Twombly, 550 U.S. at 555.
Having reviewed the complaint under the appropriate standard, the Court finds that plaintiff has adequately alleged a per se unfair act,3 public interest, and a causal connection between the unfair acts and the injuries alleged. If the Washington Supreme Court determines that some or all of the type of injuries alleged are cognizable under the CPA, the claim may proceed.
