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Hickey v. Allstate Property and Casualty Insurance Co.

June 25, 2010

EUGENE F. HICKEY, II, PLAINTIFF
v.
ALLSTATE PROPERTY AND CASUALTY INSURANCE COMPANY, DEFENDANT



The opinion of the court was delivered by: Judge James M. Munley United States District Court

(Judge Munley)

MEMORANDUM

Before the court is Defendant Allstate Property and Casualty Insurance Company's motion to dismiss Count II of the complaint, or in the alternative, motion for a more definite statement (Doc. 5). Having been fully briefed, the matter is ripe for disposition.

BACKGROUND

On August 9, 2007, the Plaintiff, Eugene F. Hickey, II, ("Plaintiff") suffered injuries to his neck and back in a motor vehicle accident caused by another vehicle. (Compl. ¶ 9 (Doc. 1-3)). At the time of the collision, Plaintiff was an insured under an automobile insurance policy issued by the Defendant, Allstate ("Defendant"). (Id. ¶ 10). The policy contained first-party medical benefits coverage in the amount of $100,000.00. (Id.)

Following the collision, Plaintiff sought treatment at Mercy Hospital. (Id. ¶ 12). Thereafter, Dr. Michael Montella prescribed physical therapy which Plaintiff underwent from September 5, 2007 through October 11, 2007 and December 12, 2007 through the present. (Id. ¶ 14). Dr. Montella also referred Plaintiff to Northeastern Rehabilitation Associates where another doctor prescribed cervical facet injections. (Id. ¶ 15). During the course of Plaintiff's treatment, his healthcare providers submitted bills to the Defendant which the Defendant paid. (Id. ¶¶ 17, 19). These healthcare providers also submitted Plaintiff's medical records to the Defendant at various times over the course of Plaintiff's treatment. (Id. ¶ 18).

On July 20, 2009, Defendant informed Plaintiff it would require an Independent Medical Examination ("IME") before processing any further medical bills. (Id. ¶ 20). On September 17, 2009, Plaintiff attended an IME performed by Dr. Eugene Kim. (Id. ¶ 24). Dr. Kim concluded that Plaintiff "sustained a soft tissue musculoligamentous strain in the cervical and lumbar spines which remains symptomatic." (Id. ¶ 28). While Dr. Kim reported that Plaintiff's "current treatment and physical therapy is related and necessary," he also stated Plaintiff had "essentially reached his point of maximum medical improvement." (Id.) By a letter dated January 5, 2010, Defendant informed Plaintiff that Defendant would pay Plaintiff's medical bills through December 23, 2009. (Id. ¶ 27). Citing the results of the IME, Defendant stated that no bills beyond that date would be considered. (Id.)

Thereafter Plaintiff filed a complaint in the Court of Common Pleas of Lackawanna County asserting two counts. Count I, Breach of Contract, alleges Defendant breached its contractual obligations under the insurance policy by failing to pay Plaintiff's medical bills after December 23, 2009. (Id. ¶¶ 32-38). Count II, Bad Faith, asserts a violation of Pennsylvania's insurance bad faith statute, 42 PA. CONS. STAT. ANN. § 8371. (Id. ¶¶ 39-43). Plaintiff requests recovery for first-party medical benefits allegedly owed with interest, punitive damages, and reasonable attorney fees and costs. (Id. ¶ 43).

Defendant timely removed to this court on the basis of diversity of citizenship and an amount in controversy in excess of $75,000.00. (Notice of Removal (Doc. 1-1)). Thereafter, Defendant filed the instant motions: a motion to dismiss Count II of the complaint pursuant to Federal Rule of Civil Procedure 12(b)(6), and, in the alternative, a motion for a more definite statement regarding paragraph 40(h) of the complaint pursuant to Federal Rule of Civil Procedure 12(e), bringing the case to its present posture.

JURISDICTION

The court has diversity jurisdiction over this action pursuant to 28 U.S.C. §§ 1332. Plaintiff is a citizen of Pennsylvania and Defendant is an Illinois corporation with its principal place of business not in Pennsylvania. (Doc. 1-1). The amount in controversy exceeds $75,000.00. (Id.)

As a federal court sitting in diversity, we must apply state law. Chamberlain v. Giampapa, 210 F.3d 154, 158 (3d Cir. 2000) (citing Erie R.R. v. Tompkins, 304 U.S. 64, 78 (1938)). In this case, the relevant state is Pennsylvania. If the state supreme court has not yet addressed an issue before us, we must predict how that court would rule if presented with that issue. Nationwide v. Mutual Ins. Co., 230 F.3d 634, 637 (3d Cir. 2000). In so doing, we must examine the opinions of the lower state courts, and we cannot disregard them unless we are convinced by other persuasive data that the highest court would rule otherwise. Id.

LEGAL STANDARD

When a 12(b)(6) motion is filed, the sufficiency of a complaint's allegations are tested. Granting the motion is appropriate if, accepting as true all the facts alleged in the complaint, the plaintiff has not pleaded "enough facts to state a claim to relief that is plausible on its face," or put another way, "nudged [his or her] claims across the line from conceivable to plausible." Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007). The Third Circuit interprets Twombly to require the plaintiff to describe "enough facts to raise a reasonable expectation that discovery will reveal evidence of" each necessary element of the claims alleged in the complaint. Phillips v. County of Allegheny, 515 F.3d 224, 234 (3d Cir. ...


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