BASSETT

IN THE UNITED STATES DISTRICT COURT

FOR THE WESTERN DISTRICT OF PENNSYLVANIA

PITTSBURGH

CRISTEN BASSETT, )

)

Plaintiff, ) 2:26-CV-00664-MJH

)

)

vs. )

)

GOLDEN RULE INSURANCE )

COMPANY, A UNITED HEALTHCARE )

COMPANY; AND UNITED

HEALTHCARE SERVICES, INC.,

Defendants,

OPINION AND ORDER

Plaintiff, Cristen Bassett, brings the within action against Defendants, Golden Rule

Insurance Company, A United Healthcare Company; and United Healthcare Services, Inc.

(“UHS”) for breach of contract (Count I), and statutory bad faith pursuant to 42 Pa.C.S. § 8371

(Count II) regarding her claims for health insurance coverage. (ECF No. 1-4). UHS moves for

dismissal pursuant to Fed. R. Civ. P. 12(b)(6). The matter is now ripe for decision.

Upon consideration of Ms. Bassett’s Complaint (ECF No. 1-4), UHS’s Motion to

Dismiss (ECF No. 13), the respective briefs (ECF Nos. 14 and 17), and for the following

reasons, UHS’s Motion to Dismiss will be denied.

I. Background

Ms. Basssett alleges that, between November 15, 2023, and August 10, 2024, Golden

Rule Insurance Company ("Golden Rule") and UHS insured her on a short-term, limited duration

medical expense certificate. (ECF No. 1-4 at ¶ 6). On February 12, 2024, Ms. Bassett was

diagnosed with metastatic breast cancer. Id. at ¶ 10. Plaintiff received initial treatment for her

breast cancer between February 12-16 of 2024. Id. at ¶ 11. On or about February 23, 2024, Ms.

Bassett began a treatment regimen; however, she could not receive all of the recommended

treatment due to an "insurance delay,” such that her treatment did not begin until May 1, 2024.

Id. at ¶ 12. Ms. Bassett has averred claims for breach of contract and bad faith due to UHS

and Golden Rule’s alleged failure to timely authorize medical care and pay some or all of the

benefits owed to her under the subject policy.

II. Relevant Standard

When reviewing a motion to dismiss pursuant to Federal Rule of Civil Procedure

12(b)(6), the court must “accept all factual allegations as true, construe the complaint in the light

most favorable to the plaintiff, and determine whether, under any reasonable reading of the

complaint, the plaintiff may be entitled to relief.” Eid v. Thompson, 740 F.3d 118, 122 (3d Cir.

2014) (quoting Phillips v. Cty. of Allegheny, 515 F.3d 224, 233 (3d Cir. 2008)). “To survive a

motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a

claim to relief that is plausible on its face.’” Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S. Ct.

1937, 173 L. Ed. 2d 868 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.

Ct. 1955, 167 L. Ed. 2d 929 (2007)).

The Supreme Court clarified that this plausibility standard should not be conflated with a

higher probability standard. Iqbal, 556 U.S. at 678. “A claim has facial plausibility when the

plaintiff pleads factual content that allows the court to draw the reasonable inference that the

defendant is liable for the misconduct alleged.” Iqbal, 556 U.S. at 678 (citing Twombly, 550 U.S.

at 556); see also Thompson v. Real Estate Mortg. Network, 748 F.3d 142, 147 (3d Cir.

2014). “Threadbare recitals of the elements of a cause of action, supported by mere conclusory

statements, do not suffice.” Iqbal, 556 U.S. at 678. “Factual allegations of a complaint must be

enough to raise a right to relief [*5] above the speculative level.” Twombly, 550 U.S. at 555. A

pleading party need not establish the elements of a prima facie case at this stage; the party must

only “put forth allegations that ‘raise a reasonable expectation that discovery will reveal

evidence of the necessary element[s].’” Fowler v. UPMC Shadyside, 578 F.3d 203, 213 (3d Cir.

2009) (quoting Graff v. Subbiah Cardiology Assocs. Ltd., 2008 U.S. Dist. LEXIS 44192, 2008

WL 2312671 (W.D. Pa. June 4, 2008)); see also Connelly v. Lane Constr. Corp., 809 F.3d 780,

790 (3d Cir. 2016).

Nonetheless, a court need not credit bald assertions, unwarranted inferences, or legal

conclusions cast in the form of factual averments. Morse v. Lower Merion Sch. Dist., 132 F.3d

902, 906 n.8 (3d Cir. 1997). The primary question in deciding a motion to dismiss is not whether

the plaintiff will ultimately prevail; but rather, whether he or she is entitled to offer evidence to

establish the facts alleged in the complaint. Maio v. Aetna, 221 F.3d 472, 482 (3d Cir. 2000). The

purpose of a motion to dismiss is to “streamline[] litigation by dispensing with needless

discovery and factfinding.” Neitzke v. Williams, 490 U.S. 319, 326-27, 109 S. Ct. 1827, 104 L.

Ed. 2d 338 (1989).

III. Discussion

UHS argues that Ms. Bassett has a failed a state a claim for breach of contract because

Golden Rule, and not UHS, was the insuring entity on the subject medical expense certificate.

Thus, UHS maintains that it cannot be held liable for breach of contract where a contractual

relationship between Ms. Bassett and UHS does not exist. In the same vein, UHS argues that,

because it is not the insurer, it cannot be held liable for bad faith.

Ms. Bassett contends that UHS’s motion is premature because she has not yet had the

opportunity to develop record evidence of UHS’s status as a de-facto insurer or master of Golden

Rule.

“Clearly one cannot be liable for breach of contract unless one is a party to that

contract.”Lockhart v. Federal Ins. Co., 1998 WL 151019, at *3 (E.D. Pa. Mar. 30, 1998)

(citation omitted). “[A]n action for bad faith under 42 Pa.C.S.A. § 8371 can only be brought

against an ‘insurer.’ ” Brown v. Progressive Ins. Co., 860 A.2d 493, 498 (Pa.Super. 2004). The

determination of who is the insurer for a bad faith claim is a question of fact, “to be determined

both by examining the policy documents themselves, and by considering the actions of the

company involved.” Id. Courts consider two factors: “(1) the extent to which the company was

identified as the insurer on the policy documents; and (2) the extent to which the company acted

as an insurer.” Id.

Here, Ms. Bassett sufficiently alleges a contractual relationship with UHS and that UHS

was the insurer. In particular, her Complaint alleges that “[b]etween November 15, 2023 and

August 10, 2024 Plaintiff was insured by Golden Rule and United Healthcare via short-term,

limited duration health insurance ("Golden Rule Policy") issued to Plaintiff under Policy ID

Number 097077594.” (ECF No. 1-4 at ¶ 6). Ms. Bassett also alleges that Golden Rule is owned

and operated by UHS and that UHS administered the insurance policy purchased by Plaintiff. Id.

at ¶¶ 2-3. At this stage, such averments sufficiently allege a contractual relationship and UHS’s

status as an insurer. Therefore, the Court concurs that UHS’s motion is premature.

Accordingly, UHS’s Motion to Dismiss will be denied.

IV. Conclusion and Order

For the reasons stated, UHS’s Motion to Dismiss is denied. UHS shall file its answer on

or before August 10, 2026.

DATED this 27th day of July, 2026.

BY THE COURT:

United States District Judge