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Pitre v. Nationwide Mutual Insurance Co.

United States District Court, M.D. Louisiana

September 21, 2018

CAITLYN PITRE
v.
NATIONWIDE MUTUAL INSURANCE COMPANY

          RULING AND ORDER

          BRIAN A. JACKSON UNITED STATES DISTRICT COURT.

         Before 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.

         I. BACKGROUND

         Defendant 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. (Id.)

         In 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. (Id.)

         Plaintiff 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)

         In the 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)

         II. LEGAL STANDARDS

         Under 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)).

         A 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.

         In 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."[1] 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.).

         III. DISCUSSION

         A. Dismissal for Lack of Subject Matter Jurisdiction

         Defendant 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 ...


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