FORT MYERS – A Lee County health care facility alleges an insurer breached terms of a plan when it denied a claim.

Lee Memorial Health System filed a complaint on Sept. 28 in the U.S. District Court for the Middle District of Florida, Fort Myers Division against Blue Cross and Blue Shield of Florida Inc. alleging violation of the Employee Retirement Income Security Act.

According to the complaint, the plaintiff alleges that in October 2013, Lee Memorial Health System provided hospital services to Shannon Anderson after a motor vehicle accident, who was a covered employee under the plaintiff's plan. However, when the plaintiff submitted a claim to defendant for payment of the hospital services of more than $74,000, it denied the claims. 

The plaintiff holds Blue Cross and Blue Shield of Florida Inc. responsible because the defendant allegedly failed to include a copy of the benefit booklet where it based its denial of plaintiff's claim, refused to pay amount due and owing to plaintiff, and failed to provide specific reasons for its determination to deny claims.

The plaintiff seeks judgment in its favor, damages, interest, cost of action and attorney's fees and further relief as the court deems just. It is represented by Joel W. Walters of Walters Levine PA in Sarasota.

U.S. District Court for the Middle District of Florida, Fort Myers Division Case number 2:16-cv-00738

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U.S. District Court for the Middle District of Florida, Fort Myers Division
2110 First Street
Fort Myers, FL 33901

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