Ensey v. Government Employers Insurance Co.
663 F. App'x 172
| 3rd Cir. | 2016Background
- Plaintiff Shannon Ensey sued GEICO alleging multiple claims after she changed her existing auto policy in January 2008 and later received lower UM/UIM limits than she expected.
- Ensey alleged GEICO failed to: inform her of the option to increase UM/UIM limits to match Bodily Injury Liability (BIL) limits; send a buyer’s guide and coverage selection form (CSF) when she increased BIL limits; and that an unlicensed agent processed the January 2008 changes.
- District Court dismissed five claims (CFA, TCCWNA, breach of contract, breach of implied covenant, and a licensing statutory claim) on 12(b)(6) grounds and granted summary judgment to GEICO on Ensey’s remaining statutory-duty/reformation claim.
- The Third Circuit reviews the 12(b)(6) dismissals and the grant of summary judgment de novo and affirms the District Court.
- Court’s key factual/legal findings: (1) Ensey called to modify an existing policy, not to obtain a new policy or renewal; (2) statutory duties to offer UM/UIM matching limits and to provide CSFs/buyer’s guides apply to new policies or renewals, not mere midterm changes; (3) administrative rules exempt clerical office employees from licensing when processing changes to existing policies; (4) GEICO sent renewal materials including a CSF and buyer’s guide before the renewal effective date and otherwise met minimum-statutory requirements, entitling it to statutory immunity.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether GEICO engaged in unlawful practice under NJ Consumer Fraud Act by failing to offer UM/UIM matching limits, not sending buyer’s guide/CSF, and using an unlicensed agent | Ensey: GEICO failed statutory duties (offer matching UM/UIM, send CSF/buyer’s guide, used unlicensed agent) | GEICO: Duties apply to new policies/renewals; midterm policy changes not covered; administrative rules permit clerical processing without license | Held: Dismissed — no unlawful statutory violation alleged; CFA claim fails |
| Whether Ensey pleaded breach of contract | Ensey: Statutory violations amount to contract breach | GEICO: Complaint does not allege breach of any policy term or contractual obligation | Held: Dismissed — plaintiff failed to allege GEICO breached the contract |
| Whether GEICO breached implied covenant of good faith and fair dealing | Ensey: Conduct (not offering matching UM/UIM, using unlicensed agents, not providing CSFs, later denying claims) shows bad faith/inequitable performance | GEICO: Performed its obligations, paid to policy limits, no inequitable conduct alleged | Held: Dismissed — allegations insufficiently particular to show bad faith |
| Whether Ensey is entitled to reformation/summary judgment on statutory-duty claim (failure to offer/inform; failure to provide CSF/buyer’s guide) | Ensey: Statutory breaches require reformation to increase UM/UIM limits to match BIL | GEICO: Met statutory minima, provided CSF/buyer’s guide at renewal, statutory immunity applies absent willful/gross negligence; reformation requires clear, mutual mistake or fraud | Held: Summary judgment for GEICO — no statutory breach warranting reformation; reformation not available given evidence of insured’s notice and lack of mutual mistake |
Key Cases Cited
- Wyndham Worldwide Corp. v. F.T.C., 799 F.3d 236 (3d Cir. 2015) (pleading standards and review principles)
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007) (plaintiff must plead factual content supporting entitlement to relief)
- Santini v. Fuentes, 795 F.3d 410 (3d Cir. 2015) (summary judgment standard and genuine dispute definition)
- Black Horse Lane Assoc., L.P. v. Dow Chem. Corp., 228 F.3d 275 (3d Cir. 2000) (implied covenant of good faith and fair dealing principles)
- Bohus v. Restaurant.com, Inc., 784 F.3d 918 (3d Cir. 2015) (TCCWNA purpose to prohibit illegal terms in consumer contracts)
- Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (1986) (standard for genuine dispute at summary judgment)