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Tovar v. Essentia Health

United States Court of Appeals, Eighth Circuit

May 24, 2017

Brittany R. Tovar Plaintiff- Appellant
Essentia Health; Innovis Health, LLC, doing business as Essentia Health West; HealthPartners, Inc.; HealthPartners Administrators, Inc. Defendants-Appellees Transgender Legal Defense and Education Fund; Whitman Walker Health; World Professional Association for Transgender Health Amid on Behalf of Appellant (s)

          Submitted: March 7, 2017

         Appeal from United States District Court for the District of Minnesota - Minneapolis

          Before BENTON, BEAM, and MURPHY, Circuit Judges.

          MURPHY, Circuit Judge.

         Brittany Tovar was employed by defendant Essentia Health or defendant Innovis Health, LLC, dba Essentia Health West (collectively, Essentia) from 2010 to 2016. One of the benefits of Tovar's employment was enrollment in an employer provided health insurance plan which also covered her teenage son. In 2014 Tovar's son was diagnosed with gender dysphoria. Tovar sought coverage for medications and surgery for her son, but her requests for coverage were denied on the basis of a categorical exclusion in the insurance plan for "[s]ervices and/or surgery for gender reassignment." Tovar then filed this lawsuit against Essentia and the plan's third party administrator for sex based discrimination in violation of Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e et seq., the Minnesota Human Rights Act (MHRA), Minn. Stat. § 363A.01 et seq., and the Affordable Care Act (ACA), 42 U.S.C. § 18116. The defendants moved to dismiss Tovar's claims, and the district court granted their motions. Tovar appeals. We affirm in part, reverse in part, and remand for further proceedings.


         Brittany Tovar is a nurse practitioner who was employed by Essentia from 2010 to 2016. Tovar's benefits as an employee of Essentia included health insurance provided through the Essentia Health Employee Medical Plan (the plan). The plan corresponded to an insurance policy offered to employers by HealthPartners, Inc. and was administered either by HealthPartners, Inc. or by its subsidiary HealthPartners Administrators, Inc. (HPAI).

         In 2014 Tovar's teenage son became a beneficiary of the plan. Later that year Tovar's son was diagnosed with gender dysphoria, a condition that arises when an individual's gender identity differs from the gender assigned at birth. Health professionals decided that various treatments were necessary to treat her son's condition, including medications and gender reassignment surgery. Tovar sought coverage under the plan, but because the plan at that time categorically excluded coverage of "[s]ervices and/or surgery for gender reassignment, " the defendants declined to pay for her son's treatment. The coverage dispute caused Tovar "worry, anger, disappointment, and sleepless nights, " made it "more difficult for her to focus on her work, " and led her to suffer "a sharp increase in migraines." Tovar also paid herself for at least one of her son's prescribed medications although Essentia "later agreed to provide Tovar with coverage for [that medication] as a one-time exception" to its categorical bar on coverage. Tovar's son was forced to forgo another prescribed medication that the family was unable to pay for and was unable to go forward with gender reassignment surgery.

         Tovar filed this lawsuit in January 2016. Her complaint charged Essentia with sex discrimination in violation of Title VII and the MHRA and charged HealthPartners, Inc. with discrimination in violation of the ACA. The defendants moved to dismiss the complaint. The district court granted the defendants' motions, concluding that Tovar's claims against Essentia failed for lack of statutory standing and that her claim against HealthPartners, Inc.[1] failed for lack of Article III standing. Tovar appeals.



         Tovar argues that the district court erred by dismissing her claims against Essentia under Title VII and the MHRA for lack of "statutory standing." The Supreme Court has recently commented that it has observed confusion about the concept of standing and has suggested that the use of that term in conjunction with anything other than the "irreducible constitutional minimum of standing" provided by Article III should be disfavored. See Lexmark Int'l, Inc. v. Static Control Components, Inc., 134 S.Ct. 1377, 1386-87 & n.4 (2014) (quoting Lujan v. Defs. of Wildlife, 504 U.S. 555, 560 (1992)). Although the term "statutory standing" may be subject to some confusion, its purpose is clear: a plaintiff who seeks relief for violation of a statute must "fall[] within the class of plaintiffs whom Congress has authorized to sue" under that statute. See id. at 1387. Determining whether this requirement is satisfied is "a straightforward question of statutory interpretation." Id. at 1388. If a court determines that Congress has not provided a statutory cause of action in a particular case, it may be subject to dismissal under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim. See, e.g., Leyse v. Bank of Am. Nat'l Ass'n, 804 F.3d 316, 320 (3d Cir. 2015); Minden Pictures, Inc. v. John Wiley & Sons, Inc., 795 F.3d 997, 1001 (9th Cir. 2015).

         We review a district court's dismissal of a complaint under Rule 12(b)(6) "de novo, accepting as true the factual allegations contained in the complaint and granting [the plaintiff] the benefit of all reasonable inferences that can be drawn from those allegations." Gomez v. Wells Fargo Bank, N.A., 676 F.3d 655, 660 (8th Cir. 2012). To avoid dismissal, "a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face." Id. (quoting Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009)). The requirement of facial plausibility is satisfied "when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Iqbal, 556 U.S. at 678.

         In this case the district court concluded that Tovar's complaint failed to state a claim for relief under Title VII and the MHRA because she does not fall within the class of plaintiffs these statutes protect. Specifically, Title VII prohibits an employer from discriminating "against any individual with respect to his compensation, terms, conditions, or privileges of employment, because of such individual's . . . sex." 42 U.S.C. § 2000e-2(a) (emphasis added). The court concluded that because Tovar had not alleged her employer discriminated against her on the basis of her own sex, but rather alleged discrimination against her on the basis of her son's sex, her complaint failed to state a claim for relief under Title VII. Similarly, the MHRA makes it illegal for an employer to discriminate against someone because of her sex with respect to her terms, conditions, or privileges of employment. Minn. Stat. § 363A.08, subd. 2(3). The MHRA further states that "[a]ny person aggrieved by a violation of this chapter may bring a civil action." Id. § 363A.28, subd. 1. The district ...

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