FORT MYERS — The U.S. District Court for the Middle District of Florida Fort Myers Division has rejected a magistrate judge's report and recommended in a case involving a Winn Dixie employee being denied her medical claims after an alcohol related vehicle crash.
According to the July 1 filing, the court reviewed a magistrate judge's report and recommendation from January in which the defendant Winn Dixie Stores Inc.'s motion for summary judgment was granted and plaintiff Lee Memorial Health System's motion to leave to file seconded amended complaint was denied.
The case stems from Blue Cross & Blue Shield of Florida, Winn Dixie's third party claims administrator, denying the medical claims for Shannon Anderson, a Winn Dixie employee. In 2013 Anderson sustained injuries in a car crash and was admitted to Lee Memorial. When Lee Memorial submitted claims to Blue Cross & Blue Shield on behalf of Anderson, the insurance carrier denied them because Anderson's injuries "were the result of the member's alcohol intoxication."
Lee Memorial then filed suit against Blue Cross & Blue Shield and Winn Dixie, alleging Winn Dixie "improperly denied" Anderson's health care benefit claims and that Blue Cross & Blue Shield misconstrued the Employee Retirement Income Security Act (ERISA) provision in Winn Dixie's health benefits plan. The hospital also seeks damages from Winn Dixie for Blue Cross & Blue Shield's non-payments of Anderson's claims. Lee Memorial also argues that Winn Dixie violated ERISA and breached the terms of its employee health plan.
Blue Cross was dropped from the suit after winning a dismissal for lack of standing in March 2018, followed by Winn Dixie's move for judgment on the pleadings with the case being referred to the magistrate judge.
One main issue in the case is an admissions contract that included an assignment of benefits waiver that Anderson signed while being admitted to Lee Memorial allowing the hospital to receive payments under her health insurance plan.
Senior U.S. District Judge John Steele rejected the magistrate judge's findings and stated "Lee Memorial’s assertion of derivative standing based on Anderson’s assignment, establish that the second amended complaint states a claim to relief that is plausible on its face."
The court granted Lee Memorial's leave to amend and denied Winn Dixie's motion for summary judgment as moot.