Doe v. Mutual of Omaha Insurance

999 F. Supp. 1188, 1998 U.S. Dist. LEXIS 4894, 1998 WL 166856
CourtDistrict Court, N.D. Illinois
DecidedApril 3, 1998
Docket98 C 0325
StatusPublished
Cited by1 cases

This text of 999 F. Supp. 1188 (Doe v. Mutual of Omaha Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Doe v. Mutual of Omaha Insurance, 999 F. Supp. 1188, 1998 U.S. Dist. LEXIS 4894, 1998 WL 166856 (N.D. Ill. 1998).

Opinion

MEMORANDUM OPINION AND ORDER

CONLON, District Judge.

John Doe (“Doe”) and Richard Smith (“Smith”) (“plaintiff's”) bring a two count complaint against Mutual of Omaha Insurance Company (“Mutual”). 1 The claims arise from plaintiffs’ purchase of individual health insurance policies from Mutual. Count I alleges disability discrimination in violation of the Americans with Disabilities Act (“ADA”), 42 U.S.C. §§ 12101 et seq. Count II alleges a violation of Section 364 of the Illinois Insurance Code (“IIC”), 215 ILCS 5/364. Mutual moves to dismiss the complaint pursuant to Fed.R.Civ.P. 12(b)(6). Plaintiffs filed a timely response. The Department of Justice (“DOJ”) also filed a response brief for the United States as amicus curiae.

BACKGROUND

For purposes of a motion to dismiss, the court accepts all well-pleaded allegations in the complaint as true and draws all reasonable inferences in favor of the plaintiff. Travel All Over The World, Inc. v. Kingdom of Saudi Arabia, 73 F.3d 1423, 1429 (7th Cir.1996). Plaintiffs are Chicago residents infected with the human immunodeficiency virus (“HIV”); Mutual is a Nebraska corporation with its principal place of business in Omaha, Nebraska. Mutual offers and sells its insurance directly to members of the public at various office locations.

Both Doe and Smith hold Mutual health insurance policies that place significant limits on the amount of benefits available to individuals suffering from Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Conditions (ARC) (“AIDS/ARC caps”). Doe’s policy limits recoverable benefits to a lifetime maximum of $100,000. Smith’s policy limits recoverable benefits to a lifetime maximum of $25,000. By contrast, each policy provides benefits for other medical care up to a lifetime maximum of $1,000,000. In addition, for medical conditions other than AIDS and ARC, Mutual will reinstate the million dollar maximum benefit and pay additional claims on the policy after the limit is reached, provided the insured does not incur any expenses for two consecutive calendar years.

Plaintiffs allege a number of ways the AIDS/ARC caps impact their ability to obtain continued medical care. According to medical guidelines published by the National Institutes of Health, HIV infection is best treated through early medical intervention, including antiretroviral therapies and related care aimed at reducing the levels of HIV in the body. Because Mutual considers expenses related to any treatment or care for HIV infection as part of the insured’s lifetime maximum benefit for AIDS or ARC, the benefits caps adversely affect plaintiffs’ ability to obtain the recommended medical care, including the initiation and continuation of antiretroviral therapies and related treatment. In particular, the AIDS/ARC caps *1191 place plaintiffs at substantial risk of exhausting their coverage in the near future. Once plaintiffs have reached the policy limits, they will be left without insurance benefits for all medical treatment related to AIDS or ARC. Thus, the policy caps not only impair the plaintiffs’ ability to make treatment decisions, but pose the risk of jeopardizing plaintiffs’ health by forcing an untimely interruption in medical treatment.

In Count I, plaintiffs allege that Mutual’s policy caps on AIDS and ARC benefits violate the ADA’s prohibition against discrimination on the basis of a disability because they deny plaintiffs the opportunity to participate in and benefit from the $1,000,000 lifetime maximum and potential reinstatement of benefits provided to insureds with other medical conditions. Count II alleges a violation of Section 364 of the IIC based on Mutual’s inability to support its coverage distinctions with reference to sound actuarial principles and actual experience. 215 ILCS 5/364. Mutual moves to dismiss the complaint pursuant to Fed.R.Civ.P. 12(b)(6).

DISCUSSION

1. Motion to Dismiss Standards

In ruling on a motion to dismiss, the court considers “whether relief is possible under any set of facts that could be established consistent with the allegations.” Bartholet v. Reishauer A.G., 953 F.2d 1073, 1078 (7th Cir.1992) (citing Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957)). A claim may be dismissed only if it is beyond doubt that under no set of facts would a plaintiff’s allegations entitle him to relief. Travel All Over The World, Inc., 73 F.3d at 1429 (7th Cir.1996); Venture Associates Corp. v. Zenith Data Systems Corp., 987 F.2d 429, 432 (7th Cir.1993) (citing Beam v. IPCO Corp., 838 F.2d 242, 244 (7th Cir. 1988)). The purpose of a motion to dismiss is to test the sufficiency of the complaint, not to decide its merits. Gibson v. City of Chicago, 910 F.2d 1510, 1520 (7th Cir.1990).

II. Scope of Title III of the ADA

This case presents a novel threshold issue of statutory interpretation under Title III of the ADA. 2 The issue is whether Title Ill’s prohibition against unlawful discrimination extends to the content of insurance policies offered directly through an insurer. Title Ill’s general anti-discrimination provision is found in § 302(a) of the ADA. 42 U.S.C. § 12182(a). The provision reads:

No individual shall be discriminated against based on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation.

42 U.S.C. § 12182(a). 3 In Mutual’s view, the plain language of this provision dictates that Title III regulates only access to goods and services offered by places of public accommodation, as opposed to the content of the goods and services themselves.

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Cite This Page — Counsel Stack

Bluebook (online)
999 F. Supp. 1188, 1998 U.S. Dist. LEXIS 4894, 1998 WL 166856, Counsel Stack Legal Research, https://law.counselstack.com/opinion/doe-v-mutual-of-omaha-insurance-ilnd-1998.