Brittany Tovar v. Essentia Health
2017 U.S. App. LEXIS 9009
| 8th Cir. | 2017Background
- Brittany Tovar worked for Essentia Health (2010–2016) and was covered by an employer-provided self-funded health plan that also insured her son.
- Tovar’s teenage son was diagnosed with gender dysphoria in 2014; recommended treatments included medication and gender reassignment surgery.
- The plan contained a categorical exclusion for “services and/or surgery for gender reassignment,” and claims for the son were denied; Tovar paid for some medication out-of-pocket and the surgery did not occur.
- Tovar sued Essentia (Title VII and Minnesota Human Rights Act) and HealthPartners/HPAI (under the Affordable Care Act §1557), alleging sex discrimination based on the coverage exclusion.
- The district court dismissed: (1) Tovar’s Title VII and MHRA claims for lack of statutory standing (she was not discriminated against on the basis of her own sex), and (2) her ACA claim for lack of Article III standing as to HealthPartners. Tovar appealed.
- The court of appeals: affirmed dismissal of Title VII/MHRA claims; reversed dismissal of the ACA §1557 claim for Article III standing and remanded to allow the district court to consider whether the ACA claim states a claim against HealthPartners/HPAI.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Tovar may sue Essentia under Title VII for denial of benefits to her son | Tovar contends employer discrimination in denying coverage for her son’s transgender treatment harms her and is actionable under Title VII/MHRA | Employer argues Title VII protects employees from discrimination based on their own protected characteristic, not the characteristics of a beneficiary | Held: No — Title VII/MHRA do not create a cause of action for an employee whose injury is based on denial of benefits to a dependent because of the dependent’s protected characteristic |
| Whether Newport News/related precedents permit beneficiary-based claims | Tovar relies on cases where plan distinctions affected employees (e.g., pregnancy/spouses) to argue coverage discrimination can be employee-based | Defendants: those cases involve discrimination against employees themselves, not distinct beneficiary-only harms | Held: Court distinguishes Newport News and similar cases; they involved discrimination based on the employee’s own protected characteristic as manifested by plan differences |
| Whether Tovar has Article III standing to sue HealthPartners/HPAI under §1557 (ACA) | Tovar argues she suffered concrete injuries (denied benefits, OOP payments, emotional harm) traceable to HealthPartners/HPAI because the plan corresponds to a HealthPartners policy and claims/appeals were directed to HealthPartners | Defendants argue Tovar sued the wrong entity (administrator was HPAI), Essentia as plan sponsor controls and funds the self-funded plan so injuries are not traceable/redressable to HealthPartners/HPAI | Held: Reversed — Tovar has alleged injury in fact and plausible traceability/redressability at this pleading stage (plan corresponds to HealthPartners policy and claims directed to HealthPartners); remanded for district court to address whether §1557 claim states a claim against HealthPartners/HPAI |
| Whether the §1557 claim against a third-party administrator (TPA) can proceed | Tovar asserts HPAI/HealthPartners participated in or provided the plan and thus can be liable under §1557 | Defendants argue OCR guidance limits TPA liability when the employer/plan sponsor designs benefits; absent allegations of common control, subterfuge, or discriminatory administration, §1557 liability is implausible | Held: Court remands — declines to decide on the merits whether §1557 claim against HealthPartners/HPAI fails as a matter of law and directs district court to address failure-to-state-a-claim defenses in the first instance; concurring judge would have resolved dismissal now in favor of defendants based on OCR guidance |
Key Cases Cited
- Iqbal v. Ashcroft, 556 U.S. 662 (2009) (plausibility standard for pleading under Rule 12(b)(6))
- Lexmark International, Inc. v. Static Control Components, Inc., 572 U.S. 118 (2014) (statutory standing: plaintiff must fall within class Congress authorized to sue)
- Newport News Shipbuilding & Dry Dock Co. v. EEOC, 462 U.S. 669 (1983) (plan distinctions can constitute discrimination against employees when benefits differ by employee sex)
- Thompson v. North American Stainless, LP, 562 U.S. 170 (2011) (Title VII retaliation provision has broad coverage for third-party retaliation where both parties are employees)
- Geissal v. Moore Medical Corp., 524 U.S. 74 (1998) (Article III standing can be satisfied by allegations of economic injury such as out-of-pocket payments)