T hi s or derand j udgm enti s notbi ndi ng pr ece dentexce ptundert he * doctr i nes of l aw of the ca s e, r es j udi cat a and c ol l at er al es t oppel . I tm aybe ci t ed, h o w e v e r, fo r its p e rsu a siv e v a lu e c o n sis ten t w ith F e d . R . A p p . P . 3 2 .1 a n d 1 0 th C i r . R . 32. 1. 

## F I LED United States C ourt of Appeals Tenth Circuit 

### F e b r u ary15,2007 Elisab eth A. Shumaker C l erk of C ourt UNI TED S TATES CO URT O F AP PEALS

T E N T H C IR C U IT DONNA J . HOL L I NGS HE AD,

P lain tiff-A p p e llan t, N o. 05- 6276 v. W . D . of O kl a. BLU E CRO SS AN D B LUE SHI ELD O F O K L A H O M A , doi ng bus i nes s as BL UE L I NC S HM O,

D efe ndant - A ppel l ee. ( D . C . N o . C I V - 0 4 - 1 6 4 0 - W)

ORDE R AND J UDGM EN T * B efor e TA CHA, C h ie f J u d g e , TY M KOVI CH , and GORS UCH , C i rcui tJudg es. T h is c a s e a s k s u s to in te rp re t a n in s u ra n c e p la n ’s o rg a n tr a n s p la n t p o lic y . T he pl an’ s expr es s excl us i on deni es anybenef i tfort r ans pl ant s of “more t han one or gan of the s ame t ype. ” H er e, D onna J . H ol l i ngs head unde rw enta l i ver t r ans pl ant . U nfor tunat el y , w i t hi n s event een da y s , hert r ans pl ant ed l i verfai l ed and s he r equi r ed a s econd l i vert r ans pl antt o s ur vi ve. H eri ns ur ance companyr efus ed paym entfort hi s s econd tr ans pl antbas ed on the exc l us i on and H ol l i ngs head now-2-

s eeks r ei m bur s ement . T he di s t r i ctcour tdeni ed H ol l i ngs head’ s cl ai m bas ed on the excl us i on. B eca us e w e ca nnotes cape the conc l us i on that“one or gan” means “one o rg a n ,” w e a ffir m . I . Backg r ound D efen dan tB l ue C ross and B l ue S hiel d o f O klahom a (B l ue C ross ) i s a h e a lth m a in te n a n c e o rg a n iz a tio n d o in g b u s in e s s a s B lu e L in c s H M O . H o lli n g sh e a d w o rk e d fo r th e C u sh in g H o sp ital A u th o rity , a m u n icip a l h o sp ital, and had a n i ns ur ance pol i cy( Pl an) w i th B l ueLi ncs t hr ough herw or k. She w as diagnosed w i t h p ri m aryscl erosi ng cho l ang i t i s ( P S C ) i n 1 98 4. P S C i s a pr ogr es s i ve l i verdi s eas e thatr es ul t s i n ci rrhos i s and l i verfai l ur e. I n 2002, H o llin g s h e a d w a s in th e e n d s ta g e s o f liv e r d is e a s e s e c o n d a ry to P S C . A s a re su lt o f

th e a d v a n c e d P S C , H o lli n g sh e a d w o u ld h a v e d ied w ith o u t a l i vert r ans pl ant . T he Pl an expr es s l yal l ow ed a l i vert r ans pl antw hen the cl ai m ant i s fac i ng death w i t hi n ei ght een mont hs , fi t t i ng H ol l i ngs head’ s condi t i on. B l ue C r os s pr e- appr oved and pr e- cert i fi ed the tr ans pl antand i tw as per form ed att he U n iv e rs ity o f

