Facts

Kathleen Levasseur suffered from complex regional pain syndrome, also known as reflex sympathetic dystrophy, after undergoing spine surgery. In 2011, she asked Dr. Edward Carden for treatment of the condition. Dr. Carden treated the pain associated with the disease by giving her ketamine infusions. Later, Levasseur sought coverage from the Los Angeles Country Fire Fighters Local 1014 Health and Welfare Plan in order cover the costs of the infusions, but the claim was denied on the basis that the infusions were an experimental drug. Levasseur appealed, arguing that the Food & Drug Administration had approved the infusions. However, the claim was denied once again. Consequently, Levasseur filed suit against the Plan.

PLAINTIFF'S CONTENTIONS:
Plaintiff sought to require defendant to cover the costs of her ketamine infusions, arguing that the infusions were approved by the FDA and were very common in the treatment of complex regional pain syndrome. She alleged claims under the Employment Retirement Income Security Act, and for breach of plan and plan benefits, and sought injunctive relief and declaratory relief.

DEFENDANT'S CONTENTIONS:
Defendant argued that its denial of coverage was warranted because the FDA had not approved ketamine infusion for pain management based on the medical opinion of a practicing board certified anesthesiologist who was certified in pain management.

Result

The court granted summary judgment in favor of defendant, finding that its denial of the claim was reasonable and supported by qualified medical opinions.