Court Opinion

ID: 9492217
Source: CourtListenerOpinion
Date Created: 2023-08-05 14:35:08.326315+00
Date Added: 2024-06-11T17:55:10.912149
License: Public Domain

TERENCE T. EVANS, Circuit Judge,
dissenting.
The Americans with Disabilities Act is a broad, sweeping, protective statute requiring the elimination of discrimination against individuals with disabilities. See Talanda v. KFC Nat’l Management Co., 140 F.3d 1090 (7th Cir.), cert. denied, — U.S. —, 119 S.Ct. 164, 142 L.Ed.2d 134 (1998). Because I believe the insurance policies challenged in this case discriminate against people with AIDS in violation of the ADA, I dissent.
The majority believes we are being asked to regulate the content of insurance policies — something we should not do under the ADA. But as I see it we are not being asked to regulate content; we are being asked to decide whether an insurer can discriminate against people with AIDS, refusing to pay for them the same expenses it would pay if they did not have AIDS. The ADA assigns to courts the task of passing judgment on such conduct. And to me, the Mutual of Omaha policies at issue violate the Act.
Chief Judge Posner’s opinion likens the insurance company here to a camera store forced to stock cameras specially designed for disabled persons. While I agree that the ADA would not require a store owner to alter its inventory, I think the analogy misses the mark. The better analogy would be that of a store which lets disabled customers in the door, but then refuses to sell them anything but inferior cameras. To pick up on another analogy raised at oral argument, we are not being asked to force a restaurant to alter its menu to accommodate disabled diners; we are being asked to stop a restaurant that is offering to its nondisabled diners a menu containing a variety of entrees while offering a menu with only limited selections to its disabled patrons. Section 501(c)’s “safe harbor” would allow Mutual of Omaha to treat insureds with AIDS differently than those without AIDS if the discrimination were consistent with Illinois law or could be justified by actuarial principles or claims experience. But Mutual of Omaha conceded that its AIDS and ARC caps do not fall under the ADA’s safe harbor protection.
The parties stipulated that the very same affliction (e.g., pneumonia) may be both AIDS-related and not AIDS-related and that, in such cases,' coverage depends solely on whether the patient has AIDS. In my view that is more than enough to trigger an ADA violation. Chief Judge Pos-ner reasons that, although the policies appear to discriminate solely based on an insured’s HIV status, they really don’t, when you consider the nature of AIDS. He suggests that the phrase “AIDS related conditions” embodies a unique set of symptoms and afflictions that would make it easy for the insurance company to determine with certainty whether an expense incurred for a particular illness is “AIDS-related” and therefore subject to the cap. His analysis — charitable to Mutual of Omaha to be sure — may very well be medically sound. But it doesn’t come from the insurance policies. The policies don’t even hint at what illnesses or afflictions might fall within the ARC exclusion. Nor has the medical community embraced an accepted definition for what “conditions” are “AIDS-related.” The practical effect of all this, as Mutual of Omaha concedes, is that coverage for certain expenses would be approved or denied based solely on whether the insured had AIDS. Given that the ADA is supposed to signal a “clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities,” see 42 U.S.C. *566§ 12101(b)(1), I would use the statute to right the wrong committed by Mutual of Omaha.
I also part company with the majority on the McCarran-Ferguson Act analysis, and I think the faultiness of its conclusion is evident in the way the issue is framed. The Chief Judge writes: “It is one thing to say that an insurance company may not refuse to deal with disabled persons; the prohibition of such refusals can probably be administered with relatively little interference with state insurance regulation. ... It is another thing to require federal courts to determine whether limitations on coverage are aetuarially sound and consistent with state law.” Slip op. at 564. This is somewhat misleading because, as the majority acknowledges, the question of whether these caps are actuarially sound or consistent with state law has been taken out of the equation by Mutual of Omaha’s concession in the parties’ stipulation. Consistent with McCarran-Fergu-son we can — and we should — decide exactly what the majority seemed to think is permissible: whether an insurer may refuse to deal with disabled persons on the same terms as nondisabled persons. Because any conceivable justification for the caps (under section 501(c)) is not at issue, and because an insurer cannot legally decide to pay or not pay expenses based solely on whether an insured has AIDS and is therefore disabled under the ADA, I dissent from the opinion of the court.