Blue Cross & Blue Shield of Florida, Inc. v. Ming

Appellant, Blue Cross and Blue Shield of Florida, Inc., issued a health and accident policy to Terrance J. Lasek under which the insurer agreed to pay as benefits certain costs of medical care necessitated by the illness of, or injuries to, the insured. Benefits are expressly excluded as to injury resulting from an insured’s participation in a felony and from the insured’s being drunk. Under the claims processing provisions, the policy provides that the insurer:

*772Has sixty (60) days to make a decision on your claim after we receive the claim....

The policy further provides that if the claim is…