FORT MYERS — A woman is suing Premera Blue Cross and CTS International Inc., insurer, citing alleged violation of the Employee Retirement Income Security Act (ERISA).
Bonnie A. Brown filed a complaint on Oct. 28, in the U.S. District Court for the Middle District of Florida against the defendants alleging that they breached their duties of good faith and fair dealing.
According to the complaint, the plaintiff alleges that, in June 2014, she had surgery to treat her common hernia. Her medical providers billed the defendants as she was covered by a health insurance plan provided by Premera through her husband's employer, CTS. Subsequently, a year after surgery a substantial bill from her medical providers arrived as there was a problem in her claim for coverage. Apparently, the defendants denied her claim because they theorized that her hernia and surgery was related to a 2012 gastric bypass. When she appealed the denial, she was told that the appeal was untimely, whereas she could not have appealed a denial she had no knowledge of.
The plaintiff holds Premera Blue Cross and CTS International Inc. responsible because the defendants allegedly failed to provide the proper documentation to fully assess the viability of the claim, relied on the opinion of a registered nurse on its decision to deny coverage, and improperly denied plaintiff's claim for health insurance benefits to which she is entitled to under the plan.
The plaintiff requests a trial by jury and seeks judgment against defendants, damages, attorney's fees, costs of action, and other relief as the court deems just. She is represented by Jeffrey L. Greyber of Merlin Law Group PA in West Palm Beach.
U.S. District Court for the Middle District of Florida Case number 16-cv-00801