Otani v. State Farm Fire & Cas. Co.
| Decision Date | 20 May 1996 |
| Docket Number | CV. NO. 95-00291 DAE. |
| Citation | 927 F. Supp. 1330 |
| Parties | Janine Naomi OTANI, Plaintiff, v. STATE FARM FIRE & CASUALTY CO., Sandra Gomes, Claims Representative and Julie Quinn, Claims Supervisor, John Does 1-10, Jane Does 1-10, Doe Partnerships 1-10, Doe Corporations 1-10, Roe Non-Profit Organizations 1-10, and Roe Governmental Entities 1-10, Defendants, and State of Hawaii, Intervenor-Defendant. |
| Court | U.S. District Court — District of Hawaii |
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Jacob M. Merrill, Gary D. Weingarden, William Harrison Elkner, Law Offices of William H. Elkner, Honolulu, HI, for plaintiff.
Lennes N. Omuro, Goodsill Anderson Quinn & Stifel, Alii Plaza Honolulu, HI, for defendants.
David A. Webber, Office of the Attorney General — State of Hawaii, Honolulu, HI, for State of Hawaii.
The court heard Plaintiff's and Defendants' Motions on April 22, 1996. William Elkner, Esq., and Jacob M. Merrill, Esq., appeared on behalf of Plaintiff; Lennis N. Omuro, Esq., appeared on behalf of Defendant State Farm Fire & Casualty Co. ("State Farm") and Deputy Attorney General David A. Webber appeared on behalf of Intervenor-Defendant, the State of Hawaii ("Hawaii"). After reviewing the motion and the supporting and opposing memoranda, the court GRANTS State Farm's Motion to Dismiss, GRANTS Hawaii's Motion to Dismiss Constitutional Claims, and DENIES Plaintiff's Motion for Partial Summary Judgment.
Plaintiff was involved in an automobile accident on December 16, 1992 ("accident"). Plaintiff allegedly suffered bodily injury and submitted a claim for no-fault insurance benefits to State Farm.
State Farm paid benefits for chiropractic treatment from December 1992 until February 1993 and for acupuncture treatment during September and October 1993. Nearly a year after the accident, State Farm received a no-fault treatment plan dated December 3, 1993 from chiropractor, Gina Whest ("Whest"), of Scientific Chiropractic Clinic. The treatment plan requested additional continuing chiropractic adjustments scheduled from December 3, 1993 until March 24, 1994.
State Farm submitted the chiropractic treatment plan to peer review by Peer Review Challenge dated December 7, 1993, pursuant to and in accordance with Hawaii no-fault law. State Farm also requested Plaintiff to submit to an independent medical examination ("IME"). According to State Farm, it sent Plaintiff a reservation of rights letter dated February 1, 1994 when Plaintiff failed to respond to its request in reasonable time. Several days after the reservation letter was issued, Plaintiff, through her attorney, contacted State Farm and agreed to submit to an IME; State Farm made arrangements for Plaintiff to see Dr. Jeffrey Korchek on March 19, 1994. Plaintiff, again through a letter from counsel, informed State Farm that she would not submit to the IME — because, this time, she objected to the selection of doctors. Construing Plaintiff's letter as a refusal to submit to a legitimately requested IME, State Farm issued a denial of all benefits pending the conduct, results, and findings of an IME.
State Farm received two more no-fault treatment plans dated April 15, 1994 and July 8, 1994 from Whest requesting chiropractic adjustments from April 24, 1994 to July 21, 1994 and from July 22, 1994 to November 4, 1994 respectively. State Farm denied all three treatment plans, allegedly based on the Peer Review Report which concluded that the proposed chiropractic treatment "is of no curative value and, at most, offers temporary palliation." State Farm's Opposition to Plaintiff's Motion, Exh. K, at 3.
State Farm claims that it should prevail in this litigation because (a) Plaintiff fails to state a claim upon which relief can be granted, and (b) it has fully complied with the provisions of the contract and with applicable no-fault laws by paying all benefits owed Plaintiff under the Policy.
Plaintiff contests the constitutionality of the peer review process as well as State Farm's application of the recent legislation to her case.
Plaintiff initially filed her claim in state court seeking relief from State Farm and certain of its employees. The state court granted defendants' motion to dismiss Plaintiff's claims against the individual employees. Plaintiff filed an amended complaint on November 15, 1994 ("Amended Complaint"). On April 18, 1995, State Farm removed the action to this court pursuant to 28 U.S.C. §§ 1441 and 1446. There is original diversity jurisdiction in this court under 28 U.S.C. § 1332.
