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Doe v. Mutual of Omaha Insurance Company

Doe v. Mutual of Omaha Insurance Company

Status:

Closed

Issues:

Health Care Fairness, HIV

Attorneys:

Plaintiffs

John Doe and Richard Smith (both anonymous)

Attorneys

Co-counsel/Cooperating Attorneys
Stuart Graff, Lisa Brown & Laura Weinberg of the Chicago law firm Schiff, Hardin & Waite; Ann Hilton Fisher of AIDS Legal Council of Chicago

Case arguing against a health insurance provider’s limiting policies for clients living with HIV

Summary

In 1998, Lambda Legal and the AIDS Legal Council of Chicago filed a lawsuit in federal court against Mutual of Omaha, a major health insurer, on behalf of two HIV-positive Chicago residents, John Doe and Richard Smith (who chose to remain anonymous). Doe’s Mutual of Omaha policy capped his lifetime benefits for HIV-related conditions at $100,000, while Smith’s were capped at just $25,000 — in contrast to their policies’ $1 million lifetime cap for other medical conditions. The lawsuit charged that limiting HIV-related health coverage violated both the Illinois Insurance Code and the federal Americans with Disabilities Act (ADA), which prohibits discrimination against people with disabilities (including HIV). The lawsuit also charged that the caps on HIV-related care affected Doe’s and Smith’s treatment decisions, forcing them to consider going without therapies that could prolong their lives. The trial judge ruled against Mutual of Omaha, finding that the caps on benefits violated the ADA. However, the company prevailed in federal appeals court, which found that the ADA’s protections against discrimination in public accommodations do not apply to insurance policies.

Context

Other insurers watched this case closely, and the appeals court’s decision severely limited the antidiscrimination protections of the ADA. Although some other legal protections exist, people with HIV continue to experience discrimination by health insurers.

Lambda Legal’s Impact

Though this case did not succeed on appeal, Lambda Legal and the AIDS Legal Council of Chicago received a strongly favorable judgment in the trial court, raising public awareness of health insurers’ unfair practices toward those with HIV.

History

  • January 1998 Lambda Legal and the AIDS Legal Council of Chicago file a lawsuit in federal court against Mutual of Omaha.
  • April 1998 The trial court rules that drastic restrictions on Mutual of Omaha’s coverage for HIV-related medical expenses are illegal under the ADA.
  • June 1999 An appeals court reverses the trial court’s decision and rules that insurance policies aren’t subject to the ADA.