A Jefferson County woman and her husband have filed suit against Blue Cross Blue Shield of Texas and a claims adjuster, alleging they were wrongfully denied coverage after the woman was diagnosed with colon cancer.
Gloria and Rodney Landry claim they applied for medical insurance coverage on May 7, 2007, and were issued a policy on June 1, 2007, according to a complaint filed Oct. 27 in Jefferson County District Court.
But Blue Cross rescinded the policy on Sept. 4, 2007, "based upon 'supporting medical documentation' that was obtained by her medical doctor stating that 'further testing recommended but not completed prior to the application date would have resulted in the application being denied,'" the suit states.
The Landrys claim the policy was denied after Gloria went to an appointment with Dr. Robert Y. Faseler on June 14, 2007, complaining of abdominal pain and rectal bleeding.
Faseler ordered a colonoscopy on Gloria, and she was diagnosed with colon cancer, according to the complaint.
The company hired Peter Fischer to adjust the claim, the suit states.
After Blue Cross denied the couple coverage, Faseler sent the company a note on Sept. 20, 2007, "stating that on Ms. Landry's initial visit on July 18, 2006, ' the bleeding was resolved with treatment,' and therefore no further testing was needed," the suit states.
Gloria claims she did not misrepresent her condition on her application because she was not diagnosed with colon cancer until after her testing on June 14, 2007.
Gloria and Rodney claim Blue Cross misrepresented the terms of the insurance policy and its benefits.
The company also made false statements, saying it would cover the type of claim Gloria filed, but did not, according to the complaint.
In addition, it did not attempt to make fair and prompt payments on the claims or to provide a reasonable explanation for its cancellation of Gloria's policy, the suit states.
The Landrys claim Blue Cross failed to notify them of its denial of the claim within required time limits and delayed payment longer than allowed under Texas code.
"Blue Cross Blue Shield and Fischer acted unfairly and in bad faith in dealing with Plaintiffs," the suit states. "Blue Cross Blue Shield and Fischer took advantage of Plaintiffs' lack of knowledge, ability, experience, or capacity to a grossly unfair degree."
Gloria and Rodney are seeking actual damages, which include the loss of benefits that should have been paid and mental anguish. They are seeking three times their actual damages.
The couple is also seeking 18 percent per annum of the amount of damages, plus attorney's fees.
In addition, the Landrys are seeking three times their economic damages, which include benefits wrongly held or denied.
They are seeking the amount of Gloria's claim and the benefit of her bargain, plus exemplary damages, prejudgment interest, attorney's fees, court costs and other relief the court deems just.
Mark Sparks of Provost Umphrey Law Firm in Beaumont will be representing the couple.
The case has been assigned to Judge Gary Sanderson, 60th District Court.
Case No. B182-590
Couple sues Blue Cross over denial of cancer claim
ORGANIZATIONS IN THIS STORY