ACLU of Missouri and Zuckerman Spaeder Sue Jack Henry & Associates, UMR, and Quantum Health Claiming Unlawful Denial of Medically Necessary Treatment for Transgender Woman
Partnering with the ACLU of Missouri, Zuckerman Spaeder LLP has brought a lawsuit against Jack Henry & Associates, Inc., The Jack Henry & Associates, Inc. Group Health Benefit Plan, UMR, Inc., and Quantum Health, Inc., on behalf of a transgender woman who was denied insurance coverage for facial feminization surgery (FFS), a type of gender transition treatment that was prescribed by her health care providers.
The plaintiff is employed by Jack Henry & Associates. Jack Henry & Associates sponsors plaintiff’s health benefit plan, which is administered by UMR and Quantum. According to the complaint, the plaintiff’s ERISA-governed health insurance plan covers medically necessary gender transition surgery, as well as treatment for gender dysphoria, a “mental health condition characterized by psychological distress arising from an incongruence between one’s sex assigned at birth and one’s gender identity.” Nevertheless, the complaint alleges, the defendants denied the plaintiff’s request for coverage after misinterpreting the plan document and applying coverage criteria that conflict with prevailing medical standards. The complaint alleges this denial violated the terms of the plaintiff’s health plan and constituted a breach of defendant’s fiduciary duties to the plaintiff.
The complaint alleges that the defendants relied on UnitedHealthcare’s “Gender Dysphoria Policy” to deem the plaintiff’s prescribed FFS surgery a “Cosmetic Treatment,” even though her plan explicitly states that gender transition surgeries are covered and that the exclusion for cosmetic treatment does not apply to services that are otherwise covered under the plan. According to the complaint, the defendants also violated the federal Mental Health Parity and Addiction Equity Act by classifying FFS as a cosmetic treatment without allowing for individual assessment and by imposing “separate and more restrictive limitations” for facial surgeries prescribed to treat gender dysphoria—a mental health condition—than for surgeries that treat medical conditions.
“Due to the unlawful denial of benefits for a medically necessary treatment that should be covered under her plan, our client is faced with two grim options,” said Zuckerman Spaeder partner Caroline E. Reynolds. “She’s forced to pay out of pocket for her surgeries, imposing a severe financial burden, or to continue to suffer the psychological distress and functional impairment caused by her untreated mental health condition. No one should have to make this choice, especially when they have an insurance plan that says it covers their treatment.”
The complaint also alleges that the defendants discriminated against the plaintiff concerning compensation and privileges of employment based on her transgender status and sex, and failed to extend equally comprehensive coverage to cisgender and transgender employees, violating Title VII of the Civil Rights Act, the American Disabilities Act, and the Missouri Human Rights Act.
This lawsuit is part of Zuckerman Spaeder’s national effort to hold health insurers accountable for wrongful denials of mental health claims. The firm has successfully brought numerous lawsuits against UnitedHealth entities and other insurers for treatment denials related to major depressive disorder, eating disorders, autism, and more. The complaint was filed yesterday evening in the U.S. District Court for the Western District of Missouri Southern Division by Zuckerman Spaeder attorneys, partner Caroline E. Reynolds and associate Leila Bijan, and ACLU of Missouri Legal Director, Anthony E. Rothert and Deputy Director for Litigation, Gillian R. Wilcox. The case is Sabrina Briony Duncan v. Jack Henry & Associates, Inc., The Jack Henry & Associates, Inc. Group Health Benefit Plan; UMR, Inc.; and Quantum Health, Inc., no. 6:21-cv-03280-WBG; the complaint can be found here.