Insurer failed to pay for surgery, suit says

Kelly Holleran Jun. 30, 2010, 2:49pm

An Edwardsville man has filed suit against his insurance company, alleging the company refused to pay for his surgery.

Edward Schaeffer claims he purchased a health insurance policy from defendant Assurant Health, which was issued on Nov. 24, 2009. The policy excluded treatment to his left shoulder for bone spurs and any complication thereof, according to the complaint filed June 21 in Madison County Circuit Court.

"Subsequent to policy being issued, Plaintiff was injured in a youth hockey game where he suffered a labial tear and a glenohumeral dislocation with Benkart lesion," the suit states. "That Plaintiff had surgery on 2/1/10 to repair said condition and submitted bills to Defendant. That Plaintiff's injury has nothing to do with bone spurs and bone spurs have caused no complications to his injury or surgery."

However, Assurant denied Schaeffer a payment of $57,655.66 for his surgery, the complaint says.

In addition to the money he says the insurance company owes him, Schaeffer seeks costs and 60 percent of $55,655.66.

Bob L. Perica of The Perica Law Firm in Wood River will be representing him.

Madison County Circuit Court case number: 10-L-650.

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