United States District Court, S.D. Mississippi, Northern Division
WILBURN F. DELANCEY AND THE ESTATE OF VELM B. DELANCEY PLAINTIFFS
MEDAMERICA INSURANCE CO. DEFENDANT
MEMORANDUM OPINION AND ORDER
CARLTON W. REEVES UNITED STATES DISTRICT JUDGE
the Court is the defendant's motion to dismiss. Docket
No. 9. The motion has been fully briefed and the Court is
ready to rule.
Factual and Procedural History
below allegations are drawn from the complaint and taken as
true for purposes of this motion.
Delancey purchased a long-term-care insurance policy from
MedAmerica in 1998. Beginning in 2007, “MedAmerica
approved of and paid for Mrs. Delancey's use of
privately-hired caregivers under the Alternative Care Benefit
(ACB) provision of the policy for approximately five
years.” Docket No. 1-1, at 5.
changed in April 2012, when MedAmerica notified Mrs. Delancey
in writing that it would no longer reimburse her for private
care services unless the services were first approved by a
third-party verification company. Id. In March 2013,
MedAmerica denied Mrs. Delancey's insurance claims due to
her failure to satisfy the verification requirement.
Id. These denials continued until her death in
December 2013. Id. at 7.
Delancey and Mrs. Delancey's estate (“the
Estate”) filed this lawsuit in Hinds County Circuit
Court on February 29, 2016, asserting claims for breach of
contract, tortious breach of contract, breach of the covenant
of good faith and fair dealing, bad faith denial of insurance
benefits, negligence, intentional infliction of emotional
distress, and negligent infliction of emotional distress.
Id. at 3. They allege that the policy gave
MedAmerica no authority to condition Mrs. Delancey's
benefits on the verification requirement. “By imposing
a requirement of third-party verification, ” they say,
“MedAmerica attempted to unilaterally change the terms
of its Policy to Mrs. Delancey's detriment.” Docket
No. 13, at 3.
action was removed to this Court on March 30, 2016 pursuant
to diversity jurisdiction, Docket No. 1, and now MedAmerica
seeks dismissal of every claim. Docket No. 9.
considering a motion to dismiss for failure to state a claim,
the Court accepts the plaintiff's factual allegations as
true and makes all 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).
this case is proceeding in diversity, the applicable
substantive law is that of the forum state, Mississippi.
State law is determined by looking to the decisions of the
state's highest court.” Burrell v. Allstate
Prop. & Cas. Ins. Co., No. 3:13-CV-493-CWR-FKB, 2014
WL 4851273, at *1 (S.D.Miss. Sept. 29, 2014) (citations
argues that the claims asserted by Mr. Delancey in his
individual capacity fail for lack of standing. Mr. Delancey
has conceded the issue by failing to address it in his
response. See Rutter v. Conseco Life Ins. Co., No.
3:09-CV-680-DPJ-JCS, 2011 WL 2532467, at *5 (S.D.Miss. June
24, 2011). Accordingly, the individual-capacity claims are
claims of the Estate all stem from MedAmerica's refusal
to reimburse Mrs. Delancey for private care services not
first approved by a third-party verification company.
MedAmerica asserts that the causes of actions accrued in
April 2012 when it notified Mrs. Delancey that future
reimbursements would be contingent upon her satisfying the
verification requirement. It contends that the claims are,
therefore, time-barred under the applicable statutes of
limitations. See Miss. Code Ann. §§