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Agape Senior Primary Care, Inc. v. Evanston Insurance Co.

United States District Court, D. South Carolina, Columbia Division

September 14, 2016

Agape Senior Primary Care, Inc., Plaintiff,
v.
Evanston Insurance Company, Defendant.

          ORDER

          Joseph F. Anderson, Jr. United States District Judge.

         I. INTRODUCTION

         This matter is before the Court on Defendant Evanston Insurance Company's (“Defendant”) motion to dismiss under Fed.R.Civ.P. 12(b)(6) for failure to state a claim upon which relief can be granted. (ECF No. 4). This matter has been fully briefed, and, after reviewing the briefs and considering the oral arguments on this motion, Defendant's motion to dismiss is granted in part and denied in part.

         II. FACTUAL AND PROCEDURAL HISTORY

         Plaintiff Agape Senior Primary Care (“Plaintiff”) filed this action on April 14, 2016, in the Richland County Court of Common Pleas, Case No.: 2016-CP-40-02436, against Defendant. (ECF No. 1-1). According to the complaint, Plaintiff purchased a Physicians, Surgeons, Dentists, and Podiatrists Professional Liability Insurance Policy (the “Policy”) for the policy period of August 1, 2011, to August 1, 2012, from Defendant. (Id.). Plaintiff has alleged bad faith, or, in the alternative, breach of contract for Defendant's (A) failure to provide coverage or a defense in the “Watts Litigation”[1]; and (B) mishandling of prior claims, namely (1) reassignment of prior claims to new counsel midway through the claim process and (2) failure to properly participate in mediation, adjustment, and settlement of prior claims.[2] (Id.).

         In accordance with the requirements of 28 U.S.C. § 1332, this matter was removed by Defendant on the basis of diversity jurisdiction to the United States District Court, District of South Carolina, Columbia Division pursuant to 28 U.S.C. §§ 1441 and 1446 on May 19, 2016. (ECF No. 1). On May 19, 2016, Defendant moved to dismiss the action for failure to state a claim upon which relief can be granted. (ECF No. 4). On June 14, 2016, Plaintiff filed a response.[3] (ECF No. 7). On June 21, 2016, Defendant replied. (ECF No. 10). On August 11, 2016, a motion hearing was held and this matter was taken under advisement. (ECF No. 19).

         III. LEGAL STANDARD

         A pleading must contain a “short and plain statement of the claim showing that the pleader is entitled to relief.” Fed.R.Civ.P. 8(a)(2). “To survive a motion to dismiss, a complaint must contain 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 Atlantic v. Twombly, 550 U.S. 544, 570 (2007)). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Iqbal, 556 U.S. at 678. The court must determine whether the factual allegations in a complaint state a plausible claim for relief based on “judicial experience and common sense.” Id. at 679. In addition, the court “should view the complaint in a light most favorable to the plaintiff.” Mylan Labs., Inc. v. Matkari, 7 F.3d 1130, 1134 (4th Cir. 1993).

         IV. DISCUSSION

         A. Watts Litigation

         Defendant argues that Watts' complaint does not allege “anything outside the issues addressed in this Court's Amended Order and the Fourth Circuit's Order” as it “stems solely from allegations regarding Addo's acts and the negligent hiring and retention of Addo by [Plaintiff], which are not covered under the Policy.”[4] (ECF No. 4-1, p. 10). However, Plaintiff argues that these allegations involve the acts or omissions of others-nurses and a different physician other than Addo-so it does not stem solely from those of Addo or the negligent administrative acts of Plaintiff and, therefore, is covered by the Policy. (ECF No. 7, p. 4).

         First, the Court will look to the underlying complaint, Watts' complaint, to determine if insurance coverage may exist. Collins Holding Corp. v. Wausau Underwriters Ins. Co., 666 S.E.2d 897 (S.C. 2008).

         Based upon the factual allegations regarding the specific actions and omissions of the nurses and a physician, other than Addo, and failure of these agents to properly supervise and investigate medical care for Ms. Jones, the Watts' complaint appears to state a claim beyond Addo's or Plaintiff's acts or omissions as viewed in the light most favorable to Plaintiff. (See ECF No. 4-5, ¶¶ 15-21, 34). Therefore, it is plausible that the Policy provides coverage for at least some of the claims in the Watts' complaint and Defendant unreasonably refused to defend Plaintiff.

         Second, after determining coverage may have been applicable based upon the Watts' complaint, the Court looks to Plaintiff's complaint to determine if sufficient facts are alleged to show ...


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