On May 18, 1995, Plaintiff moved for remand back to state court; this court denied that petition on July 13, 1995. Additionally, the court refused to certify the denial of remand on grounds that it was not a controlling question of law. On September 9, 1995, this court entered an order granting Defendant State Farm's Motion for Partial Dismissal with Prejudice and DISMISSED Counts II, VI, and VIII of Plaintiff's Amended Complaint.
On December 19, 1995, the parties stipulated to allow Hawaii to intervene as Intervenor-Defendant pursuant to 28 U.S.C. § 2403(b). On January 30, 1996, Hawaii filed a motion to dismiss Plaintiff's constitutional claims. State Farm joined in that motion.
That same day, State Farm moved for dismissal with prejudice or in the alternative for summary judgment on the remaining counts in Plaintiff's Amended Complaint, and Plaintiff filed a Motion for Partial Summary Judgment.
A motion to dismiss will be granted where the plaintiff fails to state a claim upon which relief can be granted. Fed.R.Civ.P. 12(b)(6). For the purposes of a 12(b)(6) motion, "review is limited to the contents of the complaint." Clegg v. Cult Awareness Network, 18 F.3d 752, 755 (9th Cir.1994).
A complaint should not be dismissed "unless it appears beyond doubt that plaintiff can prove no set of facts in support of her claim which would entitle her to relief." Buckey v. County of Los Angeles, 968 F.2d 791, 794 (9th Cir.1992) (quoting Love v. United States, 915 F.2d 1242, 1245 (9th Cir.1989)) (further citations omitted). All allegations of material fact are taken as true and construed in the light most favorable to the plaintiff. Id. Civil rights complaints are to be liberally construed. Id. (citing Gobel v. Maricopa County, 867 F.2d 1201, 1203 (9th Cir.1989)).
To the extent, however, that "matters outside the pleadings are presented to and not excluded by the court, the motion shall be treated as one for summary judgment." Fed.R.Civ.P. 12(b); Del Monte Dunes at Monterey, Ltd. v. Monterey, 920 F.2d 1496, 1507 (9th Cir.1990).
Rule 56(c) provides that summary judgment shall be entered when:
The pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law.
Fed.R.Civ.P. 56(c). The moving party has the initial burden of demonstrating for the court that there is no genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 2552-53, 91 L.Ed.2d 265 (1986) (citing Adickes v. S.H. Kress & Co., 398 U.S. 144, 90 S.Ct. 1598, 26 L.Ed.2d 142 (1970)). However, the moving party need not produce evidence negating the existence of an element for which the opposing party will bear the burden of proof at trial. Id. 477 U.S. at 322, 106 S.Ct. at 2552.
Once the movant has met its burden, the opposing party has the affirmative burden of coming forward with specific facts evidencing a need for trial. Fed.R.Civ.P. 56(e). The opposing party cannot stand on its pleadings, nor simply assert that it will be able to discredit the movant's evidence at trial. See T.W. Elec. Serv., Inc. v. Pacific Elec. Contractors Ass'n, 809 F.2d 626, 630 (9th Cir.1987); Fed.R.Civ.P. 56(e). There is no genuine issue of fact "where the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party." Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 1355-56, 89 L.Ed.2d 538 (1986) (citation omitted).
A material fact is one that may affect the decision, so that the finding of that fact is relevant and necessary to the proceedings. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986). A genuine issue is shown to exist if sufficient evidence is presented such that a reasonable fact finder could decide the question in favor of the nonmoving party. Id. The evidence submitted by the nonmovant, in opposition to a motion for summary judgment, "is to be believed, and all justifiable inferences are to be drawn in its favor." Id. at 255, 106 S.Ct. at 2513-14. In ruling on a motion for summary judgment, the court must bear in mind the actual quantum and quality of proof necessary to support liability under the applicable law. Id. at 254, 106 S.Ct. at 2513. The court must assess the adequacy of the nonmovant's response and must determine whether the showing the nonmovant asserts it will make at trial would be sufficient to carry its burden of proof. See Celotex, 477 U.S. at 322, 106 S.Ct. at 2552.
At the summary judgment stage, this court may not make credibility determinations or weigh conflicting evidence. Musick v. Burke, 913 F.2d 1390, 1394 (9th Cir. 1990). The standard for determining a motion for summary judgment is the same standard used to determine a motion for directed verdict: does the evidence present a sufficient disagreement to require submission to a jury or is it so one-sided that one party must prevail as a matter of law. Id. (citation omitted).
State Farm argues that Plaintiff's claims for breach of contract (Count IV) and tortious breach of contract (Count V) must be...
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