Kilar

Kilar v. Blue Cross Blue Shield Ass'n, "BCBSA"

Good Law
195 F. App'x 547
United States Court of Appeals for the Ninth CircuitJuly 24, 2006No. 05-15053; D.C. No. CV-03-00420-SOM/BMKCalifornia695 words

Opinion

Lead Opinion

MEMORANDUM *

Jo Ann Kilar appeals the district court’s grant of summary judgment in this ERISA action arising out of Hawaii Medical Services Association’s (HMSA) refusal to pay for lung volume reduction surgery to treat Kilar’s emphysema. We have jurisdiction over the district court’s final judgment. See 28 U.S.C. § 1291 . We review de novo the grant of summary judgment, and we affirm. See Boise Cascade Corp. v. United States, 329 F.3d 751, 754 (9th Cir.2003).

HMSA did not act arbitrarily or capriciously 1 when it denied coverage for lung volume reduction surgery because it was an experimental procedure that the policy excluded. See Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 370 F.3d 869, 874-75 (9th Cir.2004) (stating that a discretionary determination is an abuse of discretion “only when it is arbitrary and capricious”). The plan excluded “experimental or investigative” treatments which it defined as procedures *549 that are “the subject of’ phase I, II, or III trials, or “otherwise under study” to determine “its maximum tolerated dose, its toxicity, its safety, its efficacy or its efficacy as compared with a standard means of treatment or diagnosis.” When Kilar…

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