The Case Challenge
The Blue Cross Blue Shield Association (BCBSA) is one of the largest and most recognized healthcare insurance organizations in the United States. BCBSA filed a lawsuit against Sisters of Charity of Leavenworth, a Colorado-based nonprofit and faith-based healthcare provider, alleging that Sisters of Charity infringed on and diluted its federally protected word and design marks.
To support claims of trademark recognition and distinctiveness, BCBSA retained our consumer survey experts to evaluate fame, awareness, and brand association of the BCBSA word and design marks.
The Expert Solution
Our team designed a survey to measure consumer perception regarding 1) the Blue Cross word mark, 2) the solid Blue Cross design mark, and 3) the Blue Cross with Vitruvian Man design mark.
We employed a methodology aligned with established standards for trademark fame and awareness research. The survey tested a combination of known and fictitious marks, ranging from widely recognized national brands to smaller or regional names, alongside the disputed BCBSA marks. The inclusion of fictitious names and logos served as controls to assess baseline recognition and ensure the validity of the results. Survey participants were presented with logo stimuli in two sizes: one resembling large-scale brand uses such as building signage or billboards, and another simulating everyday use cases such as insurance cards, invoices, or patient documents. The dimensions of the images replicated real-world conditions, visibility, and prominence, as explained by BCBSA.
We qualified participants based on age, gender, and geography, and then randomly assigned them to evaluate either the solid Blue Cross design mark or the Vitruvian Man design mark, in either standard or large format. Survey questions contextualized each logo in a plausible healthcare or insurance setting, including “Have you heard of this company or organization before?” and “Which company, if any, do you associate this symbol or name with?” The survey was administered to 3,118 online respondents, drawn from a representative national sample.
The Outcome
The survey analysis revealed that 92.8% of respondents indicated prior awareness of the Blue Cross word mark, with a net recognition of 86.1% after subtracting the control measure. For the standard-size solid Blue Cross design, 70.1% recognized the mark (net measure 64.6%), and 83.1% associated it with BCBSA. The standard Vitruvian Man design was recognized by 67.4% of respondents (net measure 60.7%), and 83.1% associated it with BCBSA.
Across geographic regions tested, more than 56% of respondents recognized the disputed marks, and over 76% associated them with the Blue Cross Blue Shield Association. The US District Court accepted these survey findings as reliable evidence of national and regional consumer recognition of BCBSA’s trademarks. The findings contributed to the court’s assessment of the fame and distinctiveness of the marks at issue—critical components in evaluating claims of trademark dilution and infringement.
Expert Survey Evidence for Trademark Litigation
When recognition of and associations with a mark are at the core of your case, reliable survey evidence provides a strategic advantage. IMS Legal Strategies’ survey experts bring methodological rigor and litigation-tested experience to every case. Our surveys have supported outcomes in federal court, arbitration, and regulatory disputes.
To explore how our trademark and IP survey services can support your strategy, reach out to contactus@imslegal.com.
This case study represents work conducted by MMR Strategy Group, which joined IMS in May 2025 to form our dedicated Litigation Surveys & Consumer Science division. Learn more about trademark
