Fuja v. Benefit Trust Life Insurance Company
United States Court of Appeals for the Seventh Circuit
18 F.3d 1405 (1994)
Grace Fuja (plaintiff), whose breast cancer had spread to both lungs after earlier treatment, was prescribed an experimental HDC/ABMT regimen (high-dose chemotherapy with bone marrow removal and reinfusion) once standard chemotherapy stopped helping; the treatment had shown some effectiveness for certain cancers but was not universally accepted. Benefit Trust Life Insurance (defendant) refused to cover it, citing a policy exclusion for treatment "furnished in connection with medical or other research." Fuja sued to force coverage, and after a hearing the district court, finding the exclusion clause ambiguous, ordered Benefit Trust to pay; Fuja underwent the treatment but died before it succeeded, and Benefit Trust appealed.
Whether a clause in an insurance contract excluding coverage for treatment furnished in connection with medical or other research is ambiguous.