Ana Alpizar-Fallas v. Frank Favero
Opinion
Ana Lidia Alpizar-Fallas brought a class action claim against Progressive Garden State Insurance Company ("Progressive") and one of its agents, Bryan Barbosa, alleging that Progressive and Barbosa's deceptive business practices violated New Jersey's Consumer Fraud Act ("CFA"). The District Court dismissed her claim, characterizing it as a denial of insurance benefits, which the New Jersey appellate courts have ruled is not covered by the CFA. Because we view Alpizar-Fallas's complaint as alleging deception that would be covered by the CFA rather than a denial of benefits, we disagree and will vacate and remand.
I.
A. 1
This case began with an all too common occurrence: a car accident. Frank Favero's car struck that of Alpizar-Fallas, causing *913 Alpizar-Fallas "serious injuries and damages," including substantial pain and suffering, expenses for medical bills, and diminished earning capacity. A. 4-5. At the time of the accident, both Alpizar-Fallas and Favero were insured by Progressive.
The morning following the accident, Barbosa, a Progressive claims adjuster, contacted Alpizar-Fallas by phone. He represented that he was a Progressive agent and asked if he could come to her home to inspect the damage to her car and have her sign "paperwork" that would "expedite the processing of the property damage claim." A. 2, 6. Barbosa arrived about an hour later with multiple documents for Alpizar-Fallas to sign. She alleged in her complaint that he told her that her accident "had a questionable issue of liability" and that her signature was "necessary" for Progressive to advance the payment of her claim. A. 6. Barbosa presented a document to Alpizar-Fallas that he "required" her to sign and that he "expressly represented would expedite the property damage claim of the accident." Id. In reliance on Barbosa's statements, Alpizar-Fallas signed the document.
Contrary to Barbosa's assertions, the document was, in fact, "a broadly written comprehensive general release of any and all claims," including claims against Favero for "any and all known and unknown personal injuries resulting from the motor vehicle accident." A. 7. Alpizar-Fallas was unaware of the legal significance of the release language in the document, and Barbosa failed to alert her to it. Barbosa also failed to advise Alpizar-Fallas to seek legal counsel and did not communicate with her in Spanish, her native language. Furthermore, he required that Alpizar-Fallas "sign the release in his presence at her home." Id.
B.
Alpizar-Fallas commenced this action in New Jersey state court against Favero,
2
seeking damages for the personal injuries she sustained in the accident. She amended her complaint to include a class action claim against Progressive and Barbosa under the New Jersey Unfair Claims Settlement Practices Regulations ("UCSPR"),
Once in federal court, Progressive and Barbosa (collectively, "Appellees") moved to dismiss Alpizar-Fallas's class action claim for failure to state a claim. They lodged several arguments: the UCSPR does not provide a private right of action, the UCSPR precludes application of the CFA, the CFA does not apply to schemes to defraud policyholders of their benefits and personal injury claims, and Alpizar-Fallas failed to properly plead a claim for relief under the CFA. Specifically, with respect to their final argument, Appellees contended that Alpizar-Fallas did not meet the heightened pleading standard of Federal Rule of Civil Procedure 9(b), did not plead an "ascertainable loss" as required by the CFA, and did not allege a violation of the CFA because Appellees were acting pursuant to Favero's insurance policy, not her policy, when Barbosa visited Alpizar-Fallas's residence.
C.
The District Court granted Appellees' motion without prejudice in an order and letter opinion. The District Court first dismissed
*914
Alpizar-Fallas's class action claim to the extent it alleged a violation of the UCSPR because that set of regulations does not provide a private right of action. Next, the District Court dismissed Alpizar-Fallas's CFA claim, construing the CFA to only apply to the "sale or marketing" of insurance policies. A. 40. Although the District Court referred to our opinion in
Weiss v. First Unum Life Insurance Co.
,
Thereafter, the District Court, upon Alpizar-Fallas's motion and the agreement of the other parties, entered a consent order, amending its dismissal to one with prejudice and remanding the remaining personal injury claims to New Jersey state court. Alpizar-Fallas filed this timely appeal.
II.
The District Court had jurisdiction pursuant to
III.
