Ferrer v. Carefirst, Inc.
Civil Action No. 2016-2162
| D.D.C. | Jul 17, 2017Background
- Plaintiffs are three women insured or administered by CareFirst who allege the ACA requires coverage of lactation services as a no-cost preventive service.
- Plaintiffs claim CareFirst has no in-network lactation providers, forcing them to use out-of-network providers and pay hundreds of dollars out of pocket.
- Plaintiffs sued, alleging CareFirst violated the ACA by not covering the full cost of out-of-network lactation services.
- CareFirst moved to dismiss under Rule 12(b)(1), arguing plaintiffs lack standing because each received the maximum plan benefit and only paid balance-billed amounts.
- CareFirst supported its motion with an employee affidavit (Lessner) asserting plaintiffs received plan benefits and only paid balance-billed amounts.
- The district court considered whether, at the motion-to-dismiss stage, the court may rely on a defendant’s extrinsic evidence to rebut the complaint’s allegations about injury and standing.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether plaintiffs have Article III standing to sue | Plaintiffs allege concrete economic injury: out-of-pocket payments for lactation services caused by CareFirst’s failure to cover full cost | CareFirst says plaintiffs received plan benefits and therefore suffered no injury; it offers an affidavit to show no injury | Court held plaintiffs sufficiently alleged injury, causation, and redressability for standing at the motion-to-dismiss stage |
| Proper scope of a Rule 12(b)(1) standing inquiry at pleadings stage | Standing is determined from complaint allegations (and any plaintiff affidavits); plaintiffs need only plausibly plead injury | Defendant may present outside evidence (Lessner affidavit) to negate alleged injury | Court held defendants may not rely on their own evidence to defeat standing at the Rule 12(b)(1) motion-to-dismiss stage; Haase controls |
Key Cases Cited
- Haase v. Sessions, 835 F.2d 902 (D.C. Cir. 1987) (at the motion-to-dismiss stage a defendant may not introduce extrinsic evidence to negate the allegations supporting standing)
- Arpaio v. Obama, 797 F.3d 11 (D.C. Cir. 2015) (elements and burdens of Article III standing and how they apply at successive litigation stages)
- Lujan v. Defs. of Wildlife, 504 U.S. 555 (1992) (defining the three elements of constitutional standing)
- Carpenters Indus. Council v. Zinke, 854 F.3d 1 (D.C. Cir. 2017) (recognizing that even small economic harms satisfy injury-in-fact)