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TALLEY v. BLUE CROSS BLUE SHIELD OF LOUISIANA

No. 99-1974.

760 So.2d 1193 (2000)

Calvin J. TALLEY and Mary B. Talley v. BLUE CROSS BLUE SHIELD OF LOUISIANA.

Court of Appeal of Louisiana, Third Circuit.

May 3, 2000.

Attorney(s) appearing for the Case

Paul J. Hebert, Lafayette, Counsel for Defendant-Appellant, Blue Cross Blue Shield of Louisiana.

J. Minos Simon, Bradley D. Watts, Lafayette, Counsel for Plaintiffs-Appellees, Calvin J. Talley and Mary B. Talley.

Before DOUCET, C.J., COOKS and DECUIR, Judges.

DECUIR, Judge.

Calvin and Mary Talley filed suit against Blue Cross/Blue Shield of Louisiana seeking payment of medical benefits, totaling $96,024.02, under a health insurance policy. They also sought penalties and attorney's fees for the arbitrary and capricious failure to pay the claim. Blue Cross denied benefits based on its contention that Mrs. Talley's cancerous tumor found on the spine was in fact metastatic breast disease, a condition specifically excluded...

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