Lavoie v. Aetna Life and Cas. Co., Inc.

• Decision Date: 31 August 1979
• Citation: 374 So.2d 310
• Parties: Margaret W. LAVOIE and Robert J. Lavoie, Sr. v. AETNA LIFE AND CASUALTY COMPANY, INC., a corporation. 78-170.
• Court: Alabama Supreme Court

Page 310

374 So.2d 310

Margaret W. LAVOIE and Robert J. Lavoie, Sr. v. AETNA LIFE AND CASUALTY COMPANY, INC., a corporation.

78-170.

Supreme Court of Alabama.

Aug. 31, 1979.

Joseph M. Brown, Jr., of Cunningham, Bounds, Byrd, Yance & Crowder, Mobile, for appellants.

Peter V. Sintz and William M. Cunningham, Jr., of Sintz, Pike, Campbell & Duke, Mobile, for appellee.

TORBERT, Chief Justice.

This appeal arises out of the trial court's granting appellee Aetna Life and Casualty Company's motion to dismiss for failure to state a claim upon which relief can be granted.

Appellants, Margaret W. Lavoie and Robert J. Lavoie, Sr., filed a five-count complaint seeking recovery from appellee insurance company for non-payment of benefits allegedly due Mrs. Lavoie under a group medical insurance policy. Appellants claimed both compensatory and punitive damages. The first count alleged breach of contract. The second count alleged reckless, wanton, malicious, oppressive, and outrageous conduct on the part of appellee in refusing to honor the claim thereby causing Mrs. Lavoie severe emotional distress. The third count alleged breach of appellee's implied duty to deal in good faith and to exercise reasonable care in the performance of its contractual obligations. The fourth and fifth counts contained Mr. Lavoie's claim for loss of consortium based upon the second and third counts. The trial court granted appellee's 12(b)(6) motion as to all counts except the first. Final judgment was entered in accordance with ARCP 54(b), and the Lavoies appeal.

Mrs. Lavoie alleges in her complaint the following set of facts. She entered the Mobile Infirmary, while insured under a group medical insurance policy, to undergo a series of tests prescribed by her physician. Hospitalization was necessary since the tests could only be conducted in the controlled atmosphere of a hospital. As a result of the tests and hospitalization, Mrs. Lavoie incurred a charge of $3,028.25. Appellee only paid a portion of such expenses and refused to pay the balance of $1,650.22 on the ground that the tests should have been performed on an outpatient rather than inpatient basis. However, appellee had in its possession a physician's report stating that hospitalization was necessary to properly perform the tests; therefore, appellee had no valid ground to refuse to pay benefits properly due under the policy of insurance.

The sole issue presented for review is whether the complaint should have been dismissed for failure to state a claim for relief.

At the outset, we note that Mrs. Lavoie is attempting to recover for the "tort of outrage," that is, she alleges a claim for relief in tort for the bad faith refusal of the insurer to pay legitimate benefits due under a policy of insurance. This court has neither accepted nor rejected such a theory of recovery. Childs v. Mississippi Valley Title Insurance Co., 359 So.2d 1146 (Ala.1978). This view was most recently reiterated in Vincent v. Blue Cross-Blue Shield, 373 So.2d 1054 (Ala.1979): ¹ "(T)his court might, under appropriate circumstances, recognize a tort action for the wrongful refusal to pay a valid claim . . . ." However, we added: "(But) facts supporting such circumstances have not been developed here. For us to attempt to delineate circumstances, or to hypothesize facts under which the court would recognize a tort claim in the posture of this case, would amount to no more than an advisory opinion. We, therefore, decline to do so." ²

Whether appellants are entitled to relief under such a theory of recovery is not at issue in the instant appeal. Rather what is at issue is the sufficiency of the complaint under ARCP 12(b)(6).

The classic statement of the proper test of the sufficiency of a complaint appears in Conley v. Gibson, 355 U.S. 41, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957). In that case, the Supreme Court of the United States stated:

In apprising the sufficiency of the complaint we follow, of course, the accepted rule that a complaint should not be dismissed for failure to state a claim unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.

355 U.S. at 45-46, 78 S.Ct. at 102, 2 L.Ed.2d at 84. Accordingly, this court has stated:

A motion to dismiss can never be granted unless it appears that the movant would not be entitled to recover under any theory of the case or any applicable state of facts. . . . Upon consideration of such a motion, the allegations of the complaint are construed in a light most favorable to the complainant, with all doubts and allegations resolved in his favor.

Pruitt v. Pruitt, 343 So.2d 495, 497 (Ala.1977). Dismissal, then, is warranted only when the allegations of the complaint itself clearly demonstrate that the plaintiff does not have a claim. 5 Wright & Miller, Federal Practice & Procedure § 1357 (1969). Not only should dismissals for failure to state a claim be used sparingly, Trabits v. First National Bank of Mobile, 295 Ala. 85, 323 So.2d 353 (1975), but "(t)he court should be especially reluctant to dismiss on the basis of the pleadings when the asserted theory of liability is novel or extreme, since it is important that new legal theories be explored and assayed in light of actual facts rather than a pleader's suppositions." Wright & Miller, Supra, § 1357, at 603. Shull v. Pilot Life Insurance Co., 313 F.2d 445, 447 (5th Cir. 1963); Trabits v. First National Bank of Mobile, supra. See Vincent v. Blue Cross-Blue Shield, supra. If after development of the facts it appears that the plaintiff is entitled to no relief, then summary judgment is the appropriate procedure to dispose of the claim. Trabits v. First National Bank of Mobile, supra. See Vincent v. Blue Cross-Blue Shield, supra.

In the instant case, we cannot say that as a matter of law appellants could not prove any set of facts which would entitle them...