Trustmark Life Insur. Co. v. The University of Chicago Hospitals, 207 F.3d 876 (7^th Cir. 2000)-The issue was whether Trustmark could recover payments made to University of Chicago Hospitals & Health System (UCH) for breast cancer treatment of one of Trustmark's insureds, Ms. Fuja. Trustmark had originally denied coverage for Fuja's high dose chemotherapy and autologous bone marrow transplant ("HDC/ABMT") treatment claiming it was not "medically necessary" as the Plan defined that term.  Mrs. Fuja sued and the district court granted injunctive relief forcing Trustmark to pay.

Trustmark paid, but later appealed to this court.  This court held that Trustmark had been correct in determining Fuja's treatment was not "medically necessary" since it was "furnished in connection with medical ... research."  Fuja v. Benefit Trust Life Ins. Co., 18 F.3d 1405 (7^th Cir. 1994).  Trustmark then won recovery in district court of the money it had paid, and the district court denied the hospital's common law defenses of breach of contract and promissory estoppel.

This court reversed since it found that the hospital did state a common law defense of promissory estoppel.  (The hospital did not succeed on the breach of contract claim because this circuit has refused to recognize a breach of contract claim in an ERISA setting.)  UCH reasonably relied on Trustmark's statements guaranteeing payment (made without conditions) when it decided to proceed with Mrs. Fuja's expensive and urgent procedures.  This court apparently did not find it relevant that Trustmark had paid "under court order."  The court reasoned that Trustmark misled UCH when it failed to state any conditions, specifically, for example, that it would make the payment subject to appellate review.