Cheryl Bowen alleged that prolonged exposure to toxic mold and bacteria in her workplace caused the recurrence of systemic lupus erythematosus that had previously been in remission and triggered severe asthma and allergic disease. Her condition resulted in repeated episodes of anaphylactic shock, emergency treatment, and frequent hospitalizations, sometimes occurring every four to six weeks.
Treating physicians prescribed daily intravenous Benadryl and Phenergan, administered through a surgically implanted port-a-cath, which dramatically reduced hospitalizations and steroid dependence. After a change in plan administration, the plan approved the port insertion but denied coverage for the prescribed IV medications as not medically necessary, relying on non-examining reviewers despite the life-threatening consequences of interrupted treatment.
Bowen sought injunctive relief under ERISA to prevent termination of prescribed care during litigation. The court conducted a detailed review of the medical record and claims-handling process and addressed whether ERISA permits an insurer to withhold physician-prescribed, life-sustaining treatment while a benefits dispute is pending.
