Fuja v. Benefit Trust Life Insurance Company

18 F.3d 1405 (1994)

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Fuja v. Benefit Trust Life Insurance Company

United States Court of Appeals for the Seventh Circuit
18 F.3d 1405 (1994)

  • Written by Genan Zilkha, JD

Facts

In August 1989, Grace Fuja (plaintiff) was diagnosed with breast cancer. Fuja underwent a lumpectomy, a modified radical mastectomy, and then six months of chemotherapy treatment. Although Fuja’s breast cancer went into remission, in February 1992, her oncologist discovered that the cancer had spread to both of her lungs. Fuja received standard chemotherapy from February until December 1992. Fuja’s doctor then determined that chemotherapy would not increase her chance of survival. As a result, Fuja’s doctor prescribed a regimen of HDC/ABMT, which was a treatment that involved removing and freezing a patient’s bone marrow, subjecting the patient to high-dose chemotherapy, and then reinfusing the patient’s bone marrow. HDC/ABMT had been proven effective in treating certain types of cancers, but it was not universally accepted. Benefit Trust Life Insurance Company (Benefit Trust) (defendant) refused to cover HDC/ABMT, because Benefit Trust claimed, HDC/ABMT was not medically necessary under the insurance contract. Benefit Trust claimed that this was, in part, because HDC/ABMT was “furnished in connection with medical or other research.” Fuja sued Benefit Trust to enjoin Benefit Trust from denying coverage. After a hearing, the court ordered Benefit Trust to pay for Fuja’s HDC/ABMT treatment. Fuja underwent the treatment, but the treatment was unsuccessful, and Fuja died in April 1993. Benefit Trust appealed.

Rule of Law

Issue

Holding and Reasoning (Coffey, J.)

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