Sisia v. State Farm Mut. Auto. Ins. Co.

588 F.Supp.3d 1320

Kimberly K. SISIA, individually and on behalf of others similarly situated, Plaintiff,

v.STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant.

1:21-CV-02376-ELR

United States District Court, N.D. Georgia, Atlanta Division.

Signed January 5, 2022

James L. Ford, Sr., James Lee Ford, P.C., Atlanta, GA, for Plaintiff.

Daniel Francis Diffley, Melissa Guiselle Quintana, Alston & Bird, LLP, Atlanta, GA, for Defendant.

ORDER

Eleanor L. Ross, United States District Judge

Presently before the Court is Defendant State Farm Mutual Automobile Insurance Company's "Motion to Dismiss the Complaint" [Doc. 5] and Plaintiff Kimberly K. Sisia's "Motion for Conditional Class Certification." [Doc. 24]. The Court's reasoning and conclusions are set forth below.

I. Background

This action stems from Defendant's purported breach of its insurance contract (the "Policy") with Plaintiff. See Compl. [Doc. 1]. After an alleged car accident on May 19, 2009, Plaintiff submitted a claim to Defendant for medical expenses related to chiropractic treatment and physical therapy. See id. ¶¶ 4, 16–17. Defendant issued only a partial payment on Plaintiff's insurance claim because it determined that certain medical expenses incurred by Plaintiff were not "reasonable medical expenses" pursuant to the medical payment coverage provision of the Policy—leaving Plaintiff with a deficit of $8,047.00 in submitted claims. See id. ¶¶ 5, 21; [see also Doc. 5-2 ¶ 8]. In sum, Plaintiff alleges that Defendant breached the Policy by "deny[ing] contractual medical payments insurance coverage for payment of medical expenses incurred by its insureds" in violation of the Policy's "ambiguous" medical payments coverage provisions. See id. ¶ 2. As further context for the analysis herein, the Court provides the following factual and procedural history.

A. State Court Proceedings

On May 14, 2012, Plaintiff filed a complaint in the State Court of Cobb County, Georgia (or the "state court"), and brought a claim for breach of the Policy (the "medical expenses" claim) based on Defendant's alleged failure to pay the full medical [damages/expenses] to which she was entitled pursuant to the Policy. (the "Sisia I" case). [See Docs. 5-5, 5-6]. The medical expenses claim sought recovery for "the amount of her medical expenses ... plus interest on that amount at the legal rate."¹ [See Doc. 5-3 ¶ 10]. Thereafter, in October 2013, Plaintiff amended her state court complaint to include two (2) new counts: (1) a claim for breach of contract on the asserted basis that Defendant's "medical payments policy ... is illusory" (the "illusory provisions" claim); and (2) a claim for attorney's fees and litigation expenses. [See Doc. 5-6 at 3]. Additionally, within the amended state court complaint, Plaintiff alleged that she also sought relief on behalf of a putative class of similarly situated individuals. [See Doc. 5-4 ¶¶ 23–35]. On November 1, 2013, Defendant filed a motion for summary judgment. [See Doc. 5-5 at 2]. Thereafter, on January 6, 2014, Defendant moved to dismiss Plaintiff's amended state court complaint. [See id. at 6].

Upon review, state court Judge Maria B. Golick considered Plaintiff's claims from both the original and amended state court complaints together. [See Doc. 5-4 at 2]. Thus, by an order dated August 28, 2014 (the "Sisia I Order"), Judge Golick addressed Defendant's dispositive motions as to three (3) claims: (1) the medical expenses claim; (2) the illusory provisions claim; and (3) attorney's fees and litigation expenses. [See id. ]

By the Sisia I Order, Judge Golick denied Defendant's motion for summary judgment on Plaintiff's medical expenses claim related to non-payment of her medical expenses, rejecting Defendant's argument that Plaintiff could not recover for breach of contract because the injuries for which Plaintiff sought recovery were caused by a prior automobile accident. [See id. ] Contrary to Defendant's assertion, Judge Golick found that "Plaintiff would not necessarily be precluded from seeking recovery for medical expenses" because Georgia law and the Policy at issue "does not exclude medical expenses for bodily injury caused by the aggravation of a previous injury." [See id. ] However, as to all Counts in the amended complaint, Judge Golick granted Defendant's dispositive motions. [See id. at 4–5] (granting Defendant's motion to dismiss, and, "in the alternative," motion for summary judgment).

Thereafter, the case remained pending for more than two (2) years in the state court. [See Doc. 5-5 at 6–9]. On March 28, 2017, Plaintiff filed a motion for reconsideration of the Sisia I Order and moved for summary judgment on the medical expenses claim. [See Docs. 11 at 7; 5-6 at 5]. However, on February 10, 2021—before Judge Golick ruled on Plaintiff's motions—Plaintiff voluntarily dismissed her state court action without prejudice and stated she "reserv[ed] the right to renew the action in a court of proper jurisdiction[ ] within six (6) months from the date of dismissal[ ]" pursuant to O.C.G.A. § 9-11-41. [See Docs. 5-7 at 23; 5-5 at 7–9].

