James v. Wash. Nat'l Ins. Co.
| Decision Date | 28 August 2018 |
| Docket Number | Case No. 3:18-cv-628-J-34JRK |
| Parties | SARA C. JAMES, Plaintiff, v. WASHINGTON NATIONAL INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — Middle District of Florida |
THIS CAUSE is before the Court on Plaintiff's Motion to Remand (Doc. 10; Motion), filed on June 8, 2018. Defendant filed a response on June 22, 2018. See Defendant, Washington National Insurance Company's Response Memorandum of Law in Opposition to Plaintiff's Motion to Remand (Doc. 11; Response). Accordingly, this matter is ripe for review.
Plaintiff Sara C. James purchased a home health care policy, PL1147001A (Doc. 2-1; Policy), effective August 2, 1995, from Pioneer Life Insurance Company, acquired by Defendant Washington National Insurance Company. See Complaint for Declaratory Judgment, and for Breach of Contract (Doc. 2; Complaint) ¶5. Pursuant to the Policy, Plaintiff is eligible for a home health care daily benefit of $180.00 per day if preauthorized, and $135.00 per day if not preauthorized. See Policy at 5.1 Plaintiff is eligible for alifetime maximum benefit of $250,000.00, and a per occurrence maximum benefit of $150,000.00 per illness. Id. The Policy provides that "[s]uccessive confinement due to the same or related cause not separated by at least 6 months of normal daily living will be considered as the same occurrence." Id. at 8.
Plaintiff asserts that Defendant has paid home care health benefits for Plaintiff since April 1, 2010. See Complaint ¶8. The benefits were intended to enable Plaintiff to obtain assistance bathing and dressing as a result of her herniated lumbar disc and spinal stenosis. Id. ¶9.
On July 4, 2017, Plaintiff fell and fractured her hip, which required her to undergo surgery and to be admitted to an inpatient rehabilitation facility on a temporary basis. Id. ¶11. As a result of her fall, Plaintiff "continues to experience limitations to mobility, activity, pain and the ability to perform activities of daily living on a constant basis including but not limited to transferring, toileting, walking, mobility, and ambulating." Id. ¶12. These injuries and limitations are permanent. Id.
Plaintiff requested acknowledgment from Defendant that her fractured hip is a new occurrence for which she is eligible for an additional $150,000.00 of benefits, subject to the $250,000.00 lifetime maximum benefit. See Affidavit of Kimberly Martin (Doc. 11-1; Martin Aff.), Ex. A: August 8, 2017, Letter, Ex B: August 28, 2017, Letter, Ex. C: August 29, 2017 Letter. Defendant denied Plaintiff's request because it determined that her hip fracture was "related to her original diagnoses of spinal stenosis and osteoporosis," and "there is no objective evidence of a return to normal daily living for at least six months." See Martin Aff., Ex. D: November 8, 2017 Letter at 2. Plaintiff requested that Defendant reconsider its decision based on her belief that her fractured hip was not "the same" or"related to" her herniated lumbar disc or spinal stenosis. See Complaint ¶¶17-18. Defendant denied Plaintiff's request. Id. ¶18.
According to Plaintiff, because Defendant did not regard Plaintiff's fractured hip as a new injury, she "has underutilized her $150,000.00 initial benefit in order to 'save' benefits and prolong her coverage as long as she can into the future." Id. ¶19. Additionally, she "has foregone hours of needed and beneficial home health care," and paid out of pocket for care which should have been covered, in order to "stretch" her initial benefits "as much as possible." Id.
On April 5, 2018, Plaintiff filed the two-count Complaint in the Circuit Court, Fourth Judicial Circuit, in and for Duval County, Florida. See Complaint at 1. In Count I, Plaintiff seeks a declaration that she "is immediately entitled to home health care benefits in an amount up to the $250,000.00 Lifetime Limit due to injuries and limitations resulting from her fractured hip," and that Defendant "is immediately obligated to cover Plaintiff Sarah James for home health care under the Policy in an amount up to the $250,000.00 Lifetime Limit due to injuries and limitations resulting from her fractured hip." Id. at 5 (Wherefore Clause). Additionally, Plaintiff seeks a "Judgment declaring that . . . Plaintiff be awarded her costs and attorneys' fees incurred herein," as well as "such other relief as the Court deems just and proper." Id. In Count II, Plaintiff asserts a breach of contract claim against Defendant based on Defendant's denial of "Plaintiff's eligibility for additional home health care benefits under the Policy in an amount up the Lifetime Limit of $250,000[.00] on account of her hip fracture injury in July of 2017." Id. ¶28. Plaintiff alleges that Defendant breached the Policy "both anticipatorily and in fact." Id. As a result, Plaintiff seeks damages, as well as interest, costs and attorney's fees. Id.
