Facts

Todd Kimsey sued Blue Cross Blue Shield of Texas relating to his employee benefits under the Employee Retirment Income Security Act.

PLAINTIFF'S CONTENTIONS:
Kimsey contended that he was an employee of U.S. Jesco International Inc. and was enrolled in Jesco's group insurance plan. He alleged the plan was issued and underwritten by Blue Cross Blue Shield of Texas. In July 2013, Kimsey was diagnosed with large cell lymphoma. He was approved for California State Disability Insurance and deemed totally disabled. He alleged that although his procedures had been pre-authorized, his claims were subsequently denied. He later learned that the Jesco group insurance policy had been cancelled due to Jesco's nonpayment. Jesco did not reimburse Kimsey for the premiums deducted from his paycheck that were not paid to Blue Cross Blue Shield. He sued Blue Cross Blue Shield of Texas for breach of the ERISA, seeking enforcement and clarification of rights, prejudgment and post-judgment interest, and attorney fees and costs.

Result

Defendant agreed to pay the health insurance claim submitted by plaintiff. The court granted Kimsey's motion for attorney fees and ordered Blue Cross Blue Shield of Texas to pay Kimsey $40,920 in attorney fees and $597 in costs, for a total award of $41,517.

Other Information

Health Care Services Corp., a mutual legal reserve company, doing business as Blue Cross and Blue Shield of Texas, answered the complaint. Kimsey, a California resident, was permitted to participate in the Blue Cross of California network. FILING DATE: July 16, 2014.