Therese Johnson and David Johnson, Her Husband v. District 2 Marine Engineers Beneficial Association--Associated Maritime Officers, Medical Plan

As a result of David Johnson’s employment, he and his wife Therese (collectively “Johnsons”) became members of the District 2 Marine Engineers Beneficial Association — Associated Maritime Officers, Medical Plan (“Plan”). As members of the Plan, they were entitled to certain costs incurred in applicable medical treatment. The Plan is an employee benefits plan, which consists of a “Fund” jointly administered by a board of trustees of multiple employer and union representatives, and is governed by ERISA. 29 U.S.C. § 1001 , et seq. (1982).

In 1985, Therese Johnson was diagnosed as having biliary cirrhosis. The only medical means available to ensure her survival was a liver transplant. In order to obtain the transplant, the hospital required Johnson to show that either she or her medical insurance could cover at least 80% of the estimated cost of the transplant. Upon her application to provide coverage, the Plan denied the payment of benefits on the ground that a liver transplant was “experimental surgery” and that such procedures were excluded from coverage. Later, the trustees amended the Plan to exclude transplant procedures, specifically liver transplants, from coverage as…