What Do You Mean It's Not Covered: The Court Upholds the Policy's Language

For all these reasons, the appeals court wrote that "to adopt the district court's construction of the term -- in connection with medical or other research -- would contravene the explicit language of the contract." The appeals court also rejected the trial court's concern that "an insurance company might attempt to exploit the exclusion and deny coverage for a treatment whose results were merely being tabulated (as opposed to being collected to assess the very efficacy of the treatment itself) but there is no evidence in this record that Benefit Trust is guilty of exploiting the contract term "in connection with medical research." Having concluded that Fuja failed to satisfy the burden of proof concerning the "in connection with medical or other research," the court didn't have to address Benefit Trust's second point of appeal. Failure to meet any of the five criteria was cause to deny a claim. The court sided with Benefit Trust. Kenneth Fuja asked for a new hearing from the appeals court. His attorney implied that they would ask the U.S. Supreme Court to consider a review. "All cancer treatment is done in connection with research since there's no cure," said Eugene Schoon, Fuja's attorney. "So there's virtually no limit to what insurance companies can do to exclude procedures." The purpose of the procedure performed on Grace Fuja "was primarily, if not exclusively, performed for the purpose of medical research," countered Daniel Engel, an attorney for Benefit Trust. He argued that the insurance company "pays 99 percent of every claim that comes in. [The policy language is designed] so policyholders don't have to pay for unproven medical treatment."