HARRISBURG – A Pennsylvania-affiliated health care provider wants the discrimination lawsuit filed by a transgender male state employee over being denied insurance coverage for his gender/sex-affirming surgery dismissed with prejudice, for failure to state a claim and being barred by the statute of limitations.
John Doe filed a complaint Dec. 23, 2019, in the U.S. District Court for the Middle District of Pennsylvania against the Commonwealth of Pennsylvania, the Department of Human Services, Pennsylvania Employees Benefit Trust Fund and others alleging violation of the Civil Rights Act of 1964, the Americans with Disabilities Act and other claims.
The suit stated that Doe, who was diagnosed with gender dysphoria, is currently receiving hormone therapy and that his treatment providers believe that a bilateral mastectomy is a medically necessary treatment for his gender dysphoria.
According to Doe’s complaint, the Highmark Health Insurance Company defendants are “the third-party administrators of the Commonwealth of Pennsylvania’s employer-sponsored health plan that offers health insurance plans to Commonwealth of Pennsylvania employees including Doe.”
As the third-party administrator, Doe claimed that the Highmark defendants, “exercised significant control over an important aspect of the employment relationship” and “acted as the agent of the Commonwealth defendants such that an agency relationship between the two entities existed.”
Specifically, Doe alleged that the Highmark defendants are subject to liability for employment and disability discrimination, as a result of denying insurance coverage for Doe’s gender reassignment surgery, according to the terms of the Commonwealth’s health insurance plan.
UPDATE
On June 29, counsel for defendant Highmark filed an answer to Doe’s complaint, seeking for it to be dismissed for failure to state a claim and other reasons, with prejudice.
“In Counts I, II, III and V, Doe fails to state a plausible employment discrimination claim against the Highmark defendants in violation of Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act and the Pennsylvania Human Relations Act,” defense counsel member Mariah P. McGrogan said.
“Specifically, Doe’s employment discrimination claims fail because the Highmark defendants were not Doe’s employer and, therefore, he cannot state claims against them under Title VII, the ADA or the PHRA.”
McGrogan additionally argued that Doe’s Title VII, ADA and PHRA claims should be dismissed for the separate reason that he had failed to exhaust his administrative remedies as to the Highmark defendants, as is required by those statutes.
“Finally, Counts VIII and IX of Doe’s complaint should be dismissed against the Highmark defendants because they are time-barred. Specifically, Doe’s Section 1557 of the Affordable Care Act claims are barred by a two-year statute of limitations, which expired in February 2019 – 10 months prior to the filing of this complaint,” McGrogan stated.
Doe seeks injunctive and monetary relief, a trial by jury and all other just relief.
The plaintiff is represented by Justin Robinette of The Law Offices of Eric Shore, in Philadelphia.
The defendants are represented by Caleb Curtis Enerson of the Pennsylvania Attorney General’s Office in Harrisburg, plus Douglas Cameron, Catherine S. Ryan and Mariah H. McGrogan of Reed Smith, in Pittsburgh.
U.S. District Court for the Middle District of Pennsylvania case 1:19-cv-02193
From the Pennsylvania Record: Reach Courts Reporter Nicholas Malfitano at nick.malfitano@therecordinc.com