Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_06-cv-00801/USCOURTS-caed-2_06-cv-00801-7/pdf.json

Parties Involved:
Conseco Senior Health Insurance Company
Defendant
Edythe Kagan
Plaintiff

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28 This matter was determined to be suitable for decision without *

oral argument. L.R. 78-230(h).

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

)

)

EDYTHE KAGAN, ) 2:06-cv-801-GEB-EFB

)

Plaintiff, )

)

v. ) ORDER*

)

CONSECO SENIOR HEALTH INSURANCE )

COMPANY, )

)

Defendant. )

)

Defendant moves to dismiss this case. Plaintiff opposes the

motion.

BACKGROUND

Plaintiff Edythe Kagan (“Plaintiff”) holds an insurance

policy from Defendant Conseco Senior Health Insurance Company

(“Defendant”). (Second Am. Compl. ¶ 5.) On September 30, 2005,

Plaintiff made a claim for home health care benefits under this

policy. (Id. ¶ 11.) Defendant denied Plaintiff’s claim on

February 23, 2006. (Id. ¶ 14.) Based on that denial Plaintiff

Case 2:06-cv-00801-GEB-EFB Document 49 Filed 10/23/06 Page 1 of 2
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brought this action against Defendant alleging breach of contract and

breach of the duty of good faith and fair dealing.

DISCUSSION

Defendant asserts that Plaintiff’s claim is not ripe for

adjudication because Plaintiff has not provided Defendant with the

proof necessary for Defendant to evaluate her claim. (Def.’s Mot. to

Dismiss at 5.) Plaintiff does not dispute that she has not provided

Defendant with the requisite proof, but argues that the “entire basis

of Defendant’s motion is a lie if Defendant won’t agree to agree [sic]

to stay litigation to consider the documentation that would render the

claim ‘ripe’ for controversy.” (Pl.’s Opp’n at 2.) 

“[C]ompliance with the formal [p]roof of [l]oss requirements

is a well established rule of law.” Binkley v. FIA, 1998 U.S. Dist.

LEXIS 18216, at *2-3 (N.D. Cal. Nov. 18, 1998). Plaintiff has “not

presented legal authority supporting the proposition that [her] breach

of contract cause of action is ripe for litigation in the absence of a

denial from [Defendant].” Hillyer v. Allstate Ins. Co., 1995 U.S.

Dist. LEXIS 13504, at *8 (C.D. Cal. Sept. 11, 1995). Since Plaintiff

has not complied with Defendant’s proof of loss requirements her claim

is not ripe for adjudication.

CONCLUSION

Defendant’s Motion to Dismiss is granted. Therefore, this

action is dismissed. 

IT IS SO ORDERED.

Dated: October 20, 2006

 

GARLAND E. BURRELL, JR.

United States District Judge

Case 2:06-cv-00801-GEB-EFB Document 49 Filed 10/23/06 Page 2 of 2