Plaintiff served Defendant with a copy of the Complaint and summons on April 18, 2018. See Defendant, Washington National Insurance Company's Notice of Removal (Doc. 1; Notice) ¶1. Defendant filed its answer on May 9, 2018, see Defendant, Washington National Insurance Company's Answer and Affirmative Defenses to Plaintiff's Complaint (Doc. 3; Answer), and removed the action to this Court and invoked the Court's diversity jurisdiction under 28 U.S.C. § 1332 on May 11, 2018, see Notice ¶¶6-11. In the Notice, Defendant contends that the parties are diverse because Plaintiff is a citizen of Florida and Defendant is a citizen of Indiana, and that the amount in controversy is satisfied because "[i]n her Complaint, Plaintiff seeks an additional $100,000.00 benefit under the Lifetime Limit of her Ho[m]e Health Care insurance policy." Id. ¶¶7-8, 10 (citing Complaint ¶19). In the Motion, Plaintiff requests that the Court remand this matter back to the state court because Defendant has failed to establish that the amount in controversy satisfies the $75,000.00 jurisdictional threshold required under 28 U.S.C. § 1332. See generally Motion. Defendant opposes the requested relief. See generally Response.
"If a state-court complaint states a case that satisfies federal jurisdictional requirements, a defendant may remove the action to federal court pursuant to 28 U.S.C. § 1446(b)." See Roe v. Michelin N. Am., Inc., 613 F.3d 1058, 1060 (11th Cir. 2010). The removing party bears the burden of demonstrating that federal jurisdiction exists. Kirkland v. Midland Mtg. Co., 243 F.3d 1277, 1281 n.5 (11th Cir. 2001); see also Pretka v. Kolter City Plaza II, Inc., 608 F.3d 744, 752 (11th Cir. 2010).2 Here, where Defendant relies ondiversity jurisdiction under § 1332(a) as the basis for removal, this burden requires Defendant to show both that the parties to the action are of diverse citizenship and that the amount in controversy exceeds $75,000. See Williams v. Best Buy Co., 269 F.3d 1316, 1319 (11th Cir. 2001). In this case, Plaintiff does not dispute that the parties are of diverse citizenship. See Motion at 3. Therefore, the only jurisdictional question before the Court concerns whether the amount in controversy requirement has been satisfied. Williams, 269 F.3d at 1319.
Where, as here, "the plaintiff has not plead[ed] a specific amount of damages . . . the defendant is required to show . . . by a preponderance of the evidence that the amount in controversy can more likely than not be satisfied." Kirkland, 243 F.3d at 1281 n.5; see also Pretka, 608 F.3d at 752 (quoting Williams, 269 F.3d at 1319); Roe, 613 F.3d at 1061.3 "In some cases, this burden requires the removing defendant to provide additional evidence demonstrating that removal is proper." Roe, 613 F.3d at 1061. However, in other cases, "it may be 'facially apparent' from the pleading itself that the amount in controversy exceeds the jurisdictional minimum, even when 'the complaint does not claim a specific amount of damages.'" Id. (quoting Pretka, 608 F.3d at 754). In determining whether the amount in controversy requirement is met, the Court "focuses on how much is in controversy at the time of removal, not later." Pretka, 608 F.3d at 751 (citations omitted); see also Poore v. Am.-Amicable Life Ins. Co., 218 F.3d 1287, 1290-91 (11th Cir.2000) (), overruled on other grounds, Alvarez v. Uniroyal Tire Co., 508 F.3d 639, 640-41 (11th Cir. 2007); Sierminski v. Transouth Fin. Corp., 216 F.3d 945, 946 (11th Cir. 2000).
A court may not speculate or guess as to the amount in controversy. See Pretka, 608 F.3d at 752. However, "Eleventh Circuit precedent permits district courts to make 'reasonable deductions, reasonable inferences, or other reasonable extrapolations' from the pleadings to determine whether it is facially apparent that a case is removable." Roe, 613 F.3d at 1061-62 (quoting Pretka, 608 F.3d at 754). Indeed, "courts may use their judicial experience and common sense in determining whether the case stated in a complaint meets federal jurisdictional requirements." Id. at 1062. Moreover, "a removing defendant is not required to prove the amount in controversy beyond all doubt or to banish all uncertainty about it." Pretka, 608 F.3d at 754. All that is required is that a removing defendant show, by a preponderance of the evidence, that the amount in controversy exceeds the jurisdictional requirement. See id. at 752. However, in considering the propriety of a removal, federal courts consistently caution that removal statutes must be strictly construed, and all doubts resolved in favor of remand. See Burns v. Windsor Ins. Co., 31 F.3d 1092, 1095 (11th Cir. 1994); see also Shamrock Oil & Gas Corp. v. Sheets, 313 U.S. 100, 109 (1941) (...
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