Carr v. Gates Health Care Plan, 1999 U.S. App. LEXIS 26521 (7^th Cir. October 21, 1999)-Before Bauer, Flaum, and Ripple Janet Carr was denied benefits under the Gates Health Care Plan ("the Plan"), an employee welfare benefit plan, because the treatment she received "related to" complications caused by a 1979 gastric stapling surgery which was specifically excluded under the plan. After exhausting her administrative remedies, Carr initiated a suit under 29 U.S.C. § 1132(a)(1)(B), in state court to recover benefits under an employee welfare plan. The Plan then removed the case to the United States District Court of the Central District of Illinois, where the court determined that the Plan did not arbitrarily and capriciously deny Carr's claim.

 This court found that the plan language could reasonably interpreted to exclude coverage for Ms. Carr’s treatment. The relevant part of the plan stated: "Exclusions. By way of example, but not of limitation, the following are specifically excluded services and benefits: . . . 2. Cosmetic or surgical procedures . . . [such as] any services performed in connection with the enlargement, reduction, implantation, or change in appearance of a portion of the body . . . gastric stapling or diversion from weight loss."

Under the plan  the Committee is authorized, in its sole discretion, to interpret the Plan. This discretion empowers the Committee to construe disputed or ambiguous terms under the Plan, decide all questions of fact that may arise and determine the right of any member to a benefit, in accordance with the Plan. Under the Plan, such interpretations or determinations made by the Committee in good faith shall be conclusive and binding on all parties. Where the plan gives the administrator discretion to interpret the plan terms or determine benefits eligibility, courts review the denial of benefit claims under 29 U.S.C. § 1132(a)(1)(B), using the arbitrary and capricious standard. The court is only to determine if the decision was "downright unreasonable." Mers v. Marriott Int'l Group & Accidental Death and Dismemberment Plan, 144 F.3d 1014, 1021 (7^th Cir. 1997).