On appeal, Alpizar-Fallas contends that the District Court erred in dismissing her CFA claim because the allegations of her complaint set forth the type of harm that the CFA is designed to remedy. 3 In opposition, Appellees argue that her CFA claim is precluded by the UCSPR, that her allegations are not within the scope of the CFA, and that her pleading fails to conform to the requirements of the CFA and Federal Rule of Civil Procedure 9(b).
A.
In determining the extent to which the CFA applies to the performance of insurance contracts, we must predict how the New Jersey Supreme Court would rule if faced with the issue.
Covington v. Continental Gen. Tire, Inc.
,
*915 decisions of state intermediate appellate courts, of federal courts interpreting that state's law, and of other state supreme courts that have addressed the issue, as well as to analogous decisions, considered dicta , scholarly works, and any other reliable data tending convincingly to show how the highest court in the state would decide the issue at hand.
Spence v. ESAB Grp., Inc.
,
1.
In relevant part, the CFA prohibits:
[t]he act, use or employment by any person of any unconscionable commercial practice, deception, fraud, false pretense, false promise, misrepresentation , or the knowing, concealment, suppression, or omission of any material fact with intent that others rely upon such concealment, suppression or omission, in connection with the sale or advertisement of any merchandise or real estate, or with the subsequent performance of such person as aforesaid , whether or not any person has in fact been misled, deceived or damaged thereby....
The CFA is intended to "combat the increasingly widespread practice of defrauding the consumer."
Cox v. Sears Roebuck & Co.
,
2.
The New Jersey Supreme Court addressed whether the sale of insurance is covered by the CFA in
Lemelledo v. Beneficial Management Corp.
,
In extending the CFA to the sale of insurance, the
Lemelledo
court endorsed a broad application of the statute: "The language of the CFA evinces a clear legislative intent that its provisions be applied broadly in order to accomplish its remedial purpose, namely, to root out consumer fraud."
The court also addressed whether application of the CFA to the sale of insurance "would run counter to our traditional reluctance to impose potentially inconsistent administrative obligations on regulated parties."
We were guided by
Lemelledo
's holding in
Weiss v. First Unum Life Insurance Co.
, where we addressed whether the CFA covered the allegedly fraudulent practice of discontinuing previously authorized benefit payments.
3.
Appellees contend that the UCSPR precludes application of the CFA in this case. Specifically, Appellees argue that the ITPA, the statute pursuant to which the UCSPR regulations were promulgated, creates a "direct and unavoidable conflict" with the CFA because the former does not offer a private right of action while the latter does. Br. for Appellees at 14 (quoting
Lemelledo
,
*917
Moreover, the fact that a private right of action exists under the CFA but not the ITPA does not create a "direct and unavoidable conflict" that would preclude application of the CFA here. The
Lemelledo
court established a presumption that the CFA applies in the face of potential conflicts.
The allowance of a private right of action in conjunction with regulatory action does not amount to "a direct and unavoidable conflict" reproved by
Lemelledo
. First, the New Jersey Supreme Court has explicitly authorized multiple remedies of these types, stating that the allowance of a cause of action for damages in one statute does not "inhibit[ ] enforcement of ... other statutes, because a court can assess damages in addition to any other penalty to which a defendant is subject."
4.
Appellees rely, as did the District Court, on
Myska
for the proposition that the denial of benefits is outside the scope of the CFA.
See
Myska v. N.J. Mfrs. Ins. Co.
,
That case is inapposite. Here, Alpizar-Fallas alleges neither that she filed an insurance claim nor that she was denied any benefits. Instead, the allegations in her complaint fall squarely within the language of the CFA and our holding in *918 Weiss . Specifically, she alleges the following:
• Alpizar-Fallas "relied on the express false representations of the agent and/or employee of her insurance company's claims adjuster-Defendant Barbosa-that the documents he prepared and delivered to her needed to be signed merely to facilitate her receipt of the money for the damages to her motor vehicle;"
• Barbosa "falsely represented the nature of the documents that [she] signed;"
• "The document, prepared by the [Appellees,] was in fact a broadly written comprehensive general release of any and all claims;"
• "Plaintiff reasonably relied on the materially false representations of [Appellees] when she signed the documents since Defendant Barbosa, [sic] represented to [Alpizar-Fallas] that he was an agent of [her] own insurance company, Progressive;"
• "[Appellees] and others at the insurance company have engaged in this same pattern of unlawful conduct with respect to other similarly situated individuals;" and
• "As a result of this deceptive and unconscionable practice, present and former insurance policy holders of Defendant, Progressive[,] have continued to be stripped of their rights to pursue claims against other policy holders of Progressive Garden State Insurance Company due to the [Appellees'] false and misleading representations...." A. 7-8.
