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Federal Insurance Co. v. Windherburg-Cordeiro

United States District Court, D. New Jersey

November 24, 2014



JOEL A. PISANO, District Judge.

Plaintiff brings this action against defendant Dina von Windherburg-Cordeiro ("Defendant") alleging violation of New Jersey's Insurance Fraud Prevention Act N.J.S.A. 17:33A-1 et seq. Presently before the Court is a motion by Plaintiff Federal Insurance Company ("Plaintiff" or "Federal") for judgment on the pleadings. For the reasons below, Plaintiff's motion is granted in part and denied in part.


According to the amended complaint (D.I. 33, referred to herein at times as the "complaint"), as of November 7, 2002, Defendant was an insured under a $1.5 million Voluntary Accident Insurance Policy (the "Policy"). The Policy provided coverage for "Permanent Total Disability." In 2005, Defendant gave notice to Federal of a claim for Permanent Total Disability ("PTD") benefits as a result of injuries allegedly suffered on March 20, 2004, from a fall down an escalator at the Munich Airport in Munich, Germany. Plaintiff claimed that as a result of this fall she suffered dental damage, facial injuries, serious cervical spine injury, and traumatic brain injury causing the loss of use of her extremities. After seeking information from Defendant and conducting its review, Federal ultimately denied Defendant's claim.

On March 3, 2011, in accordance with the arbitration provision in the Policy, Defendant filed a demand for arbitration with the American Arbitration Association disputing the denial of her PTD claim and asserting claims for breach of contract, equitable reformation, insurance bad faith and violations of the New Jersey Consumer Fraud Act. Federal filed a counterclaim in the arbitration that included a count for common law fraud founded upon representations made by Defendant during the claim investigation and the arbitration. A final award was issued in that arbitration on August 2, 2012 ("August 2 Award") on all claims and the counterclaim, and a final award on attorney's fees was entered on April 3, 2013 ("April 3 Award").

The August 2 Award was a full and final award in favor of Federal on all of Defendant's claims and a partial award as to liability on Federal's counterclaim for fraud. In the written decision, the arbitration panel chair concluded that the disabilities and limitations claimed by Defendant were "largely or entirely feigned." D.I. 41-5 at 2. The decision stated that Defendant had "engaged in deliberate deception and [had] feigned her injuries and symptoms for the purpose of financial gain." Id. at 5. The April 3 Award granted fees and costs to Federal in the amount of $513, 303.72. This Court granted Plaintiff's motion to confirm these awards on November 26, 2013. D.I. 61, 62.

In addition to seeking confirmation of the arbitration awards, the complaint in this case also includes a count (Count I) for violations of New Jersey's Insurance Fraud Prevention Act ("IFPA") and a count (Count III) seeking an Order from this Court that the findings of fact in the aforementioned arbitration awards are binding on Defendant in this proceeding and that Defendant is precluded from re-litigating any findings of fat made in the arbitration. On March 22, 2013, Defendant filed a document purporting to be her answer to the amended complaint. D. I. 37. This "response" to the amended complaint is a lengthy submission that begins with a three-paragraph introduction (unnumbered), and is followed by sixty-three numbered paragraphs, none of which correspond with the numbered paragraphs of the complaint. These are followed by a twenty-page single-spaced narrative. As this Court noted in an earlier decision addressing a motion by Plaintiff to strike Defendant's answer, nothing contained in this "answer" appears to respond to the specific allegations in the complaint. D.I. 61 (Opinion), 62 (Order). Thus, this Court has held that to the extent that Defendant's answer fails to deny allegations in the amended complaint, those allegations are deemed admitted. Id. In light of that decision, Plaintiff now moves for judgment on the pleadings.


A. Legal Standard - Judgment on the Pleadings

Rule 12(c) of the Federal Rules of Civil Procedure allows a party to move for judgment on the pleadings "after the pleadings are closed but within such time as not to delay trial..." Fed.R.Civ.P. 12(c). The applicable standard on a motion for judgment on the pleadings is similar to that applied on a motion to dismiss pursuant to Rule 12(b)(6). Spruill v. Gillis, 372 F.3d 218, 223 n. 2 (3d Cir.2004). In reviewing a motion made pursuant to Rule 12(c), a court must take all allegations in the complaint as true, viewed in the light most favorable to the plaintiff. Gomez v. Toledo, 446 U.S. 635, 636 n. 3, 100 S.Ct. 1920, 64 L.Ed.2d 572, (1980); Robb v. City of Philadelphia, 733 F.2d 286, 287 (3d Cir. 1984). Judgment on the pleadings pursuant to Rule 12(c), will be granted where the moving party clearly establishes there are no material issues of fact to be resolved, and that he or she is entitled to judgment as a matter of law. DiCarlo v. St. Mary Hosp., 530 F.3d 255, 259 (3d Cir. 2008).

B. Discussion

Count I - New Jersey IFPA Claim

Count I alleges violations of the New Jersey Insurance Fraud Prevention Act (the "Act"), N.J.S.A. 17:33A-1 et ...

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