PADI getting sued over Insurance Program

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Nicely done, Laurie. Thanks.

If you have a PACER account for federal court, you can access the actual docket on this case. PACER reflects the following additional, new information:

1. Mr. Lesser was disqualified.
2. Lexington has filed a motion to strike the class action allegations under Rule 12(f)
3. Vicencia and Buckley has filed a motion to dismiss for failure to state a claim upon which relief can be granted.
4. PADI Risk Purchasing Group has filed a motion to dismiss for failure to state a claim upon which relief can be granted.
5. Lexington has filed a motion to dismiss for failure to state a claim upon which relief can be granted.
6. York Risk Services Group has filed a motion to dismiss for failure to state a claim upon which relief can be granted.
7. PADI has filed a motion to dismiss for failure to state a claim upon which relief can be granted.
8. The hearings are all set for May 23, 2011

To summarize the motion by PADI:

PADI challenges the Second Amended Complaint for being based on conclusions rather than on allegations of ultimate fact. It also argues that certain of the claims (fraud, misrepresentation, etc.) require greater specificity than the plaintiff has provided. In conjunction with this it argues that, for example, the plaintiff alleges the contracts with PADI were partly written and partly oral, but the plaintiff does not allege what the written parts were and what the oral parts were or who actually spoke the words that constituted the oral part or what the substance of those words was.

As expected, PADI went after the fact that there are no allegations of any actual damages. There are no allegations that anyone did not get paid for a claimed loss. Also, there are no allegations that comparable coverage was available from any other source at a comparable price (i.e. that anyone paid for a policy that was not as good as what they were getting).

In addition, PADI argues that the case is not suitable for treatment as a class action as the issues are different for different potential class members. For example, PADI notes that if part of the contract was written and part was oral, there is no way to know that the supposed oral part was the same for each insured class member without actual testimony by each purchaser of insurance as to what was or was not said orally. Thus, to the extent different purchasers were told different things, the issues would be different. Also, if there is to be rescission, i.e. PADI has to “unwind” the deal and refund money, then shops that received benefits, either by way of having claims for losses paid or being indemnified for their liabilities, would have to return the payments and benefits they received … and the particular plaintiff cannot speak for all of these.

Among other arguments, PADI argued that although the plaintiff alleges PADI collected millions of dollars in premiums, there is no allegation plaintiff or any other insured actually sent premiums to PADI.

PADI attaches policies that it says shows the argument about the $300,000 deductible makes PADI an insurer is “bogus.” It says that the policies themselves show there is no SIR or deductible in any of the liability policies. It says that the policies themselves show that the PD deductible of $300,000 is an aggregate, not a “per occurrence” deductible. It further says there is no deductible at all for the 2010 - 2011 policies.

I have not read the motions by the other defendants, but I’m guessing they are similar.

I’ll try to post when I see the opposition.
 
I still think that all that, while interesting, is a sideshow. The real question will be what the California Insurance Commissioner's office does.
 
Agreed. I don't think they will address this issue until (and if) the action survives the motion to dismiss. Private civil suits usually only work if someone has lost money and wants to recover actual losses. I think California state insurance regulators and insurance regulators in any other states where PADI provided coverage will need to investigate and, if appropriate, sanction and fine PADI. Also, I believe one of the motions or responses said that Kuaui Scuba had been paid $88,000 by PADI (or York) in connection with a fire damages under the property insurance policy provided by PADI. If the insurance contracts are rescinded (what the plaintiffs are requesting for damages) they get their premiums back but would need to return any payout under the insurance policy. Economically, I'm not sure I understand what Kuaui stands to win by bring this action. Suits like this are good for law firms but I don't think they are helpful or supportive to local dive shops or people who enjoying diving, like me.
 
I think California state insurance regulators and insurance regulators in any other states where PADI provided coverage will need to investigate and, if appropriate, sanction and fine PADI. If the insurance contracts are rescinded (what the plaintiffs are requesting for damages) they get their premiums back but would need to return any payout under the insurance policy.

So let me get this straight ...

If Acme Dive Company had insurance through PADI and suffered losses which PADI (or whoever) paid out on ... beit a fire, a theft, a diver death, bad air mix, or whatever ...

AND the "insurance contracts" are rescinded so that all the dive shops, including Acme Dive Company, receive their paid premiums back but have to give back the payouts from their "insurance" company ...

it just seems to me that Acme Dive Company would have a legitmate right to sue for damages because they relied on their "insurance company" to protect them .. PLUS possibly sue for fraud, misrepresentation, unjust enrichment ... ???

And what about those "plaintiffs" who were injured and received a payout from the insurance company because of a death or dismemberment ???

Do you REALLY think that THEY are going to be giving up their "payout"?


:shocked2:
 
Who said anything about claims dispersments being recalled?

Originally Posted by krbnlaw
I think California state insurance regulators and insurance regulators in any other states where PADI provided coverage will need to investigate and, if appropriate, sanction and fine PADI. If the insurance contracts are rescinded (what the plaintiffs are requesting for damages) they get their premiums back but would need to return any payout under the insurance policy.


