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Andrews v. Hartford Insurance Co.

United States District Court, Ninth Circuit

June 10, 2013

GARY R. ANDREWS, et al., Plaintiffs,


M. JAMES LORENZ, District Judge.

On October 17, 2012, Plaintiffs Gary R. Andrews and Gloria J. Andrews commenced this action in the San Diego Superior Court against Defendant Hartford Insurance Company. This action arises from accidental-death-and-dismemberment benefits under a policy issued by Defendant. On November 21, 2012, Defendant removed this action to federal court. Defendant now moves to dismiss Plaintiffs' complaint in its entirety. Plaintiffs oppose.

The Court found this motion suitable for determination on the papers submitted and without oral argument. See Civ. L.R. 7.1(d.1). (Doc. 7.) For the following reasons, the Court GRANTS Defendant's motion to dismiss.


Plaintiffs allege that Defendant issued an insurance policy to Plaintiffs. (Compl. ¶ 6.) They further allege that "[o]n various occasions, and in connection with the issuance of the policy (and limits) at issue herein, Plaintiffs discussed insurance with the Defendant[] and/or their agents who recommend[ed] a policy issued by Defendant[] and Plaintiffs relied upon that advice." ( Id. ¶ 4.) They relied on that advice because of Defendant's "superior knowledge in deciding insurance related matters and issues[.]" ( Id. ¶ 5.)

According to Plaintiffs, "[the] policy provides in pertinent part that the Defendant[] will pay Plaintiffs various policy benefits in the event of injuries to Plaintiffs[.]" (Compl. ¶ 7.) And they add that they have "performed all condition[s], covenants and promises required of them to be performed in accordance with the terms and conditions of said contract of insurance except, if applicable, those that had been excused or waived." ( Id. ¶ 8.)

During an unspecified time period when Plaintiffs were covered by the insurance policy, they incurred a loss when Mr. Andrews was injured. (Compl. ¶ 9.) That injury resulted in the loss of vision in his eye. ( Id. ) Plaintiffs allege that Defendant refuses to pay the full amount of their claim, which they contend is $180, 000. ( Id. ¶ 10.) Instead, Defendants have paid Plaintiffs $90, 000, representing that that is the amount they are covered for. ( Id. ¶ 10.) Plaintiffs lastly allege that "[i]t was only after Plaintiffs submitted a claim arising out of the loss of sight in Mr. Andrew's eye that they discovered that [Defendant was] contending that they did not have coverage for $180, 000 that they thought they had." ( Id. )

On October 17, 2012, Plaintiff filed a complaint asserting nine causes of action: (1) Reformation Based on Inequitable Misconduct; (2) Reformation Based on Mutual Mistake of Fact; (3) Reformation Based on Fraud; (4) Coverage by Estoppel; (5) Intentional Misrepresentation; (6) Negligent Misrepresentation; (7) Fraudulent Concealment; (8) Negligent Failure to Disclose; and (9) Declaratory Relief. About one month later, Defendant removed this action to federal court. Defendant now moves to dismiss the complaint in its entirety. Plaintiffs oppose.


The court must dismiss a cause of action for failure to state a claim upon which relief can be granted. Fed.R.Civ.P. 12(b)(6). A motion to dismiss under Rule 12(b)(6) tests the legal sufficiency of the complaint. Navarro v. Block, 250 F.3d 729, 732 (9th Cir. 2001). The court must accept all allegations of material fact as true and construe them in light most favorable to the nonmoving party. Cedars-Sanai Med. Ctr. v. Nat'l League of Postmasters of U.S., 497 F.3d 972, 975 (9th Cir. 2007). Material allegations, even if doubtful in fact, are assumed to be true. Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007). However, the court need not "necessarily assume the truth of legal conclusions merely because they are cast in the form of factual allegations." Warren v. Fox Family Worldwide, Inc., 328 F.3d 1136, 1139 (9th Cir. 2003) (internal quotation marks omitted). In fact, the court does not need to accept any legal conclusions as true. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).

"While a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, a plaintiff's obligation to provide the grounds' of his entitlement to relief' requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do." Twombly, 550 U.S. at 555 (internal citations omitted). Instead, the allegations in the complaint "must be enough to raise a right to relief above the speculative level." Id. Thus, "[t]o 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.'" Iqbal, 556 U.S. at 678 (citing Twombly, 550 U.S. at 570). "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. "The plausibility standard is not akin to a probability requirement, ' but it asks for more than a sheer possibility that a defendant has acted unlawfully." Id. A complaint may be dismissed as a matter of law either for lack of a cognizable legal theory or for insufficient facts under a cognizable theory. Robertson v. Dean Witter Reynolds, Inc., 749 F.2d 530, 534 (9th Cir. 1984).


Defendant argues that all of Plaintiffs' causes of action should be dismissed for various reasons. To summarize, Defendant argues that: (1) the First, Second, and Third causes of action for reformation fail to state a claim in that Plaintiffs fail to allege essential elements for their reformation claims; (2) the Fifth, Sixth, Seventh, and Eighth are not pled with specificity and fail to meet the heightened pleading requirements under Federal Rule of Civil Procedure 9(b); and (3) the remaining causes of action for coverage by estoppel and declaratory relief, the Fourth and Ninth causes of action respectively, are "mere restatements of their claims for reformation and fraud." (Def.'s Mot. 2:3-22.)

Plaintiffs respond with a four-page opposition. The entirety of their argument from their ...

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