Hester v. UMR Insurance Company et al

Filing 76

ORDER granting UMR, Inc.'s 35 Motion to Dismiss; denying Memorial Healthcare Group, Inc.'s 36 Motion to Dismiss; granting Plaintiff's 61 Motion to Add Memorial Family. Signed by Judge Lisa G. Wood on 9/28/2017. (ca)

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Sn tl^e ?limteb States! Bitittict Conit tor ttie ^onttiem Btotnct ot 4^eorgta li^apcrofiiO Btbtsiton GEORGE RAYMOND JR., as the Estate HESTER, administrator of of Teresa Hester and as surviving spouse of Teresa Hester, No: 5:16-CV-82 Plaintiff, V. UMR, INC. & MEMORIAL HEALTHCARE GROUP, INC. Defendants. ORDER Before the Court are Defendants UMR, Inc.'s (""UMR") Motion to Dismiss (Dkt. No. 35) and Memorial Healthcare Group, Inc.'s (^'Memorial") Motion to Dismiss (Dkt. No. 36). Plaintiff George Raymond Memorial Practice Hester also brings Associates, LLC a Motion (^'Memorial to Add Family") as a Family Defendant (Dkt. No. 61). The motions have been fully briefed and are now ripe for decision. to Dismiss (Dkt. For the reasons stated below, UMR's Motion No. 35) is GRANTED and Memorial's Motion to Dismiss (Dkt. No. 36) is DENIED. In addition. Plaintiff's Motion to Add Memorial Family (Dkt. No. 61) is GRANTED. BACKGROUND The facts stated herein are taken solely from Plaintiff Amended Complaint and are assumed to be true, pursuant to Rule 12(b)(6). Plaintiff was the husband of Teresa Hester"). Mrs. Hester received Hester (^'Mrs. gastric lapband surgery at a hospital operated by Memorial on March 3, 2015. Dkt. No. 30 25 13-14. the Plaintiff Memorial assured alleges Mrs. that a surgeon Hester that the in surgery employ would be of fully covered through her insurance, and if not, that the rest would be covered by Medicare. Id. 22 18-19. Plaintiff alleges that the surgery was ultimately not covered by either Mrs. Hester's insurance or Medicare. 22 20-21. Mrs. Hester died on March 2, 2016. Id. Plaintiff alleges that Mrs. Hester's death was due to complications from surgery. Plaintiff further alleges that Mrs. Hester never would have elected to undergo surgery had it not been for Defendants' representations that the surgery would be covered by Medicare. Plaintiff now Id. 2 21. brings an action for negligent misrepresentation against all Defendants and seeks to obtain in excess of two million dollars in damages. The Court previously granted the Plaintiff's Motion to Amend, finding that Plaintiff was required to meet the heightened pleading standard of Federal Rule of considers Civil Procedure Defendants' 9(b). renewed Dkt. No. Motions to 29. The Dismiss, that Plaintiff has failed to meet that standard. Court which now argue LEGAL STANDARD When ruling on a motion to dismiss brought pursuant to Rule 12(b)(6), a district court must accept as true the facts set forth in the complaint and draw all reasonable inferences in the plaintiff's favor. Cir. 2010). Randall v. Scott, 610 F.3d 701, 705 (11th Although a complaint need not contain detailed factual allegations, it must contain sufficient factual material ^^to raise a right to relief above the speculative level." Atl. Corp. V. Twombly, 550 U.S. 544, 555 (2007). complaint should ^^contain either direct Bell At minimum, a or inferential allegations respecting all the material elements necessary to sustain a recovery under some viable legal theory." Fin. Sec. Assurance, Inc. v. Stephens, Inc., 500 F.3d 1276, 1282-83 (11th Cir. 2007) (per curiam) (quoting Roe v. Aware Woman Ctr. for Choice, Inc., 253 F.3d 678, 683 (11th Cir. 2001)). However, pleading applies. when standard an allegation of Federal sounds in fraud, the Rule of Civil higher Procedure 9(b) Under this standard, the plaintiff must state with ^'particularity the circumstances constituting fraud." Fed. R. Civ. P. 9(b). These circumstances include "(1) the precise statements, documents, or misrepresentations made; (2) the time, place, and person responsible for the statement; (3) the content and manner in which these statements misled [Plaintiff]; and (4) what the defendants gained by the alleged fraud." Brooks v. Blue Cross & Blue Shield of Fla., Inc., 116 F.3d 1364, 1381 (11th Cir. 1997). DISCUSSION The Court previously granted Plaintiff an opportunity to amend his Complaint, with the caveat that he would need to meet the more exacting standard of Federal Rule of Civil Procedure 9(b) in order to survive dismissal, as his allegations sound in fraud. Dkt. No. 29. Plaintiff makes the allegation that ^'Mrs. Hester was assured that her surgical procedure on March 3, 2015 would be covered by her insurance with UMR." Other paragraphs from Plaintiff's Dkt. No. 30 SI 17. Amended Complaint add more detail, such as the claim that Mrs. Hester's surgeon. Dr. Arundhati Mrs. Rao (''Dr. Hester's Medicare. Rao"), surgery JA. made would SISI 18-19. certain be representations covered by that insurance and In addition, while not providing a specific date. Plaintiff alleges that the statements were made during "the final Jacksonville. Memorial pre-op SI both when visit) and facility).