Philly BC Alleges Discrimination Over Denial of Gender Affirming Coverage

A Philadelphia battalion chief has filed suit against the city, IAFF Local 22, Local 22’s Health Plan, and Independent Blue Cross alleging gender discrimination by denying her “gender-affirming care and treatment.” The chief, identified in the complaint as Jane Doe, filed suit in US District Court for the Eastern District of Pennsylvania.

The suit alleges violation of Title VII of the Civil Rights Act of 1964; violation of Philadelphia Fair Practices Ordinance; gender discrimination under the Affordable Care Act, 42 U.S.C. § 18116; disability discrimination under the Affordable Care Act; violation of the Americans with Disabilities Act; disability discrimination under the Philadelphia Fair Practices Ordinance; a violation of the Employee Retirement Income Security Act (ERISA); failure to accommodate under the Americans with Disabilities Act; and failure to accommodate under the Philadelphia Fair Practices Ordinance.

Quoting from the introductory statement of the complaint:

• Plaintiff is a firefighter—a Battalion Chief—who has worked for Defendant, the City of Philadelphia, as a long-time, faithful employee for approximately twenty-eight (28), going on twenty-nine (29) years, of employment.
• Plaintiff is a well-respected, active member in good standing of her local union, the Firefighters & Paramedics Local 22.
• Despite her contributions to this City, over the course of almost three (3) decades of employment, Defendants intentionally discriminated against Plaintiff on the basis of her gender identity and continue to cause her harm.
• Defendants, the Firefighters & Paramedics Local 22 and/or the City of Philadelphia operate a categorical plan exclusion for gender-affirming care and treatment, including excluding a series of procedures known as Facial Feminization Surgery (“FFS”), for transgender women who suffer from gender dysphoria (“GD”), in the Defendants’ self-funded employer-sponsored health plan.
• Defendant, Independence Blue Cross, underwrites and administers the plan including the aforementioned discriminatory plan exclusion.
• Despite Plaintiff’s request for pre- authorization/certification, her first-level appeal/grievance, and even her second-level appeal grievance, Defendants refused to provide Plaintiff the requested coverage for facial feminization surgery (“FFS”).
• Defendant, Independence Blue Cross, refused to provide Plaintiff the requested coverage even in the face of two (2) similar lawsuits seeking FFS as a medically necessary and covered service.
• Defendants made several pretextual requests and forced Plaintiff to face unnecessary obstacles to secure coverage from Defendants for medically-necessary gender-affirming care and treatment, which should have been covered in the first instance, including forcing Plaintiff to expend time, effort, and money researching and securing counsel to file an appeal on her behalf.
• Defendants then forced Plaintiff to submit a new pre-authorization/certification request despite Plaintiff previously submitting a pre-authorization/certification request, which was previously denied on account of discrimination by the Defendants.
• In conclusion, Plaintiff, Ms. Doe, was forced to maintain natal sex characteristics with which she no longer identified by virtue of the Defendants’ callous and discriminatory acts committed against her.
• Ms. Doe found it difficult to function at work and in public and is constantly misgendered because, without FFS, she is read as not passing or not conforming to the sex assigned to her at birth. She became suicidal and considered ending her life.
• Plaintiff therefore seeks compensatory and punitive damages against Defendants. Plaintiff also seeks coverage for FFS, hair transplant, and related procedures, that are medically- necessary and life-saving gender-affirming treatments, moving forward, in the form of future medical expenses.

Chief doe is seeking an award of damages, reimbursement for out-of-pocket expenses, injunctive relief to grant permission for her requested procedures, injunctive relief for others with gender dysphoria, court-ordered policy changes in each defendant-agency, and “an order for Defendants to hold LGBT sensitivity trainings for employees, claims agents, representatives, and specialists.”

Here is a copy of the complaint: