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Delancey v. Medamerica Insurance Co.

United States District Court, S.D. Mississippi, Northern Division

March 31, 2017

WILBURN F. DELANCEY AND THE ESTATE OF VELM B. DELANCEY PLAINTIFFS
v.
MEDAMERICA INSURANCE CO. DEFENDANT

          MEMORANDUM OPINION AND ORDER

          CARLTON W. REEVES UNITED STATES DISTRICT JUDGE

         Before 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.

         I. Factual and Procedural History

         The below allegations are drawn from the complaint and taken as true for purposes of this motion.

         Velma 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.

         That 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.

         Wilburn 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.

         The 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.

         II. Legal Standard

         When 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).

         III. Discussion

         “Because 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 omitted).

         MedAmerica 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 dismissed.

         The 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. ยงยง ...


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