KENNETH RAY McELROY et al.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY et al.
Session January 15, 2019
from the Circuit Court for Hamilton County No. 15C1479 Ward
Jeffrey Hollingsworth, Judge
insured sued for breach of contract after his insurance
company denied payment for a surgical procedure. The
insurance company moved for summary judgment, arguing that
the insured could not establish a breach of contract because
the procedure was excluded from coverage in the medical
benefits plan. The trial court granted summary judgment to
the insurance company and dismissed the complaint. Because
the insurance company was entitled to a judgment of dismissal
as a matter of law based on the undisputed facts, we affirm.
R. App. P. 3 Appeal as of Right; Judgment of the Circuit
T. Jones, Cleveland, Tennessee, for the appellants, Kenneth
Ray McElroy and Janet McElroy.
Scott Bennett and Mary C. DeCamp, Chattanooga, Tennessee, for
the appellees, Connecticut General Life Insurance Company
d/b/a Cigna Healthcare, Inc. and John Does.
Neal McBrayer, J., delivered the opinion of the court, in
which Charles D. Susano, Jr. and Thomas R. Frierson II, JJ.,
NEAL McBRAYER, JUDGE
18, 2013, Kenneth Ray McElroy had a 50-pound growth removed
from his abdominal region. Mr. McElroy was covered by a
medical benefits plan provided by the Hamilton County
Department of Education. After his surgeon's claim for
payment was denied, Mr. McElroy and his wife filed suit
against Connecticut General Life Insurance Company
("Cigna"), the third-party administrator of the
plan, and others in the Circuit Court for Hamilton County,
Tennessee, seeking damages for breach of contract and various
to the complaint, Mr. McElroy's lower abdomen began to
swell after he began a new diabetes treatment in 2006. By
2012, the growth weighed approximately fifty pounds and
extended to his knees. The excess weight adversely impacted
his back and lower extremities. He also developed skin
infections in the affected area. Antibiotic treatments
provided only temporary relief. Recurrent infections led to
multiple areas of dead tissue. Due to his physical condition,
he was unable to work or enjoy time with family.
physicians recommended surgical removal of the excess growth.
But Cigna refused several preauthorization requests for the
recommended procedure. Cigna maintained that the medical
benefits plan excluded payment for a panniculectomy, the
medical term for the requested procedure. So his physicians
continued to treat him with antibiotics, albeit with limited
2013, his physicians reconsidered surgical options. Dr.
Vincente Mejia determined that a panniculectomy was necessary
to treat his recurrent infections. Dr. Mejia described a
panniculectomy as the "removal of a large amount of the
pannus, which is basically . . . [o]vergrowth of the skin and
subcutaneous tissues in the lower abdomen." On June 18,
2013, Dr. ...