United States District Court, W.D. Missouri, Western Division
MARVIN'S MIDTOWN CHIROPRACTIC CLINIC, LLC, individually and on behalf of others similarly situated, Plaintiff,
AMERICAN FAMILY INSURANCE COMPANY, Defendant.
ORDER PARTIALLY GRANTING MOTION TO DISMISS
KAYS, CHIEF JUDGE
putative class action stems from Plaintiff Marvin's
Midtown Chiropractic Clinic, LLC (“Marvin's”)
allegation that Defendant American Family Insurance Company
(“American Family”) negligently issued and
delivered insurance payments made pursuant to an assignment
of benefits. Marvin's contends that under Mo. Rev. Stat.
§ 376.427, American Family should have issued and
delivered payments directly to it instead of its insureds.
before the Court is American Family's Motion to Dismiss
the Amended Complaint (Doc. 21) for lack of standing and
failure to state a claim. Holding that American Family did
not owe a duty to deliver payment directly to Marvin's,
and that Marvin's negligence per se claim is not
cognizable, Defendants' motion is GRANTED IN PART.
parties agree that Marvin's claims are grounded in the
allegation that American Family violated Mo. Rev. Stat.
§ 376.427, which governs assignments of benefits made by
insureds to medical providers. The parties agree that the
primary purpose of the statute is to enable insured
individuals who are injured in an automobile accident to seek
immediate medical treatment without worrying about how to pay
for that treatment up front.
provision at the heart of this dispute states:
Upon receipt of an assignment of benefits made by the insured
to a provider, the insurer shall issue the instrument of
payment for a claim for payment for health care services in
the name of the provider. All claims shall be paid within
thirty days of the receipt by the insurer of all documents
reasonably needed to determine the claim.
Mo. Rev. Stat. § 376.427.2. The statute defines
“Insured, ” in relevant part, as “any
person entitled to benefits under a contract of accident and
sickness insurance, or medical-payment insurance issued as a
supplement to liability insurance[.]” Id. at
376.427.1(2). “Provider” is defined as “a
physician, hospital, dentist, podiatrist, chiropractor,
pharmacy, licensed ambulance service, or optometrist,
licensed by this state.” Id. at §
Amended Complaint (“the Complaint”) (Doc. 20)
contends that, under this statute, American Family was
required to send payment directly to Marvin's (or any
other providers who obtained an assignment of benefits from
an insured) once Marvin's provided the assignment form to
American Family. The Complaint maintains this statutory
language gives American Family “no
discretion to send payment for benefits to any
party except for the ‘Provider.'” Am. Compl.
¶ 8 (emphasis in original).
Complaint alleges American Family insured three individuals
who received treatment from Marvin's and executed an
assignment of benefits in favor of Marvin's. Marvin's
subsequently provided these assignments to American Family
along with supporting documentation and a bill. American
Family then issued and delivered payment to the insured or
their attorneys, not to Marvin's. The Complaint claims
that by issuing and delivering payment to the insureds,
American Family inflicted “significant financial losses
to Marvin's and other class members” because of
“[n]on-payment for services rendered pursuant to an
assignment of benefits, ” and “[l]oss of time and
expenses in attempting to collect for services
rendered.” Id. ¶ 45.
alleges American Family acted negligently with respect to
Plaintiff and the other class members by: (1) failing to
issue payments in the provider's name pursuant to an
assignment of benefits; and (2) delivering payments directly
to the insured or their attorneys instead of the provider.
Similarly, Count II alleges that American Family committed
negligence per se by: (1) failing to issue payments in the
provider's name pursuant to an assignment of benefits;
and (2) delivering payments directly to the insured or their
attorneys instead of the provider.
III standing requires the plaintiff to have “(1)
suffered an injury in fact, (2) that is fairly traceable to
the challenged conduct of the defendant, and (3) that is
likely to be redressed by a favorable judicial
decision.” Spokeo v. Robins, 136 S.Ct. 1540,
1547 (2016) (citing Lujan v. Defenders of Wildlife,
504 U.S. 555, 560-61 (1992)). To establish an injury in fact,
a plaintiff must have suffered “‘an invasion of a
legally protected interest' that is ‘concrete and
particularized' and ‘actual or imminent, not
conjectural or hypothetical.'” Id. at
1548. “[A] concrete injury is required even in the
context of a statutory violation.” Id. To be
concrete, an “injury must be ‘de facto'; that
is, it must actually exist.” Id. If a litigant
lacks Article III standing, then a federal court lacks
subject-matter jurisdiction over the lawsuit and dismissal is
required. Iowa League of Cities v. EPA, 711 F.3d
844, 869 (8th Cir. 2013).
complaint may also be dismissed if it fails “to state a
claim upon which relief can be granted.” Fed.R.Civ.P.
12(b)(6). To avoid dismissal, a complaint must include
“enough facts to state a claim to relief that is
plausible on its face.” Bell Atlantic Corp. v.
Twombly, 550 U.S. 544, 570 (2007). “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, 556 U.S. 662, 678 (2009). The
Plaintiff need not demonstrate the claim is probable, only
that it is more than just possible. Id. In reviewing