Rochelle Saks v. Franklin Covey Co. And Franklin Covey Client Sales, Inc.

316 F.3d 337, 29 Employee Benefits Cas. (BNA) 2185, 2003 U.S. App. LEXIS 549, 83 Empl. Prac. Dec. (CCH) 41,309, 90 Fair Empl. Prac. Cas. (BNA) 1266, 2003 WL 122396
CourtCourt of Appeals for the Second Circuit
DecidedJanuary 15, 2003
DocketDocket 00-9598
StatusPublished
Cited by199 cases

This text of 316 F.3d 337 (Rochelle Saks v. Franklin Covey Co. And Franklin Covey Client Sales, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rochelle Saks v. Franklin Covey Co. And Franklin Covey Client Sales, Inc., 316 F.3d 337, 29 Employee Benefits Cas. (BNA) 2185, 2003 U.S. App. LEXIS 549, 83 Empl. Prac. Dec. (CCH) 41,309, 90 Fair Empl. Prac. Cas. (BNA) 1266, 2003 WL 122396 (2d Cir. 2003).

Opinion

JOHN M. WALKER, JR., Chief Judge.

This case raises the question of whether unlawful discrimination occurs when a woman is denied coverage for infertility treatments that can only be performed on women. After plaintiff-appellant Rochelle Saks was denied coverage for certain infertility procedures under her employee health benefits plan, she sued her employer, Franklin Covey Client Sales, Inc., and its parent company, Franklin Covey Co. (collectively, “Franklin Covey”), claiming that the denial of coverage constituted a breach of her contractual rights and violated her civil rights under Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e, et seq., the Pregnancy Discrimination Act (“PDA”), 42 U.S.C. § 2000e(k), the Americans with Disabilities Act (“ADA”), 42 U.S.C. § 12101, et seq., and the New York Human Rights Law, N.Y. Exec. Law § 290, et seq. The United States District Court for the Southern District of New York (Colleen McMahon, Dis *341 trict Judge) granted Franklin Covey’s motion for summary judgment on the grounds that (1) the lack of coverage for the contested infertility procedures — specifically, artificial insemination, in vitro fertilization, and in útero insemination—does not violate any of the federal statutes and (2) Saks’s state law claims were preempted by ERISA. See Saks v. Franklin Covey Co., 117 F.Supp.2d 318, 327-28, 329, 330 (S.D.N.Y.2000).

With respect to Saks’s Title VII and PDA claims, although we differ with the district court’s analysis in several important respects, we affirm the grant of summary judgment in favor of Franklin Covey. As to the preemption of Saks’s state law claims by ERISA, we remand to the district court for further proceedings.

BACKGROUND

I. Relevant Facts

Franklin Covey employed Saks as a store manager from March 1995 until she resigned in October 1999. During her tenure of employment, Saks was a member of Franklin Covey’s self-insured health benefits plan (“the Plan”), which provided coverage to full-time employees and their dependents. Claims under the Plan were handled through The TP A, Inc. (“TPA”), a third-party processing agent hired by Franklin Covey.

Under the Plan, an employee is entitled to benefits for “medically necessary” procedures, which are defined as “[a]ny service ... required for the diagnosis or treatment of an active illness or injury that is rendered by or under the direct supervision of the attending physician.” Franklin Covey Medical/Dental Plan 78 (1998) (“Franklin Covey Plan”). The Plan defines an active illness as “[a]ny bodily sickness, disease, mental/nervous disorder or pregnancy.” Id. at 77.

Under the Plan, Franklin Covey employees may claim benefits for a variety of infertility products and procedures, such as ovulation kits, oral fertility drugs, penile prosthetic implants (when certified by a physician to be medically necessary), and nearly all surgical infertility treatments. See id. at 46, 49, 52. Examples of covered surgical infertility treatments include procedures to remedy conditions such as var-iococeles (varicose veins in the testicles causing low sperm count), blockages of the vas deferens, endometriosis, and tubal occlusions. The Plan expressly excludes coverage for “[s]urgical impregnation procedures, including artificial insemination, in-vitro fertilization or embryo and fetal implants” (collectively, “surgical impregnation procedures”), even if medically necessary. Id. at 49, 52. However, once pregnancy is achieved, whether by covered or uncovered means, all pregnancy-related costs are covered. See Saks, 117 F.Supp.2d at 329.

During her employment with Franklin Covey, Saks attempted unsuccessfully to have a child with her husband. Under the care of several reproductive endocrinologists, Saks followed various courses of action, including (1) the use of ovulation kits, (2) the administration of the drug Clomid in order to induce and regulate ovulation, (3) intrauterine inseminations (“IUIs”), (4) in vitro fertilization (“IVFs”), (5) the use of progesterone and estrogen, (6) the administration of several injectable fertility drugs, such as Humagon, and (7) blood tests and ultrasounds in order to monitor the potentially harmful side effects of the drugs prescribed to her. See id. at 321-23. Saks achieved pregnancy in September 1997 and again in August 1999, but unfortunately each pregnancy ended in a miscarriage. See id. at 322-23. In April 1999, Saks also had a chemical pregnancy (one marked by a hormonal change but not confirmed by an ultrasound) that was not sustained. See id. at 323.

*342 Saks sought reimbursement from the TPA for all of the costs associated with her infertility treatments. For-the purposes of the summary judgment motion, -Franklin Covey did not dispute that infertility is an illness as defined by the Plan or that surgical impregnation procedures were “medically necessary” to treat Saks’s infertility problems. See id. at 320 & n. 1. The TPA refused to reimburse Saks for a great many of the costs, including all of the IUIs, IVFs, injectable fertility drugs, and tests necessary to monitor the potential side effects of the drugs. 1 See id. at 322-23. Compensation for the IUIs and IVFs was denied based on the Plan’s express exclusion of coverage for surgical impregnation techniques. Although the costs of non-insulin injectable drugs are generally covered under the Plan, the TPA rejected Saks’s claims for the injectable fertility drugs and the drug-related monitoring because they were used in conjunction with the surgical impregnation procedures. See Franklin Covey Plan 49; Clarke Dep. 140-43, 161, 166-67. After filing a charge against Franklin Covey with the EEOC, Saks initiated the instant action.

II. District Court Decision

In the district court, Saks alleged that Franklin Covey breached its contractual obligations and that the Plan’s exclusion of coverage for surgical impregnation procedures violates the ADA, Title VII, the PDA, and the New York Human Rights Law. Of specific relevance to this appeal, Saks argued that the Plan violates the PDA, which prohibits discrimination on the basis of pregnancy and “related medical conditions,” because the Plan’s benefits for infertility treatments are inferior to its coverage for non-pregnancy-related illnesses. Saks also argued that the Plan discriminates on the basis of sex, in violation of Title VII, because it provides incomplete coverage for surgical treatments that address female infertility but provides complete coverage for surgical procedures that remedy male infertility.

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316 F.3d 337, 29 Employee Benefits Cas. (BNA) 2185, 2003 U.S. App. LEXIS 549, 83 Empl. Prac. Dec. (CCH) 41,309, 90 Fair Empl. Prac. Cas. (BNA) 1266, 2003 WL 122396, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rochelle-saks-v-franklin-covey-co-and-franklin-covey-client-sales-inc-ca2-2003.