Moss v. Blue Cross and Blue Shield of Florida, Inc. et al

Filing 19

ORDER denying as Moot 4 Motion to Dismiss; granting 13 Motion to Amend Complaint. The Court will allow Moss fourteen days from the date of this Order to file his amended complaint. Signed by Judge B. Avant Edenfield on 10/30/2013. (loh)

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF GEORGIA
SAVANNAH DIVISION

III. ANALYSIS

MARWIN MOSS,
Plaintiff,
4:13-cv-159

V.

pay the medical bills, contending that
insurance coverage terminated on October
16, 2011. Id. at3,5.

BLUE CROSS AND BLUE SHIELD OF
FLORIDA, INC., et al.,
Defendants.
ORDER
I. INTRODUCTION
Marwin Moss brings this lawsuit
alleging that Blue Cross and Blue Shield of
Florida, Inc. and Blue Cross and Blue Shield
of South Carolina ("Blue Cross") breached a
health insurance contract by failing to pay
the costs of a back surgery. ECF No. 1-3.
Blue Cross moves the Court to dismiss
Moss's claim. ECF No. 4. Moss asks the
Court for leave to file an amended
complaint. ECF No. 13 at 7-8. The Court
GRANTS Moss leave to amend his
complaint and DENIES AS MOOT Blue
Cross's Motion to Dismiss.
H. BACKGROUND
Moss alleges that Blue Cross insured
him under a health policy. ECF No. 1-3 at
2. In anticipation of an expensive back
surgery, Moss requested preauthorization.
Id. Blue Cross authorized the surgery in
writing on October 21, 2011, although the
letter contained several disclaimers and
conditions. Id. at 7-8. Moss had the surgery
on November 9, 2011 and received bills
totaling $61,431.38. Blue Cross refused to

Federal Rule of Civil Procedure 15(a)(2)
states "a party may amend its pleading
with. . . the court's leave.. . when justice
so requires." Moss argues that permitting
him to do so here will allow the case to be
decided on its merits. ECF No. 13 at 8
(citing In re Clarus Corp. Sec. Litig., No.
100CV2841, 2003 WL 23325303, at *1
(N.D. Ga. Nov. 19, 2003)). Because the
Court favors resolution of cases on their
merits, and because amendment will cause
no undue prejudice to Blue Cross, the Court
offers Moss the chance to replead his case
under ERISA. See Laurie v. Ala. Court of
Appeals, 256 F.3d 1266, 1274 (11th Cir.
2001) ("The decision whether to grant leave
to amend a complaint is within the sole
discretion of the district court.") Moss may
also use this opportunity to add a defendant.
See ECF No. 13 at 8-9.
The Court makes clear that Moss will be
held to all pleading requirements of ERISA,
including exhaustion of administrative
remedies. See Claxton v. Conn. Gen. Life
Ins. Co., 700 F. Supp. 2d 1322, 1327-28
(S.D. Ga. 2010) (discussing the
administrative exhaustion requirement).
The Court's grant of Moss's motion is not a
waiver for futility of the administrative
exhaustion requirement as proposed by his
response. ECF No. 13 at 5-6.
IV. CONCLUSION
The Court GRANTS Moss's motion to
amend his complaint and gives him 14 days
from the date of the order to do so. The

Court DENIES AS MOOT Blue Cross's
Motion to Dismiss. The Court also
VACATES the Magistrate Judge's order
setting the deadline for any summary
judgment motion. ECF No. 18. The new
deadline will be 45 days from Moss's filing
of any amended complaint.

This

day of October 2013.

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF GEORGIA