United States District Court, S.D. Mississippi, Northern Division
Carlton W. Reeves UNITED STATES DISTRICT JUDGE
the Court is Jennifer Lemoine's motion to dismiss. Docket
No. 11. The matter is fully briefed and ready for
Factual and Procedural History
2015, Louis Thomas sustained injuries in a vehicular
accident. He filed a claim with GEICO, his automobile
insurance company, for uninsured/underinsured benefits
including medical payment benefits. When he became
dissatisfied with GEICO's settlement offer, he and his
wife filed this suit against GEICO alleging breach of
contract and bad faith denial of insurance benefits. Their
suit also claims that GEICO's adjuster, Jennifer Lemoine,
is liable for committing gross negligence in the course of
adjusting their claim.
now contends that the complaint fails to state a claim
considering a motion to dismiss for failure to state a claim,
the Court accepts the plaintiff's factual allegations as
true and makes reasonable inferences in the plaintiff's
favor. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).
To proceed, the complaint “must contain a short and
plain statement of the claim showing that the pleader is
entitled to relief.” Id. at 677-78 (quotation
marks and citation omitted). This requires “more than
an unadorned, the defendant-unlawfully-harmed-me accusation,
” but the complaint need not have “detailed
factual allegations.” Id. at 678 (quotation
marks and citation omitted). The plaintiff's claims must
also be plausible on their face, which means there is
“factual content that allows the court to draw the
reasonable inference that the defendant is liable for the
misconduct alleged.” Id. (citation omitted).
Mississippi law, an insurance adjuster “has a duty to
investigate all relevant information and must make a
realistic evaluation of a claim.” Bass v.
California Life Ins. Co., 581 So.2d 1087, 1090 (Miss.
1991) (citation omitted). An adjuster “may be held
independently liable for its work on a claim if and only if
its acts amount to any one of the following familiar types of
conduct: gross negligence, malice, or reckless disregard for
the rights of the insured.” Gallagher Bassett
Servs., Inc. v. Jeffcoat, 887 So.2d 777, 784 (Miss.
argues that a mere pocketbook dispute falls short of stating
a gross negligence claim. “[A] ‘pocketbook
dispute' exists when parties are in agreement as to the
extent of damage but disagree on the value to be assigned to
the damage.” Fonte v. Audubon Ins. Co., 8
So.3d 161, 168 (Miss. 2009), as modified on denial of
reh'g (May 14, 2009).
supporting cases stand for the proposition that judgment as a
matter of law is appropriate when the evidence adduced at the
summary judgment stage or at trial reveals the case to be a
pocketbook dispute. E.g., State Farm Mut. Auto.
Ins. Co. v. Roberts, 379 So.2d 321, 322 (Miss. 1980).
That may turn out to be true for the Thomases, but the
argument cannot be adjudicated today because we have not yet
seen the evidence. The question today is whether the
Thomases' allegations make out a claim of gross
negligence, malice, or reckless disregard.
Thomases' complaint alleges that Lemoine's adjustment
was made “based on her personal experience being
married to a National Guard member and that the injuries of
Louis Thomas were not related to his automobile
accident.” Docket No. 1, at 4. The former is probably
not an acceptable standard of adjustment in the insurance
industry, and the Thomases plainly think Lemoine's latter
assertion was grossly negligent or made with reckless
disregard for their rights. That is enough to state a claim
under Mississippi law.
then goes deeper into the details of the Thomases' claim
to argue that her adjustment was reasonable given all the
facts. Again, though, those facts are not in the record- we
only have the Thomases' allegations. Lemoine can raise
her arguments again after all of the facts have been gathered