Doe v. Louisiana Health Service & Indemnity Co.
172 So. 3d 132
La. Ct. App.2015Background
- As a child Ms. Doe’s treatment claims were repeatedly coded with ICD-9 759.82 (Marfan syndrome); providers monitored skeletal features and aortic dilation suggestive of Marfan.
- In 1994 she had an immunofluorescence test for fibrillin; results were inconclusive and no DNA testing was done. She was never diagnosed with or treated for Marfan syndrome thereafter.
- Years later Ms. Doe applied for individual coverage with Blue Cross; underwriting accessed her prior claims history and denied coverage based on the Marfan-related diagnostic codes.
- Ms. Doe sued under the Louisiana Genetic Information Non-Discrimination Act (La. R.S. 22:1023), alleging negligent disclosure of genetic information; the district court awarded $50,000 plus fees and costs.
- Blue Cross appealed, arguing (1) a diagnostic code is not "genetic information" under the statute and (2) internal use of claims data was not a "disclosure." Ms. Doe cross-appealed, seeking a willful-disclosure finding and statutory damages of $100,000.
- The court affirmed the district court: it held the diagnostic code constituted genetic information and that Blue Cross disclosed that information to underwriting, but the court declined to find willfulness.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a diagnostic code (ICD-9 for Marfan) is "genetic information" under La. R.S. 22:1023 | The code reflects inherited characteristics and manifestation risk, so it is genetic information | Diagnostic codes/diagnoses are not the statutory "genetic information" (which targets genetic tests/DNA) | Held: diagnostic code tied to a genetic disorder qualifies as genetic information (statute’s plain language includes inherited characteristics and manifestations) |
| Whether Blue Cross’s internal access/use of claims data to underwrite constituted a "disclosure" | Underwriting’s access to claims department data conveyed genetic information to a person other than the individual | Internal, intra-corporate use that remained within Blue Cross is not a statutory "disclosure" | Held: access by underwriting to claims data was a disclosure under the Act (information was provided to a person other than the individual) |
| Whether insurer could lawfully deny coverage under statutory exceptions for manifested disease | Ms. Doe stresses she never manifested Marfan syndrome; thus the underwriting exception for manifested disease doesn’t apply | Blue Cross relies on statutory language allowing underwriting based on manifestation of disease to defend denial | Held: exception did not apply because Ms. Doe never developed Marfan syndrome; underwriting relied on genetic-information coding, not a true manifested disease |
| Whether the disclosure was "willful" (entitling plaintiff to higher statutory damages) | Willfulness can be inferred from facts showing substantial certainty of the consequence; Blue Cross intentionally accessed and used the genetic info to deny coverage | No proof that denial was intended when records were accessed; access alone does not establish willfulness | Held: not willful; court affirmed negligent (but not willful) disclosure and $50,000 damages |
Key Cases Cited
- Arias v. Stolthaven New Orleans, L.L.C., 9 So.3d 815 (La. 2009) (appellate court scope of review for law and facts)
- Stobart v. State, Dep’t of Transp. and Development, 617 So.2d 880 (La. 1993) (appellate review standard: cannot overturn absent legal error or manifest factual error)
- Rosell v. ESCO, 549 So.2d 840 (La. 1989) (duty to redetermine facts de novo if reversible legal error or manifest error of fact found)
- Credit v. Richland Parish Sch. Bd., 85 So.3d 669 (La. 2012) (statutory interpretation: apply clear statutory language as written)
- State v. Main Motors, 383 So.2d 327 (La. 1979) (willfulness may be inferred from circumstantial facts)
- Hirst v. Thieneman, 905 So.2d 343 (La. App. 4 Cir. 2005) (discusses inference of intent/willfulness from facts)