A Court Will Never Accept Legal Conclusions in a Suit
Post 5115
A Contract Cannot Legally Bind A Person Or Entity Which Is Not A Party To The Contract.
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The plaintiff, Nataly Gasova, claimed a breach of contract related to an insurance policy which IISS sold to her. IISS moved to dismiss the complaint, arguing inter alia that there was no contract between these parties. Gasova moved to amend her complaint to abandon her breach of contract claim and instead bring claims related to the advertising and sale of the insurance policy.
In Nataly V. Gasova v. Intact Insurance Specialty Solutions, Civ. No. 1:24-CV-2279, United States District Court, M.D. Pennsylvania (June 26, 2025) Intact Insurance Specialty Solutions (“IISS”) moved the court to dismiss the suit.
Background
On November 4, 2023, Gasova was involved in an automobile accident while working as a rideshare driver. Gasova sued IISS, Uber Technologies Inc., and Farmers Insurance Exchange, alleging all three defendants were liable for a failure to make payments due to Gasova under the policy IISS sold to her, as well as alleging fraud. Gasova amended her complaint, dismissed Uber and Farmers, naming IISS as the sole defendant and alleging breach of contract.
On December 4, 2024, the parties entered into a settlement agreement wherein Gasova released all claims against IISS related to the car accident underlying this case. On December 31, 2024, IISS removed the case to federal court, claiming diversity jurisdiction pursuant to 28 U.S.C. § 1332(a). On January 7, 2025, IISS moved to dismiss the complaint for failure to state a claim arguing, inter alia, that the release foreclosed Gasova’s pursuit of her claims in the second amended complaint and that the complaint failed to state a claim as it did not establish there was a breach of contract.
DISCUSSION
Motion to Dismiss – Standard of Review
A court is not required to accept legal conclusions or a formulaic recitation of the elements of a cause of action. Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice. A complaint has to show an entitlement with its facts. Where the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint has alleged-but it has not shown that the pleader is entitled to relief.
The Motion to Dismiss Will be Granted.
It is axiomatic that a contract cannot legally bind a person or entity which is not a party to the contract. Because Gasova has not alleged facts showing there was a contract between the parties, the USDC concluded she has failed to state a claim.
Gasova’s theory of liability relies primarily on IISS’s inaction, alleging that IISS failed to inform her about certain elements of the policy, which is inadequate to establish a viable cause of action.
The USDC concluded there is no contract between these parties, and that permitting Gasova’s desired amendment would be futile. Therefore, IISS’s motion to dismiss was granted and it denied Gasova’s motion to amend.
ZALMA OPINION
Some people wrongly believe that it is easy to sue an insurance company and become wealthy from the attempt. This case establishes that the belief if unfounded. Insurers fight back and refuse to pay a suit that fails to state a cause of action sufficient to allow the case to go to trial. Gasova should have stopped when she settled.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Breach of Contract is not a Tort
It Doesn’t Pay to Over Charge a Suit Against an Insurer
Post 5116
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In Kole Westwood and Keeley Westwood v. The Travelers Home And Marine Insurance Company and Aaron Harrigfeld, No. 2:24-cv-00719-JNP-DBP, United States District Court, D. Utah (June 30, 2025) the case against the engineer failed completely and the case against Travelers was limited to the claim that the insurance contract was breached.
CASE BACKGROUND
Plaintiffs Kole and Keeley Westwood are homeowners in Utah whose home was damaged in a severe winter storm. The roof buckled under the weight of snow and ice, causing water damage to the house.
Their insurer, Travelers, denied their claim based on an engineering inspection report prepared by Defendant Aaron Harrigfeld. The Westwoods allege that the report contained false representations about the history ...
Motions in Limine Used to Limit Trial and Expert Testimony
Post 5116
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Trial Judge Must Limit Experts to Testimony that will Aid the Jury
The case brought by Plaintiff Gary Cawley and others against American Financial Security Life Insurance Company and others was before United States District Court for the District of Arizona’s Honorable Steven P. Logan, United States District Judge.
In Gary Cawley, et al. v. American Financial Security Life Insurance Company, et al., No. CV-22-00823-PHX-SPL, United States District Court, D. Arizona (July 2, 2025) Judge Logan resolved dozens of motions in limine filed by the parties.
Motions in Limine
Judge Logan issued orders relating to various motions in limine filed by both Plaintiffs and Defendant recognizing that a motion in limine is a procedural mechanism to limit testimony or evidence in a particular area and the practice has developed ...
Statutory Penalties Must be Based on Evidence
Without Sufficient Evidence Penalty Assessment was Wrongful
Post 5114
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When an appeal involved issues concerning the statutory penalties that apply to an insurer who knowingly or arbitrarily fails to pay a settlement to a third-party claimant within 30 days after a settlement agreement is reduced to writing The plaintiff, James Bridges, Sr., settled his claims arising from an automobile accident for $450,000. The trial court found that the settlement amount was not paid timely and applied La. R.S. 22:1892 to the penalty claim, imposing a penalty of $225,000 on one of the insurance company defendants. The insurers appealed.
In James Bridges, SS. v. Chubb Indemnity Insurance Company, Ace American Insurance Company, Southeast Louisiana Flood Protection Authority-East, East Jefferson Levee District, Deidrick Green, And Government Employees ...
ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional
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Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:
Health Care Fraud Trial Results in Murder for Hire of Witness
To Avoid Conviction for Insurance Fraud Defendants Murder Witness
In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...
Professional Health Care Services Exclusion Effective
Post 5073
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This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.
In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:
Insurance Coverage Dispute:
Travelers issued a Commercial General Liability ...
A Heads I Win, Tails You Lose Story
Post 5062
Posted on April 30, 2025 by Barry Zalma
"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime."
Immigrant Criminals Attempt to Profit From Insurance Fraud
People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.
The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...