Does not mean it's true ... but this is where it came from.

So ....

I suppose that, under this "theory", that if someone broke into my house and held a gun that I "thought" was loaded to my head and I gave him/her what was asked for ...

and later on this person was apprehended but said, "The gun was NOT loaded ... he only thought it was (because I told him so) ... and since I am going to give him back his money and all is well and I won't be going to jail for 15-20 years for armed robbery, right?"

<Side Bar : Afer all, an unloaded gun is nothing more than a VERY expensive hammer".>

Meanwhile, I suffer a stroke from the fear that has been perpetrated upon me, and I am not able to work for the rest of my life ... and I drool just a little bit.

No harm ... no foul? Did I NOT suffer injury anyway?

:idk:
 
The first claim for relief in the plaintiff's amended complaint seeks an order rescinding the policies that the plaintiff claims PADI issued. That means the plaintiff is asking the court to "unwind" the policies, as if they were never made. When that happens, everyone who paid for a policy gets his, hers or its money back and must return the policy. Anyone who got benefits under the policy must return those because it is as if there had been no policy ... because in the eyes of the law, there was no policy.

In most insurance cases, it is the insurance company asking the court to rescind a policy. It usually happens when there is a loss and in the process of investigating the loss, the insurer discovers that the insured lied in the application. It says that if it had known the truth, it would never have issued the policy. It must refund the insured's premiums, but since there is no policy, it need not pay the claim.

It is rare that an insured will ask the court to rescind a policy, but if the insured can prove all of the elements, there is no good reason why a court could not rescind on the plaintiff's behalf.

If the plaintiff wins on the first claim for relief, PADI will have to refund the premiums it received to each and every shop that is a member of the class of plaintiffs in the class action. That will mean a big hit to PADI. It will mean that each shop gets its premium payment back. It will mean that the lawyers get a huge sum of money for having gotten the premiums back. And everyone is happy ... except for those shops that had losses and received payment. They will have to return whatever benefits they got. They can, of course, opt out of the class, but then they won't get their money back or otherwise be a part of the lawsuit. (As the class representative, Kauai Scuba does not have the option of opting out.)

Which all causes us to recall an important principle of law: "Beware of what you ask for; you may get it.)

BTW: Do not cry "how can this be?" or "its not fair!" When you ask for recision and win, that's what you get. If you don't like it, don't ask for it. But don't complain to me.
 
Originally Posted by krbnlaw
I think California state insurance regulators and insurance regulators in any other states where PADI provided coverage will need to investigate and, if appropriate, sanction and fine PADI. If the insurance contracts are rescinded (what the plaintiffs are requesting for damages) they get their premiums back but would need to return any payout under the insurance policy.


Does not mean it's true ... but this is where it came from.

So ....

I suppose that, under this "theory", that if someone broke into my house and held a gun that I "thought" was loaded to my head and I gave him/her what was asked for ...

and later on this person was apprehended but said, "The gun was NOT loaded ... he only thought it was (because I told him so) ... and since I am going to give him back his money and all is well and I won't be going to jail for 15-20 years for armed robbery, right?"

<Side Bar : Afer all, an unloaded gun is nothing more than a VERY expensive hammer".>

Meanwhile, I suffer a stroke from the fear that has been perpetrated upon me, and I am not able to work for the rest of my life ... and I drool just a little bit.

No harm ... no foul? Did I NOT suffer injury anyway?

:idk:

The example is of a crime and of several distinct torts. Restitution is a remedy that a plaintiff can seek with respect to a contract. The defendant has no choice in it. You cannot get orange juice out of an apple.

(BTW: I could say: "You're right, you can recover, stand your ground ... but then we'd both be wrong.)
 
If the plaintiff wins on the first claim for relief, PADI will have to refund the premiums it received to each and every shop that is a member of the class of plaintiffs in the class action. That will mean a big hit to PADI. It will mean that each shop gets its premium payment back. It will mean that the lawyers get a huge sum of money for having gotten the premiums back. And everyone is happy ... except for those shops that had losses and received payment. They will have to return whatever benefits they got. They can, of course, opt out of the class, but then they won't get their money back or otherwise be a part of the lawsuit. (As the class representative, Kauai Scuba does not have the option of opting out.)

Can I assume that those shops will have a legitimate loss and damages due to actions by PADI, and this will open a new can of worms that might devastate PADI?

For some reason I think PADI is being maneuvered and set up for a future case.
 
Can I assume that those shops will have a legitimate loss and damages due to actions by PADI, and this will open a new can of worms that might devastate PADI?

For some reason I think PADI is being maneuvered and set up for a future case.

That is what came to my mind also when I read above that any shops that received payment on any claims would need to return the payment, so those shops would now have losses and damages caused by PADI's actions. I think PRL may have hit the nail right on the head...
 
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