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Carmen J. Pagan-Teal v. the Hartford

August 10, 2011


The opinion of the court was delivered by: Honorable Joseph E. Irenas


IRENAS, Senior District Judge:

Plaintiff Carmen J. Pagan-Teal brings this action claiming breach of contract by Hartford Life Accident Insurance Company ("Hartford"),*fn1 and Continental Casualty Company ("Continental," and together with Hartford, the "Defendants").*fn2 Pending before the Court is the Defendants' Motion to Dismiss the Complaint pursuant to Fed. R. Civ. P. 12(b)(6). For the reasons stated herein, the Motion will be granted.


On June 1, 2004, the Defendants issued a $251,000 accidental death and dismemberment insurance policy ("the Policy") to Wilbert Teal.*fn3 (Defs.' Mot. to Dismiss p. 5) The Plaintiff was the designated beneficiary of the Policy. (Compl. ¶ 3)

Pursuant to its terms, the Policy would pay an accidental death benefit to the beneficiary when an "injury" resulted in loss of life. The Policy defined "injury" as any "bodily injury caused by an accident which occurs while the person is covered under this policy and that results, directly and independently of all other causes, in loss covered by this policy." (Bachrach Dec. Ex. B) The Policy excluded from the definition of "injury" any injury caused by or resulting from "alcoholic intoxication or influence of drugs unless taken as prescribed by a physician." (Id.)

The Policy also contained a provision which imposed a time limit on when legal actions could be filed against the insurer: "[n]o action can be brought after three years. . . from the date written proof [of loss] is required." (Id.) Written proof of loss is required within 90 days of the loss. (Id.) Therefore, Plaintiff had three years and ninety days from the date of the loss (the "Period") to file suit under the terms of the Policy.*fn4

After undergoing a surgical procedure, Wilbert Teal died on April 29, 2005.*fn5 (Compl. ¶ 3) There is a factual dispute between the Plaintiff and Defendants as to the cause of death of Wilbert Teal. Plaintiff claims that Wilbert Teal died as a result of an adverse effect of prescription medication. (Compl. ¶ 3) Defendants claim that Wilbert Teal died after the ingestion of unprescribed medications. (Bachrach Dec. Ex. C)

Plaintiff submitted her claim for benefits on the day her husband died. (Defs.' Motion to Dismiss p. 5) There is no indication in the record that Plaintiff's claim for benefits was in any way deficient or faulty. Defendants wrote to Plaintiff notifying her of their final decision to deny benefits on October 27, 2006. (Bachrach Dec. Ex. C)

Plaintiff filed suit against the Defendants in New Jersey Superior Court on April 13, 2011, asserting claims of breach of contract, consumer fraud, emotional distress, and insurance claim wrongfully delayed or denied.(Defs.' Mot. to Dismiss p. 6) Defendants removed the case to this Court on June 6, 2011. Plaintiff filed a Motion to Remand on June 27, 2011, which was denied on August 1, 2011. Defendants filed this Motion to Dismiss on June 10, 2011.


Federal Rule of Civil Procedure 12(b)(6) provides that a court may dismiss a complaint "for failure to state a claim upon which relief can be granted." In order to survive a motion to dismiss, a complaint must allege facts that raise a right to relief above the speculative level. Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007); see also Fed. R. Civ. P. 8(a)(2).

While a court must accept as true all allegations in the plaintiff's complaint, and view them in the light most favorable to the plaintiff, Phillips v. County of Allegheny, 515 F.3d 224, 231 (3d Cir. 2008), a court is not required to accept sweeping legal conclusions cast in the form of factual allegations, unwarranted inferences, or unsupported conclusions. Morse v. Lower Merion Sch. Dist., 132 F.3d 902, 906 (3d Cir. 1997). The complaint must state sufficient facts to show that the legal allegations are not simply possible, but plausible. Phillips, 515 F.3d at 234. "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." Ashcroft v. Iqbal, 129 S.Ct. 1937, 1949 (2009).

When evaluating a Rule 12(b)(6) motion to dismiss, the Court considers "only the allegations in the complaint, exhibits attached to the complaint, matters of public record, and documents that form the basis of a claim." Lum v. Bank of America, 361 F.3d 217, 221 n.3 (3d Cir. 2004). A document that forms the basis of a claim is one that is "integral to or explicitly relied upon in the ...

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