N e b ra s k a M e d ic a l C e n te r ( U N M C ) o n O c to b e r 2 0 , 2 0 0 2 . H ol l i ngs head w as r el eas ed fr om the hos pi t al on O ct ober25 i n “exc el l ent c o n d iti o n .” A p lt. S u p p . A p p . II a t 4 4 9 . N e v e rth e les s, th e n e w liv e r c e a se d to funct i on effect i vel yel even da y s aft erherr el eas e and s he r ece i ved a s econd t r ans pl anton N ovember6, 2002— s event een da y s aft erheri ni t i al tr ans pl ant . B l ue C r os s deni ed cove r age fort hi s s econd tr ans pl antbeca us e a Pl an exc l us i on hol dsH ol l i ngs head w as i nform ed byB l ue C r os s t hatt he s econd l i vert r ans pl ant 1 w oul d notbe cove r ed byt he Pl an on N ovember4, 2002— tw o day s befor e her s ur gery . A pl t . Supp. A pp. I I at316. O n the s ame day , H ol l i ngs head’ s daught er as ked foran expe di t ed r evi ew of the dec i s i on. O n N ovember5, B l ue C r os s s ent H o llin g s h e a d a le tte r e x p la in in g th e d e n ia l o f th e c la im . O n N o v e m b e r 7 , 2 0 0 2 , a dayaft ert he s ur gery , B l ue C r os s ’ s appea l s comm i t t ee a ffi r m ed the deni al of the cl ai m . A s econd a ppeal s comm i t t ee a l s o r evi ew ed and a ffi rm ed the deni al of the c l a i m. -3- t h a t“ n o Be n e f

i t s wi l l b e p r o v i d e d fo r. . . [ m] o r e th a n o n e o r g a n o f th e s a me typ e .” H ol l i ngs head i nt ernal l yappea l ed B l ue C r os s ’ s deci s i on ar gui ng thatthe O c to b e r 2 0 su rg e ryw a s n o t an o rg a n tra n sp lan t b u t in ste a d a “ fa iled a ttem p t at a t r ans pl ant , ” and thatonl yt he N ovember6 oper at i on cons t i tut es an or gan tr an sp lant. D u ri n g B lue C ross ’s rev iew , itco n side red a w ri tt en let ter byR icha rd

1 G il roy , M . B . B . S . , an asso ciate o f U N M C ’s O rga n T ran sp lantati o n P rog ram . D r. G i l r oyw r ot e thatt hr ee pe r centof l i vert r ans pl ant s do notfunct i on and a r e t r a n s p l a n ti s ma n d a t o r yi n t h o s e s i tu a t i o n s ; o th e rwi s e t h e p a t i e n twi l l d i e . He cont i nued, “w e cons i dert hi s [r etr ans pl ant ] partof the or i gi nal t r ans pl ant at i on pr oces s . ” A pl t . Supp. A pp. I I at485. A ft era r evi ew byt w o comm i t t ees , B l ue Cr o s s a ffi r me d t h e d e n i a l o f Ho l l i n g s h e a d ’ s c l a i m. H ol l i ngs head f

i l ed s ui tagai ns tB l ue C r os s i n O kl ahoma st at e courtunder t he Em pl oy ee Ret i r ementand I ncome Secur i tyA ct( E R I SA ) enfor cement p ro v isio n , 2 9 U .S .C . § 1 1 3 2 (a )(1 )(B ), w h ich g o v e rn s th e P lan , to r e c o v e r b e n e fits-4-

fo rt he s e c on d l i ve rt r a ns pl a ntop e r a t i on . Bl ue Cr os s r e move d the c a s e t o the U . S. D i s t r i ctC our tfort he W es t ern D i s tr i ctof O kl ahoma. B l ue C r os s fi l ed a mot i on forj udgm enton the admi ni s tr at i ve r ecor d and the di s t r i ctcourtdeci ded thatt he i ns ur ance pl an unambi guous l yexcl uded cove r age form or e than one or gan of the s ame t ype. A ccor di ngl y , the di s tr i ctcour tdeni ed re lie f to H o llin g s h e a d a n d e n te re d ju d g m e n t fo r B lu e C ro s s . H o llin g s h e a d a p p e a ls th e d is tr ic t c o u rt ’s o rd e r. II . A n a ly sis T he q uest i on on app eal i s w hethert he P l an is am biguou s. If i ti s, H ol l i ngs head makes fourr el at ed ar gum ent s underE R I SA t hatw oul d pr ovi de c o v e ra g e fo r h e r se c o n d tra n sp lan t: (1) a n en ti re b o d yo f O k laho m a ins u ran ce law is prese rve d u n d er E R IS A ’s “s avi ngs cl aus e, ” and thi s s aved s t at e i ns ur ance l aw t rum ps t he t erm s of the Pl an d o c u m e n t, req u irin g c o v e ra g e fo r th e se c o n d su rg e ry ; ( 2) t he Tent h C i r cui thas al r eadyi s s ued a de ci s i on “s avi ng” a pr i nci pl e of O kl ahoma i ns ur ance l aw , s how i ng t hats t at e comm on l aw pr i nci pl es of i ns ur ance in terp re tatio n a n d a p p lica tio n a re to b e a p p lied in E R IS A c a se s; (3 ) B lu e C ro ss d id n o t ca rryits b u rd e n to su p p o rt its d e n ial o f b e n e fits w ith s ubs t ant i al evi dence , as r equi r ed of a n admi ni s tr at oroper at i ng underan i nher ent confl i ctof i nt er es t , and i t s deni al w as t her efor e arbi tr aryand capr i ci ous ; and-5-

( 4) fede r al comm on l aw m i rr or s s t at e i ns ur ance l aw , and r equi r es cover age in th is c a s e . H ol l i ngs head f

ur t herm ai nt ai ns thatB l ue C r os s ’ s i nt erpr et at i on of the Pl an is no t r ea so n ab le be ca u se th e se co n d li v er trans p lant w as w ith in the k n o w n fa il u re rat e of ini t i al l i ver transpl ants , w i thin the “st and ard of care” for l i ver transpl ants , deemed byt he medi cal comm uni tyt o be partof the i ni t i al tr ans pl ant , and r equi r ed fo r h e r t o liv e . B l ue C ross con t end s that s i nce the second organ e xclusi on i s unam biguou s, w e n e e d n o t r e a c h th e s e q u e s tio n s o f c o n tr a c t in te rp re ta tio n u n d e r s ta te la w . A . St andard of R evi ew W e r e v i e w t h e g r a n to f s u mma ryj u d g me n td e n o v o , a p p l y i n g t h e s a me s ta n d a rd s a s th e d is tr ic t c o u rt . Fo u g h tv . UN UM L i f e In s . Co . o

f A m. , 379 F. 3d 997, 1002 ( 10t h C i r . 2004) ( percur i am). “I ti s a bas i c rul e of i ns ur ance l aw t hat t he i ns ur ed ca r r i es t he bur den of s how i ng a cove r ed l os s has occurr ed and the i ns ur erm us tpr ove fa ct s t hatbr i ng a l os s w i thi n an exc l us i onarycl aus e of the pol i cy . ” P i tm an v. B l ue C r os s & Bl ue Shi eld of O kla. , 2 1 7 F .3 d 1 2 9 1 , 1 2 9 8 (1 0 th C ir . 2 0 0 0 ). “[A ] deni al of bene fi t s chal l enged unde r§ 1132( a) ( 1) ( B ) [ER I SA ] i s t o be r evi ew ed undera de novo s t andar d unl es s t he bene fi tpl an gi ves t he admi ni s tr at or o r fid u c iar yd isc re tio n a rya u th o rityto d e ter m in e e lig ib ili tyfo r b e n e fits o r to cons t rue the t erm s of the pl an. ” Fought , 379 F. 3d at1002–03 ( quot i ng F i r es t oneT he Pl an s t at es , “B l ueLi ncs H M O , as cl ai m s admi ni s tr at or , i s her eby 2 gr ant ed author i t yt o i nt erpr ett he t erm s and condi t i ons of the G r oup M as t er A g re e m e n t a n d to d e te rm in e its b e n e fits .” A p lt. S u p p . A p p . I a t 5 5 , 1 1 0 . -6- Ti r e & R ubberC o. v. B r uch , 4 8 9 U .S . 1 0 1 , 1 1 5 (1 9 8 9 )); s ee als o G eddes v. Un ite dS ta

ffin gA llia n c e E mp le . Me d . P la n , 4 6 9 F . 3 d 9 1 9 , 9 2 3 (10 th C ir . 2 0 0 6 ); A da ms o n v . UN UM L i f e In s . Co . o

f A m. , 4 5 5 F . 3 d 1 2 0 9 , 1 2 1 2 (10 th C ir . 2 0 0 6 ). In s uch ca s e, t he court“appl i es an ‘ arbi tr aryand ca pr i ci ous ’ s t andar d t o a pl an admi ni s t r at or ’ s act i ons . ” Fo u g h t, 379 F. 3d at1003. H ol l i ngs head doe s not chal l enge Bl ue C r os s ’ s cont ent i on that , as the Pl an’ s admi ni s tr at or , i tther ebyhas di s cr et i on t o i nt erpr et t he Pl an. 2 U ndert he arbi t r aryand ca pr i ci ous s t andar d, B l ue C r os s ’ s i nt erpr et at i on of t he Pl an w i l l s t and i f i tw as “r eas onabl e and made i n good fai th. ” Id. O urcas es r equi r e thatB l ue C r os s ’ s i nt erpr et at i on m us tbe: “( a) as a r es ul tof r eas oned and pr i nci pl ed pr oces s ( b) cons i s t entw i th anypr i ori nt erpr et at i ons byt he pl an admi ni s t r at or( c) r eas onabl e i n l i ghtof anyext ernal s t andar ds and ( d) cons i s t ent w i t h t he purpos es of the pl an. ” Id. ( quot at i on om i t t ed) . I n r evi ew i ng the deni al of bene fi t s undert he arbi t r aryand capr i ci ous s t andar d, t he courti s “l i m i t ed t o t he ‘adm i nis t rat i ve record’–the m at eri al s com pil ed b yt he ad m i nis trat or i n the cou rs e of m aki ng hi s deci s i on. ” Id. (q u o ta tio n o m itte d ). T he s t andar d of r evi ew overt he deni al of bene fi t s change s w hen, as her e, th e p la n a d m in is tr a to r i s u n d e r a n in h e re n t c o n flic t o f in te re s t. Id . a t 1 0 0 3 , 1 0 0 6 . A pl an admi ni s t r at ori s underan i nher entconfl i ctof i nt er es tw hen i t“i s both t he-7-

i ns ur erand the admi ni s t r at orof the pl an. ” P i tm an , 2 1 7 F . 3 d at 12 9 5

– 9 6 . W h ere the p lan a d m inistrator is un d er a co n fli ct of interest, a re v iew ing co u rt “undert ake[ s ] a ‘ s l i di ng s cal e’ anal y s i s , w her e the degr ee of defe r ence acc or ded t he Pl an A dm i ni s t r at ori s i nver s el yr el at ed t o the ‘ s er i ous nes s of the conf l i ct . ’ ” A l l is o n v . UN UM L i

f e In s . Co . o

f A m. , 3 8 1 F .3 d 1 0 1 5 , 1 0 2 1 (1 0 th C ir . 2 0 0 4 ). W h e n th e p lan a d m in istra to r o p e ra tes u n d e r a n in h e re n t co n flict o f in ter e st, w e r equi r e the admi ni s t r at or“t o es t abl i s h bys ubs t ant i al evi dence thatthe deni al of bene fi t s w as notarbi t r aryand ca pr i ci ous . ” Fought , 379 F. 3d at1005. I n s uch a c a se , “[ t]h e d istric t co u rt m u st ta k e a h a rd lo o k a t th e e v id e n c e a n d a rg u m e n ts pr es ent ed t o t he pl an admi ni s t r at ort o ens ur e thatthe dec i s i on w as a r eas oned appl i cat i on of the t erm s of the pl an t o the part i cul arcas e, unt ai nt ed bythe confl i ctof i nt er es t . ” Id . a t 1 0 0 6 . W e now tur n t o H ol l i ngs head’ s appea l w i th thi s fr amew or k i n m i nd. B . Is t h e P l an ’s L an gu ag e A m b i gu ou s? U n d e r e v e n th e m o st e x a c tin g sta n d a rd o f re v iew , B lu e C ro ss ’s d e c isio n to denyH ol l i ngs head’ s cl ai m m us tbe affi r m ed bec aus e of the Pl an’ s unambi guous t e r ms . W e h a v e h e l d t h a twh e r e a n e mp l o y e e b e n e fi tp l a n ’ s wr i t t e n t e r ms unambi guous l ygovern w hatbenef i t s ar e due “ undert he t erm s of the pl an, ” 29 U .S .C . § 1 1 3 2 (a )( 1 )( B ), t h e ya re d e te rm in a tiv e a s a m a tte r o f la w . A dmi n . Co mm. of the Wal
- Mar tA s s ocs . Heal th & Wel f ar e Pl an v. Wi l lar d, 393 F. 3d 1119, 1123 ( 10t h C i r . 2004) ( “I n i nt erpr et i ng an ER I SA pl an, t he courtexami nes t he pl an-8-

d o c u m e n ts a s a w h o le a n d , if u n a m b ig u o u s , c o n s tru e s th e m a s a m a tte r o f la w .” ). I n t hi s cas e, i f the Pl an’ s t erm s cl ear l y , pl ai nl y , and cons pi cuous l ydi ct at e a cert ai n out come, B l ue C r os s coul d notbe arbi tr aryand ca pr i ci ous i n fol l ow i ng t hatdi r ect i on. I n r evi ew i ng t he t erm s of the Pl an, w e fi nd no ambi gui tyi n i t s or gan tra n sp lan t p ro v isio n s. “ A m b ig u itye x ists w h e n a p lan p ro v isio n is re a so n a b ly s us cept i bl e t o m or e than one meani ng, orw her e ther e i s uncert ai ntyas t o the m eani ng of the t erm . ” Willa r d, 393 F. 3d at1123 (qu o tat ion o m itted). In cons t rui ng t he t erm s of an ER I SA pl an, l anguage i s gi ven “i t s comm on and o rd in a rym e a n in g a s a re a so n a b le p e rso n in th e p o sitio n o f th e [ p lan ] p a rticip a n t, nott he ac tual par t i ci pant , w oul d have unde r s t ood the w or ds t o m ean. ” Id. T h e P lan p ro v id e s, in re lev a n t p a rt, c. L i ver T ranspl ants . B enef i t s w i l l be pr ovi ded fora l i vert r ans pl ant , pr ovi ded the S u b scribe r: 1 ) ha s en d -st ag e li v er d isease w ith a li fe ex p ec tanc yo f 1 8 m o n ths o r le s s d u e to a n yo f

th e fo llo w in g c o n d itio n s : . . . c ) p ri m a ry sc h e ro s in g c h o la n g itis ; . . . 2 ) h a s n o rm a l k id n e yf u n c tio n ; 3 ) h a s n o c o n c u rre n t ex tra h e p a tic m a lig n a n c y(in c lu d in g e x tra h e p a tic ext ens i on orpr i m aryhepat ocel l ul arcar ci nom a, H I V i nfec t i on or A I D S; and 4 ) i s p s y c h o lo g ic a lly sta b le a n d h a s a s u p p o rt iv e s o c ia l e n v ir o n m e n t. * * * 1 . In a d d iti o n to th e E x c lu sio n s s e t fo rth e lse w h e re in th is C o n tr a c t/A g re e m e n t, no B enef i ts w i l lbe pr ovi dedfort he fol l ow i ng-9-

or gan ort i s s ue tr ans pl antorB one M arr ow T r ans pl ant s orr el at ed s e rv ic e s : . . . h . Mor e than one organ of the s am e t

ype , w i th the exc ept i on of a doubl e- l ung t r ans pl antdone atone t i m e. A heart - onl y , l ung- onl y , or h e a rt /lu n g tr a n s p la n t w ill b e c o n s id e re d th e s a m e typ e o rg a n . A p lt . S u p p . A p p . II at 28 9

– 9 2 (em p h asis ad d ed ). W e fi nd t he exc l us i on i s notr eas onabl ys us cept i bl e t o m or e than one i nt erpr et at i on, and no unce r t ai nt yexi s t s as t o the meani ng of anyt erm . T he cl aus e pr ovi di ng “no B enef i t s w i l l be pr ovi ded forthe . . . or gan . . . tr ans pl ant [of] . [m ] or e than one or gan of the s ame t ype” une qui vocal l ym eans that H o lli n g sh e a d is e n tit led to p a ym e n t o f o n lyo n e liv e r tra n sp lan t. H ol l i ngs head offer s no convi nci ng r ebutt al t o the pl ai n m eani ng of the excl us i on. I ns t ead, s he s ugges t s thatthe “i ns ur ance contr acti s s uppos ed t o be r ead a s a w hol e” a nd t hatt he Pl an “made the l i vertr ans pl anta cove r ed l os s . ” A pl t . R epl yB r . at1. B yt hi s ar gum ent , H ol l i ngs head i m pl i es thatthe Pl an ent i t l es hert o a su c c e ss fu l l i vertr ans pl ant . B utthati s nothow the pol i cyr eads and, undergener al contr actl aw pr i nci pl es , “w or ds cannotbe w r i t t en i nt o the agr eementi m par t i ng an i nt entw hol l yunexpr es s ed w hen i tw as exec ut ed. ” B la ir v. Metr opol i tan Li

f e Ins . C o. , 9 7 4 F . 2 d 1 2 1 9 , 1 2 2 1 (10 th C ir . 1 9 9 2 ). W e ar e s t r ai ned t o fi nd anyambi gui tyi n the pol i cy ’ s l anguage . A ccor di ng to W e b ste r’s T h ird N e w In ter n a tio n a l D ictio n a ry , to “ tra n sp lan t” m e a n s to “ to t r ans fer( an or gan ort i s s ue) fr om one bodyorpartof a bodyt o another . ” U nder t hi s defi ni t i on, H ol l i ngs head r ece i ved a tr ans pl anton O ct ober20, 2002 w hen her-10-

