United States District Court, E.D. Pennsylvania
For CARL ROBERT MCGUCKIN, GERI MCGUCKIN, Plaintiffs: R. STEVEN SHISLER, LEAD ATTORNEY, PHILADELPHIA, PA.
For ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY, Defendant: KRISTIN H. JONES, MARSHALL WALTHEW, LEAD ATTORNEYS, PEPPER HAMILTON LLP, PHILADELPHIA, PA; DANIEL S. DOYLE, BROOKS, BRADLEY & DOYLE, MEDIA, PA.
WENDY BEETLESTONE, J.
This action involves first-party insurance claims by Plaintiffs Carl and Geri McGuckin against their insurer Allstate Fire and Casualty Insurance Company (" Allstate" ) over insurance coverage for medical expenses Carl McGuckin incurred after an
automobile accident. Carl McGuckin has asserted claims for breach of contract (titled, " First Party Benefits" ), bad faith, breach of the covenant of good faith and fair dealing, and violations of Pennsylvania's Unfair Trade Practices and Consumer Protection Law. Carl McGuckin's wife, Geri McGuckin, has asserted claims for breach of contract (titled " First Party Benefits" ), bad faith, and breach of contract. Allstate moves to dismiss Carl McGuckin's claim for violations of the UTPCPL and to dismiss all claims asserted by Geri McGuckin. For the reasons discussed below, the motion will be granted in part and denied in part.
Sometime prior to January 5, 2008, Carl McGuckin met with an Allstate Agent, named Matthew Bean, to discuss the potential purchase of automobile insurance. Second Amended Complaint ¶ 5 (" Compl." ). Bean recommended that McGuckin purchase Allstate auto insurance and that he purchase additional, extraordinary benefits for an increased premium price. Id. Bean told McGuckin that the extraordinary medical benefits coverage would pay his or other insureds' benefits when medical bills resulting from a vehicle accident exceeded $100,000. Id. ¶ 6. The Complaint alleges that Bean knew or reasonably should have known that: (1) the representation was false, id. ¶ 10; (2) the policy contained a requirement that the medical bills be for " reasonable and necessary" medical treatment of the policyholder's accident related injuries before Allstate would cover the bills, id. ; and, (3) a determination of whether medical treatments were reasonable and necessary would be made, not by McGuckin's treating physicians, but by a peer review conducted by third parties selected by Allstate. Bean did not inform McGuckin about the " reasonable and necessary" provision of the policy or about how Allstate would make the determination whether medical bills were reasonable and necessary. Id. ¶ 14. The McGuckins purchased an extraordinary benefits policy on or about January 5, 2008 and maintained the policy in force through the events at issue in this litigation. Id. ¶ ¶ 13, 17, 29. Geri McGuckin was named as an insured under the policy. Id. Ex. A at 5.
While the insurance policy was in force, Carl McGuckin suffered serious injuries in an automobile accident, when his vehicle was struck in the back while stopped in traffic. Id. ¶ ¶ 31-34. The McGuckins sued the driver who struck Carl McGuckin's vehicle and ultimately settled their case with Allstate's consent. Id. ¶ 37. The settlement was insufficient, however, to satisfy Carl McGuckin's medical bills. The McGuckins then filed a claim against Allstate for underinsured motorist coverage. Id. ¶ 39. Plaintiffs allege that Allstate failed to make a reasonable offer to settle their claim. Id. ¶ 40. Ultimately the parties resolved that claim through arbitration. Id. ¶ 43. When McGuckin's medical bills exceeded $100,000, he filed claims for coverage under the extraordinary benefits policy. Id. ¶ 45. Allstate, at first, paid McGuckin's claims for medical expenses, but declined to pay for later bills. Id. ¶ 44. Although Allstate did conduct an independent medical examination of McGuckin in connection with his underinsured motorist claim, it did not conduct a subsequent examination in connection with its denial of his extraordinary benefits claims or rely upon the prior examination in reaching its decision to deny his claims. Id. ¶ 50. Allstate denied those claims on the grounds that a peer review had concluded that they were not reasonable and necessary. Id. ¶ 48. As the result of Allstate's denial of his claims, Robert McGuckin was " forced to pay deductibles, co-pays, medical bills, and/or to incur liens of medical providers" for treatment of his accident-related injuries.
Id. ¶ 56. When Carl McGuckin's financial resources were insufficient to pay those medical expenses, Geri McGuckin paid $1,557 towards those bills. Id. ¶ ¶ 107, 116. Allstate also declined to pay certain claims for lost earnings. Id. ¶ 111.
Carl McGuckin alleges that Allstate violated the Pennsylvania Unfair Trade Practices and Consumer Protection Law, 73 Pa. Cons. Stat. § 201-1 et seq. (the " UTPCPL" ). He alleges numerous acts of misconduct, which he details in forty-eight paragraphs of the Complaint. Id. ¶ ¶ 90 (a)-(vv). His allegations include that Allstate: misrepresented the contents of its policy, see, e.g., Compl. ¶ ¶ 90(x)-(z); falsely advertised the coverage its policy would provide, see, e.g., id. ¶ ¶ 90 (x)-(z); failed to conduct an adequate investigation of the McGuckins' claims, see, e.g., id. ¶ ¶ 90(d)-(f), (q)-(r); neglected to reevaluate its decision when faced with contrary evidence, see, e.g., id. ¶ 90 (q)-(r); relied on an inadequate and incorrect peer review to deny claims, see, e.g., id. ¶ 90 (g-h); failed to timely communicate with the McGuckins or to provide them with relevant evidence, see, e.g., id. ¶ ¶ 90(j)-(k), (gg)(2), (6); committed various acts of ...