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Cieplinski v. State Farm Mutual Automobile Insurance Co.

July 26, 2010

KRISTINE CIEPLINSKI, PLAINTIFF,
v.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, DEFENDANT,



The opinion of the court was delivered by: Judge Caputo

MEMORANDUM

Presently before the Court is Defendant State Farm Mutual Automobile Insurance Company's ("State Farm") Motion to Dismiss. (Doc. 4.) For the reasons discussed more fully below, this motion will be denied in part and granted in part.

BACKGROUND

The facts alleged in the Complaint are as follows. On December 14, 2006, Plaintiff Kristine Cieplinski was involved in a motor vehicle accident that caused her to suffer bodily injury. (Compl. ¶ 3.) At the time the accident occurred, Plaintiff was insured by State Farm; the State Farm policy provided Plaintiff with first party medical benefits. (Compl. ¶ 4.)

Plaintiff submitted medical bills to State Farm. (Compl. ¶ 8.) After a peer review, State Farm refused to pay for medical expenses incurred by Plaintiff for her treatment with Anthony J. Vigorito, D.C. (Compl. ¶ 9.) Suit was filed against State Farm, at which time State Farm agreed to pay for Plaintiff's treatment with Vigorito. (Compl. ¶ 10.) On January 4, 2010, a second peer review was performed by State Farm; State Farm used the same reviewer, Dr. Joseph Camilli, who determined that continued chiropractic care was not clinically necessary beyond October 26, 2009. (Compl. ¶ 11.)

Plaintiff alleges that State Farm refused to pay her medical claims without conducting a reasonable investigation, failed to adopt and implement reasonable standards for prompt investigation of medical claims, did not attempt to effectuate prompt, fair and equitable settlement of Plaintiff's claims, and "abused the peer review process in that chiropractor, James Camilli, D.C., who reviewed the medical bills to determine there (sic) reasonableness and the (sic) necessity had previously done a peer review on behalf of State Farm Mutual Automobile Insurance Company and he determined that prior bills were not reasonable and necessary." (Compl. ¶¶ 14, 16, 20-25.)

On March 31, 2010, Plaintiff filed a Complaint in the Court of Common Pleas of Lackawanna County, bringing causes of action for Bad Faith pursuant to 42 PA. CONS. STAT. § 8371 (Count I) and Breach of Contract (Count II). State Farm removed the case to federal court on May 21, 2010. (Doc. 1.) State Farm filed the instant motion to dismiss on June 1, 2010; State Farm seeks to have Count I dismissed and to have Plaintiff's demands for counsel fees dismissed as to Count II. This motion has been fully briefed and is currently ripe for disposition.

LEGAL STANDARD

Federal Rule of Civil Procedure 12(b)(6) provides for the dismissal of a complaint, in whole or in part, for failure to state a claim upon which relief can be granted. Dismissal is appropriate only if, accepting as true all the facts alleged in the complaint, a plaintiff has not pleaded "enough facts to state a claim to relief that is plausible on its face," Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007), meaning enough factual allegations "'to raise a reasonable expectation that discovery will reveal evidence of'" each necessary element, Phillips v. County of Allegheny, 515 F.3d 224, 234 (3d Cir. 2008) (quoting Twombly, 550 U.S. at 556); see also Kost v. Kozakiewicz, 1 F.3d 176, 183 (3d Cir. 1993) (requiring a complaint to set forth information from which each element of a claim may be inferred). In light of Federal Rule of Civil Procedure 8(a)(2), the statement need only "'give the defendant fair notice of what the ... claim is and the grounds upon which it rests.'" Erickson v. Pardus, 551 U.S. 89, 93 (2007) (per curiam) (quoting Twombly, 550 U.S. at 555). "[T]he factual detail in a complaint [must not be] so undeveloped that it does not provide a defendant [with] the type of notice of claim which is contemplated by Rule 8." Phillips, 515 F.3d at 232; see also Airborne Beepers & Video, Inc. v. AT&T Mobility LLC, 499 F.3d 663, 667 (7th Cir. 2007).

In deciding a motion to dismiss, the Court should consider the allegations in the complaint, exhibits attached to the complaint, and matters of public record. See Pension Benefit Guar. Corp. v. White Consol. Indus., Inc., 998 F.2d 1192, 1196 (3d Cir. 1993). The Court may also consider "undisputedly authentic" documents when the plaintiff's claims are based on the documents and the defendant has attached copies of the documents to the motion to dismiss. Id. The Court need not assume the plaintiff can prove facts that were not alleged in the complaint, see City of Pittsburgh v. W. Penn Power Co., 147 F.3d 256, 263 & n.13 (3d Cir. 1998), or credit a complaint's "'bald assertions'" or "'legal conclusions,'" Morse v. Lower Merion Sch. Dist., 132 F.3d 902, 906 (3d Cir. 1997) (quoting In re Burlington Coat Factory Sec. Litig., 114 F.3d 1410, 1429-30 (3d Cir. 1997)). "While legal conclusions can provide the framework of a complaint, they must be supported by factual allegations." Ashcroft v. Iqbal, 129 S.Ct. 1937, 1950 (2009).

When considering a Rule 12(b)(6) motion, the Court's role is limited to determining if a plaintiff is entitled to offer evidence in support of her claims. See Scheuer v. Rhodes, 416 U.S. 232, 236 (1974). The Court does not consider whether a plaintiff will ultimately prevail. See id. A defendant bears the burden of establishing that a plaintiff's complaint fails to state a claim. See Gould Elecs. v. United States, 220 F.3d 169, 178 (3d Cir. 2000).

DISCUSSION

1. Count I- Bad ...


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