United States District Court, M.D. Louisiana
RULING AND ORDER
A. JACKSON UNITED STATES DISTRICT COURT.
the Court is the Motion to Dismiss (Doc. 4)
and Motion to Dismiss Amended Complaint or in the
Alternative Request for Case Management Order Requiring
Specific Claims Documents (Doc. 9) filed by
Defendant Nationwide Mutual Insurance Company
("Defendant"), seeking the dismissal of the breach
of contract claim asserted by Plaintiff Caitlyn Pitre
("Plaintiff'). For the reasons herein, the
Motion to Dismiss (Doc. 4) is DENIED AS MOOT
and the Motion to Dismiss Amended Complaint or in the
Alternative Request for Case Management Order Requiring
Specific Claims Documents (Doc. 9) is DENIED.
is an insurance company which participates in the federal
government's National Flood Insurance Program
("NFIP") pursuant to the National Flood Insurance
Act f NFIA"). (Doc. 9-1 at p. 2) The NFIP allows an
individual to purchase a Standard Flood Insurance Policy
("SFIP") either directly from the Federal Emergency
Management Agency ("FEMA") or from private
insurance companies. (Id.) These private insurance
companies are known as "Write Your Own"
("WYO") carriers and are authorized by federal
regulation to sell SFIPs under their own names.
(Id.) Defendant asserts that WYO carriers act as
"fiscal agents" of the federal government because
the United States Treasury pays out all SFIP claims as well
as the costs involved in the adjustment of such claims.
August of 2016, flooding devastated large segments of
Louisiana, and allegedly caused damage to Plaintiffs
property. (Doc. 7 at p. 3) It is undisputed that Plaintiff
had purchased an SFIP from Defendant and that the property
was covered by the policy at this time. (Doc. 7 at p. 4)
Plaintiff asserts that she timely reported these losses to
Defendant. (Id.) Defendant sent an adjuster to
Plaintiffs property who, with Defendant's approval,
prepared a damage estimate and Proof of Loss. (Id.)
An SFIP requires the insured party to submit a Proof of Loss
in support of their insurance claim within sixty days of the
loss in order to recover. (Doc. 9-1 at 4) Plaintiff claims
that the Proof of Loss did not comply with the provisions of
the policy, Defendant's general claims handling
standards, or NFIP claims manuals. (Doc. 7 at p. 4) Plaintiff
further claims that she was forced to sign and submit the
Proof of Loss based on the insurance adjuster's
inspection of the property in order to receive an initial
damage assessment. (Id. at 5) Plaintiff asserts that
she ultimately realized that numerous items that were covered
under the SFIP had been omitted or underpaid by Defendant.
alleges that after realizing she had been underpaid, she
retained independent experts to evaluate the extent of the
flood loss. (Doc. 7 at p. 5) Based on this second estimate,
Plaintiff allegedly submitted a second timely Proof of Loss
to support a supplemental insurance claim. (Id.)
Plaintiff asserts that even though Defendant received this
second Proof of Loss, Defendant unfairly and improperly
persisted in denying these claims. (Id. at 6) As a
result, Plaintiff filed a breach of contract claim against
Defendant. (Doc. 7 at p. 6)
instant motions, Defendant appears to argue that the Court
lacks subject matter jurisdiction under Federal Rule of Civil
Procedure 12(b)(1) because this matter is not ripe for
judicial review and because Defendant possesses sovereign
immunity. (Doc. 9-1 at p. 8) Alternatively, Defendant argues
that Plaintiff has failed to state a claim upon which relief
can be granted under Federal Rule of Civil Procedure 12(b)(6)
because of deficiencies in Plaintiffs complaint.
(Id.) Finally, Defendant asks that, if the Court
denies the motion to dismiss, it issue a case management
order requiring Plaintiff to produce specific documents to
support her claim. (Id. at 9)
Federal Rule of Civil Procedure 12(b)(1), a claim is"
'properly dismissed for lack of subject-matter
jurisdiction when the court lacks the statutory or
constitutional power to adjudicate1 the claim." In
re FEMA Trailer Formaldehyde Prods. Liab. Litig., 668
F.3d281, 286 (5th Cir. 2012) (quoting Home Builders
Ass'n v. City of Madison, 143 F.3d 1006, 1010 (5th
Cir. 1998)). In order to "prevent[ ] a court without
jurisdiction from prematurely dismissing a case with
prejudice," a court should consider a Rule 12(b)(1)
motion for lack of subject-matter jurisdiction before
addressing any motions that concern the merits of a case.
Id. at 286-87 (citing Ramming v. United
States, 281 F.3d 158, 161 (5th Cir. 2001)).
motion to dismiss under Rule 12(b)(1) is analyzed under the
same standard as a motion to dismiss under Rule 12(b)(6).
Benton v. United States, 960 F.2d 19, 21 (5th Cir.
1992). That standard seeks to determine whether "a
complaint... contains] sufficient factual matter, accepted as
true, to 'state a claim to relief that is plausible on
its face.'" Ashcroft v. Iqbal, 556 U.S.
662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly,
550 U.S. 544, 570 (2007)). "[F]acial plausibility"
exists "when the plaintiff pleads factual content that
allows the court to draw the reasonable inference that the
defendant is liable for the misconduct alleged."
Id. at 678 (citing Twombly, 550 U.S. at
556). Hence, the complaint need not set out "detailed
factual allegations," but something "more than
labels and conclusions, and a formulaic recitation of the
elements of a cause of action" is required.
Twombly, 550 U.S. at 555. "Factual allegations
must be enough to raise a right to relief above the
speculative level." Id.
reviewing a Rule 12(b)(6) motion, a court must accept all
well-pleaded facts in the complaint as true and view them in
the light most favorable to the plaintiff. Sonnier v.
State Farm Mutual Auto Ins. Co., 509 F.3d 673, 675 (5th
Cir 2007); Baker v. Putnal, 75 F.3d 190, 196 (5th
Cir. 1996). In ruling on a Rule 12(b)(1) motion, however,
"the court is permitted to look at evidence in the
record beyond simply those facts alleged in the complaint and
its proper attachments." Ambraco, Inc. v. Bossclip
B.V., 570 F.3d 233, 238 (5th Cir.2009);
Ramming, 281 F.3d atl61 (holding that a court ruling
on a Rule 12(b)(1) motion may evaluate "(1) the
complaint alone, (2) the complaint supplemented by undisputed
facts evidenced in the record, or (3) the complaint
supplemented by undisputed facts plus the court's
resolution of disputed facts.).
Dismissal for Lack of Subject Matter Jurisdiction
asserts that the Court lacks subject matter jurisdiction in
this matter under Federal Rule of Civil Procedure 12(b)(1)
because Plaintiff fails to properly allege that Defendant
denied her supplemental insurance claim based on the second
Proof of Loss. (Doc. 16 at p. 6) First, Defendant argues that
this failure precludes the Court from finding that the issue
is ripe for review. (Id.) Second, Defendant argues
that this failure means that it is protected by sovereign
immunity. (Id. at 5) Defendant asserts that it acts
as a fiscal agent of the government by providing federal
insurance policies and is therefore immune from suit in the
absence of a congressional waiver. (Id.) Defendant