li v er w as re m o v ed an d a d o n o r’s l iver w as tran sfe rred in it s p lace . T h e su rge ry re c e iv e d o n N o v e m b e r 6 , 2 0 0 2 w o u ld c o n s titu te a n e w , s e c o n d tr a n s p la n t. Fur t herm or e, i ti s i ncontr over t i bl e thatH ol l i ngs head r ece i ved an “ or gan of the s a m e typ e ” o n N o v e m b e r 6 a s it w a s a ls o a liv e r t ra n s p la n t. W e ar e aw ar e thatt he O ct ober20 tr ans pl antfai l ed pr ematur el yl eavi ng H ol l i ngs head no c hoi ce butt o under go the s econd s ur gery . W e comm i s er at e for herunfor tunat e s i tuat i on. N everthel es s , the Pl an r ecogni zes or gan fa i l ur e as an unavoi dabl e pos s i bi l i t yw i t h t r ans pl ants ur geryand s peci fi cal l ycontr act s ar ound i t . A s H ol l i ngs head c oncede s , l i vertr ans pl ant s have a know n fai l ur e r at e of a ro u n d th re e p e rc e n t. T h e P lan c o n tem p late s th is fa ilu re ra te a n d u n e q u iv o c a lly d e n ies c laim s fo r th e se a d d iti o n a l tran sp lan ts. A f ter a ll, th e o n lyc o g n iza b le r eas on fort he Pl an’ s excl us i on i s t o di s cl ai m cover age i n thes e fe w cas es of or gan fai l ur e. A ddi t i onal l y , undert he Pl an, tr ans pl ant s ar e onl yauthor i zed i f the r eci pi ent can de m ons t r at e opt i m al t r ans pl antcondi t i ons . Forexampl e, the Pl an r equi r es t he p a tien t to h a v e (1 ) n o rm a l k id n e yf u n c tio n , (2 ) n o c o n c u rre n t ex tra h e p a tic m a lig n a n c y , a n d (3 ) a p s y c h o lo g ic a lly sta b le a n d s u p p o rt iv e s o c ia l e n v ir o n m e n t. T hes e condi t i ons s uppor tt he conc l us i on thatB l ue C r os s i nt ended t o gi ve b e n e fic ia ri e s o n ly o n e o p p o rt u n ity fo r t h e s a m e o rg a n tr a n s p la n t. If the P l an w i shed to app rove m ore than on e l i ver transpl ant, B l ue C ross cert ai nl yknew how t o cons t ructs uch a t erm . T he Pl an s peci fi cal l ycr aft s an-11-

exce pt i on t o t he exc l us i on fora “doubl e- l ung tr ans pl antdone atone t i m e. ” A c c o rd in g ly , the P lan d o e s n o t p re v e n t co v e ra g e fo r b o th lu n g s to b e re p lac e d in t he eve ntof a doubl e- l ung t r ans pl antfai l ur e. N o s uch exc ept i on exi s t s forl i ver tr a n s p la n ts . F inally , w h il e so m e m em b ers o f th e m ed ical co m m u n itym ayco n side r a s e c o n d , e a r l yr e - t r a n s p l a n t a t i o n o f a n e w l i v e rp a r to f

th e o r i g i n a l tr a n s p l a n t , we re a d th e P la n ’s la n g u a g e u n d e r c o m m o n p a rl a n c e , n o t m e d ic a l le x ic o n . See Willa r d, 3 9 3 F . 3 d at 11 2 3 . “O n e” o rga n ca n n o t m ea n “tw o ” o rga n s in o rdin ary u s a g e . A cc o rdin g ly , the re co rd m ak es c lear tha t H o ll ing sh ea d rec eive d “[ m ]ore t han one or gan of the s ame t ype” a nd s o B l ue C r os s ’ s deci s i on t o excl ude c o v e ra g e fo r th e se c o n d tra n sp lan t w a s s u p p o rte d b ysu b sta n tial e v id e n c e a n d its d e n ia l o f

h e r c la im w a s re a s o n a b le . Fought , 379 F. 3d at1003. A l though w e have deep s ym pathyforH ol l i ngs head’ s pr edi cament , unfor tunat el ythe l aw pr ecl udes u s f ro m g ra n tin g h e r r e lie f. C . E R ISA ’s S av i n g C l au se B eca us e w e hol d t hatt he Pl an’ s t erm s unambi guous l ydenycover age for m or e than one l i vert r ans pl ant , w e nee d notaddr es s H ol l i ngs head’ s ar gum ent r egar di ng E R I SA ’ s s avi ngs cl aus e.-12- I I I . C oncl usi on F o r t h e fo re g o in g re a s o n s , w e A F F IR M th e o rd e r o f th e d is tr ic t c o u rt . E n ter e d fo r th e C o u rt, T i m othyM . T ym kovi ch C i r cui tJ udge