B. Procedural History

After voluntarily dismissing the Sisia I action, Plaintiff filed a Class Action Complaint in this Court on June 9, 2021, alleging three (3) state law claims against Defendant, all of which stem from Defendant's denial of Plaintiff's medical expenses insurance claim: (1) breach of contract, (2) breach of private duty, and (3) breach of the duty of good faith and fair dealing (the "GFFD" claim). See generally Compl. The crux of Plaintiff's Class Action Complaint posits that "State Farm took advantage of ambiguous Policy terms to deny medical payments coverage to Plaintiff" and others similarly situated. See id. ¶ 3. Specifically, Plaintiff contends that "[t]he controlling issue is one of law—whether the term ‘reasonable medical expenses’ is ambiguous, and thus must be construed strictly against [Defendant] and in favor of coverage[.]" See id. ¶ 2.

Thereafter, on August 9, 2021, Defendant filed a 12(b)(6) motion to dismiss. [See Doc. 5]. On August 23, 2021, Plaintiff moved for an extension of time to respond to Defendant's motion to dismiss through September 6, 2021, which the Court granted. [See Docs. 9, 10]. On September 3, 2021, Plaintiff filed a response to Defendant's motion to dismiss, to which Defendant timely replied on September 17, 2021. [See Docs. 11, 15]. Having been fully briefed, Defendant's motion is now ripe for the Court's review.

II. Defendant's Motion to Dismiss [Doc. 5]

By its motion, Defendant argues that Plaintiff's Complaint is due to be dismissed for two (2) reasons: first, because it is barred by the doctrine of res judicata , and second, because it is barred by the relevant statute of limitations. [See Docs. 5-1 at 8–14]. The Court address each argument in turn.

A. Res Judicata

First, the Court considers the impact of the doctrine of res judicata to the matter at bar. In support of dismissal, Defendant argues that the state court adjudicated Plaintiff's instant claims on the merits during the Sisia I action, thereby precluding Plaintiff from asserting them again in this action. [See Docs. 5-1 at 1, 8–14; 15 at 2–7]. In opposition, Plaintiff argues that Judge Golick's Sisia I Order did not resolve her medical expenses claim, and thus, the doctrine of res judicata does not preclude her instant claims. [See Doc. 11 at 9–10].

"The doctrine of res judicata prevents the re-litigation of all claims which have already been adjudicated, or which could have been adjudicated, between identical parties or their privies in identical causes of action." Humphrey v. JP Morgan Chase Bank, N.A., 337 Ga.App. 331, 787 S.E.2d 303, 307 (2016) (internal citations and quotations omitted). When "asked to give res judicata effect to a state court judgment," a district court "must apply the res judicata principles of the law of the state whose decision is set up as a bar to further litigation." See Kizzire v. Baptist Health Sys., 441 F.3d 1306, 1308 (11th Cir. 2006). Accordingly, because Defendant proffers that the Sisia I Order from the State Court of Cobb County, Georgia bars Plaintiff's claims, the res judicata principles of Georgia apply.² See id.

"[A] judgment sought to be used as a basis for the application of the doctrine of res judicata must be a final judgment." Anytime Bonding Co. v. State, 228 Ga.App. 232, 491 S.E.2d 399, 400 (1997). Pursuant to Georgia law, "finality for preclusion purposes may be measured by the same standard as finality for appealability purposes." See Cmty. State Bank v. Strong, 651 F.3d 1241, 1265 (11th Cir. 2011) (internal citations omitted and alterations adopted). Notably, the Georgia Supreme Court has articulated a finer point on the finality and preclusive effect of a judgment that dispenses of fewer than all claims or parties in a suit:

The entry of a judgment as to one or more but fewer than all of the claims or parties is not a final judgment ... and lacks res judicata effect unless the trial court make[s] an express direction for the entry of the final judgment and a determination that no just reason for delaying the finality of the judgment exists.

See Wise v. Ga. State Bd. for Examination, Qualification & Registration of Architects, 244 Ga. 449, 260 S.E.2d 477, 478 (1979) (emphasis added and internal citations omitted); see also Cable Holdings of Battlefield, Inc. v. Cooke, 764 F.2d 1466, 1473 (11th Cir. 1985) (reversing district court where it gave preclusive effect to a judgment that left claims unresolved under comparable federal standard for final judgment); Gresham Park Cmty. Org., 652 F.2d 1227, 1242 n.43 (5th Cir. 1981) overruled on other grounds, Wood v. Orange Cnty., 715 F.2d 1543, 1546 (11th Cir. 1983) (recognizing finality rule pursuant to Georgia law).³

As discussed above, in the Sisia I Order, Judge Golick addressed three (3) claims in the Sisia I Order: (1) the medical expenses claim from the original state court complaint; (2) the...