These facts, taken together, amount to an allegation of fraud in connection with the subsequent performance of a consumer contract, a situation explicitly covered by the language of the CFA, sanctioned by this Court in Weiss , and supported by the New Jersey Supreme Court's broad statements regarding the application of the CFA. 4
In sum, we predict that the New Jersey Supreme Court would apply the CFA to Alpizar-Fallas's claim, where an insurance company is alleged to have fraudulently performed a contract with a consumer. Accordingly, we conclude that Alpizar-Fallas stated a viable claim under the CFA.
B.
Finally, Appellees argue that Alpizar-Fallas's complaint does not conform to the heightened pleading requirement of Federal Rule of Civil Procedure 9(b) and does not allege an "ascertainable loss" as required by the CFA. We reject both of these arguments.
1.
Federal Rule of Civil Procedure 9(b) requires that "[i]n alleging fraud or
*919
mistake, a party must state with particularity the circumstances constituting fraud or mistake." This has been interpreted to require that plaintiffs "state the circumstances of the alleged fraud with sufficient particularity to place the defendant on notice of the 'precise misconduct with which [it is] charged' " and "plead or allege the date, time and place of the alleged fraud or otherwise inject precision or some measure of substantiation into a fraud allegation."
Frederico v. Home Depot
,
2.
The CFA requires a plaintiff to allege "ascertainable loss."
See
In Alpizar-Fallas's complaint, she alleged that, because of Appellees' conduct, she and other class members were " stripped of their rights to pursue claims against other policy holders of Progressive...." A. 8 (emphasis added). In Alpizar-Fallas's case, this means that she is unable to recover certain losses from her accident with Favero, which are detailed in the beginning of her complaint. Specifically, she has required and will continue to require medical care; has suffered "impairment of her earning capacity and power;" has suffered and will continue to suffer "great pain, suffering agony, mental anguish, embarrassment and humiliation;" has been hindered and will be hindered "from attending to her daily duties, functions and occupation;" and will "continue to incur other financial losses or expenses." A. 4-5. These allegations are sufficient to demonstrate a "loss in value that is quantifiable or measureable." 5
IV.
For the foregoing reasons, we will vacate the District Court's dismissal and remand for further proceedings consistent with this opinion.
On appeal from the grant of a motion to dismiss, the factual allegations set forth below are derived from Alpizar-Fallas's complaint and are accepted as true.
See
Bridge v. Phoenix Bond & Indem. Co.
,
She also named "John Doe 1-5" and "John Doe Incorporated 1-5" as defendants, alleging that they may have caused the accident. A. 2, 4.
She does not appeal the District Court's dismissal of her UCSPA claim.
Appellees also contend that because Barbosa was acting pursuant to
Favero's
policy when he met with Alpizar-Fallas in her home, Alpizar-Fallas is not a consumer protected by the CFA for purposes of this interaction. Because Appellees failed to argue this before the District Court, this argument is waived.
Gass v. Virgin Islands Tel. Corp.
,
Appellees also argue that there were "no damages at all" because Alpizar-Fallas "was paid for her claim against Favero." Br. of Appellees at 19. Because this was not alleged in the complaint, we will not consider it at the motion to dismiss stage.
See
Mayer v. Belichick
,
Reference
- Full Case Name
- Ana Lidia ALPIZAR-FALLAS, Individually and on Behalf of All Others Similarly Situated, Appellant v. Frank E. FAVERO; Brian Barbosa; Progressive Garden State Insurance Company ; John Doe 1-5; John Doe Incorporated 1-5, (Fictitious Designations)
- Cited By
- 140 cases
- Status
- Published