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Ladson v. National Union Fire Insurance Company of Pittsburgh PA

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

April 30, 2018

Isaac Ladson, Plaintiff,
v.
National Union Fire Insurance Company of Pittsburgh PA, Defendant.

          ORDER

          DAVID C. NORTON UNITED STATES DISTRICT JUDGE

         This matter comes before the court on defendant National Union Fire Insurance Company of Pittsburgh PA's (“National Union”) motion to dismiss or for summary judgment, ECF No. 40. For the reasons set forth below, the court denies without prejudice the motion to dismiss or for summary judgment and grants the plaintiff leave to file an amended complaint.

         I. BACKGROUND[1]

         This case arises from a dispute over an insurance policy between Plaintiff Isaac Ladson (“Ladson”) and National Union. In 2008, Ladson obtained a Blanket Accident Insurance Policy (“Policy”) from National Union through his wife's employer, Bank of America. ECF No. 40 at 2. Ladson alleges that in July 2010 he was injured in a one car accident, after which he claims to have developed “severe memory loss and severe cognitive impairments with episodes of total loss of memory.” ECF No. 45 at 1. In December 2010, Ladson submitted a claim for disability benefits under the Policy, and alleges that he only received the denial of his claim in July 2015. Id. at 1-2.

         Ladson filed the instant action in the Charleston County Court of Common Pleas on May 16, 2016, alleging causes of action for breach of contract and bad faith, and requesting a declaratory judgment regarding his rights under the Policy. ECF No. 1-1. National Union removed the case on July 1, 2016. ECF No. 1. On December 18, 2017, National Union filed its motion to dismiss or motion for summary judgment, ECF No. 40, having first raised a motion to dismiss based on Rule 12(b)(6) in its Answer, ECF No. 5 ¶ 25. On January 23, 2018, Ladson filed his response to the motion, ECF No. 45, and on March 22, 2018, he filed a supplement to this response, ECF No. 53. On February 6, 2018, National Union filed its reply to Ladson's response, ECF No. 52, and on April 3, 2018, it filed its reply to Lasdon's supplement, ECF No. 56. The court held a hearing on April 25, 2018. The motion has been fully briefed and is now ripe for the court's review.

         II. STANDARD

         A. Motion to Dismiss

         A Rule 12(b)(6) motion for failure to state a claim upon which relief can be granted “challenges the legal sufficiency of a complaint.” Francis v. Giacomelli, 588 F.3d 186, 192 (4th Cir. 2009) (citations omitted); see also Republican Party of N.C. v. Martin, 980 F.2d 943, 952 (4th Cir. 1992) (“A motion to dismiss under Rule 12(b)(6) . . . does not resolve contests surrounding the facts, the merits of a claim, or the applicability of defenses.”). To be legally sufficient, 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). A Rule 12(b)(6) motion should not be granted unless it appears certain that the plaintiff can prove no set of facts that would support his claim and would entitle him to relief. Mylan Labs., Inc. v. Matkari, 7 F.3d 1130, 1134 (4th Cir. 1993). When considering a Rule 12(b)(6) motion, the court should accept all well-pleaded allegations as true and should view the complaint in a light most favorable to the plaintiff. Ostrzenski v. Seigel, 177 F.3d 245, 251 (4th Cir.1999); Mylan Labs., Inc., 7 F.3d at 1134. “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 Corp. 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.” Id.

         B. Motion for Summary Judgment

         Summary judgment shall be granted “if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine dispute as to any material fact and that the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c). “By its very terms, this standard provides that the mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment; the requirement is that there be no genuine issue of material fact.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986). “Only disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment.” Id. at 248. “[S]ummary judgment will not lie if the dispute about a material fact is ‘genuine, ' that is, if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Id. “[A]t the summary judgment stage the judge's function is not himself to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial.” Id. at 249. The court should view the evidence in the light most favorable to the non-moving party and draw all inferences in its favor. Id. at 255.

         III. DISCUSSION

         National Union brings the following main arguments in its motion: (1) the complaint should be dismissed because it does not allege facts sufficient to constitute a cause of action, and (2) Ladson's cognitive issue were pre-existing health conditions and not the result of an injury as required by the Policy in order for him to obtain disability benefits. ECF No. 40 at 9.

         A. Failure to State a Claim

         National Union argues that the “complaint contains only conclusory allegations and lacks sufficient factual matter to state a plausible claim for relief under the policy.” ECF No. 40 at 10. The very short complaint ...


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