^ pre-op 19. the visit" These at Memorial's allegations misrepresentation where it occurred tell occurred (at facility the in Defendant (the final Jacksonville Finally, Plaintiff alleges that Memorial had a financial motivation in making the misrepresentation, in that it sought to gain Mrs. Hester as a patient. Id. ^ Plaintiff alleges UMR's misrepresentations were made at about the same time. Dkt. No. 30 5 19. Plaintiff's allegations against UMR are far less specific. Plaintiff alleged did not identify misrepresentation, occurred. the nor person did responsible for identify where he the it In fact, Plaintiff asserts that neither he nor Mrs. Hester ever had any contact with Dkt. No. 30 SI 19. UMR or its representatives. As such. Plaintiff has not put UMR on notice as to either the person who made the misrepresentation or where the misrepresentation was made. Therefore, meet the while heightened Plaintiff's pleading allegations standard against Memorial under Rule 9{b), his allegations against UMR do not and will be dismissed. Memorial argues that even if Plaintiff has provided more particularity to comply with has failed to state a claim Rule for 9(b), Plaintiff nonetheless relief, because stated a claim for negligent misrepresentation. he has not Memorial cites this Court's ruling in Arch Insurance Co. v. Clements, Purvis & Stewart, P.C. as support for the proposition that Plaintiff's Amended Complaint should be dismissed. Dkt No. 35 p. 4; 850 F. Supp. 2d 1371 (S.D. Ga. 2011), aff'd, 434 F. App'x 826 (11th Cir. 2011) (per curiam). However, Plaintiff's allegations are distinguishable from those set out in Arch. That case involved a defendant that had allegedly failed to complete construction audits in plaintiff a timely manner. sustained 850 damages F. and Supp. sued 2d at for 1371. The negligent misrepresentation. Ultimately, this Court granted dismissal because the plaintiff failed to explain two things: fist, how the defendant acted negligently misrepresentation was actually made. and second, what JA. at 13. But Plaintiff's Amended Complaint suffers from neither of these two flaws. Mrs. Hester's surgery. Plaintiff alleges that Memorial misrepresented insurance status Dkt. No. 30 SI 19. in order to profit from the Unlike in Arch, the Plaintiff has alleged the exact misrepresentation made and the exact conduct that was negligent. These allegations are plausible and stated with particularity. As such. Memorial's Motion to Dismiss will be denied. Lastly, the Court Memorial Family. addresses that he Motion to Add Plaintiff asserts that Memorial Family ''does business with" Defendant Memorial. claims Plaintiff's did not Dkt. No. 61 p. 1. originally include Plaintiff Memorial Family because he believed this entity was a trade name for Memorial. Leave to amend must be granted absent a specific, significant reason for denial. Defendant for denial. Foman v. Davis, 371 U.S. 178, 182 (1962). Memorial Certainly, has not presented Defendant asserts a persuasive that reason Plaintiff had sufficient notice of the existence of this party and should have amended sooner. Dkt. No. 66. matter is in its initial stages. But the Court notes that this No scheduling order has yet been set. Furthermore, Memorial has stated no prejudice in allowing Plaintiff to add Memorial Family. Memorial's other arguments largely rely on the contentions it previously made in its Motion to Dismiss. As stated above. Plaintiff's allegations are made with sufficient particularity to survive a motion to dismiss. While the Court cannot yet discern whether claims against Memorial and Memorial Family will succeed, they particularity, are and nonetheless warrant plausible, discovery. As stated such. with Plaintiff's Motion to Add Memorial Family will be granted. CONCLUSION For the reasons set forth above, it is hereby ordered that Defendant UMR, Inc.'s Motion to Dismiss {Dkt. No. 35) is GRANTED and Defendant Dismiss {Dkt. Memorial No. 36) Healthcare is DENIED. Group, Inc.'s Plaintiff's Motion Memorial Family (Dkt. No. 61) is GRANTED. SO ORDERED, this 28™ day of September, 2017. HON. LISA GODBEY WOOD UNITED STATES DISTRICT JUDGE SOUTHERN Motion DISTRICT OF GEORGIA to to Add

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