Elizabeth Clarke v. State of Tennessee

State employee Insured received radiation treatment for tongue cancer. Insurance Company denied authorization of the treatment as “investigational” and not “medically necessary” pursuant to the insurance plan and its medical policy. After two direct appeals of the denial to the insurance claim administrator, Insured appealed to the Tennessee Claims Commission. The Claims Commission found that the treatment was investigational under the plain language of both the plan and the policy and thus not a covered expense. As the denial of coverage did not amount to a breach of contract, the Claims Commission granted Insurance Company’s motion for summary judgment. Finding no reversible error, we affirm.