Doe V. Mutual Of Omaha Insurance Company Faq
What are the facts of the case? John Doe, a 61-year-old HIV-negative gay man, applied to Mutual of Omaha for long-term care insurance in November 2014. Mutual of Omaha denied his application in February 2015 solely because he is taking a medication called Truvada that has been approved by the Food & Drug Administration (FDA) and recommended by public health authorities to prevent HIV infection in people who are HIV negative. The company rejected his appeal in April 2015, and he filed a complaint at the Massachusetts Commission Against Discrimination on September 16, 2015.
What is Truvada? Truvada is a medication which was first approved by the FDA as a treatment for HIV infection in 2004, and then as a preventative medication, or PrEP in 2012.
What is PrEP? PrEP, which stands for Pre-Exposure Prophalaxis, is a means of controlling and preventing the spread of HIV. It includes medication, regular HIV testing, and sexual health counseling.
Does Truvada work? Current scientific information indicates that PrEP dramatically reduces the risk of HIV transmission in numbers approaching 100% — higher than condoms or any other biomedical prevention intervention when consistently used. Most recently, Kaiser Permanente released results of a study in which it followed 657 users of Truvada for two years, and found that not one had become infected during that time.
What was Mutual of Omaha’s objection to Truvada? It is clear from Mutual of Omaha’s denial that Mr. Doe would have received insurance coverage if he had not been on Truvada. This irrational result leads to the conclusion that negative attitudes about HIV and gay male sexuality, rather than sound underwriting principles, were at play here.
Who is the plaintiff? The plaintiff, John Doe, is an HIV-negative 61-year-old gay man in Boston.
What is the legal argument? The complaint argues that Mutual of Omaha discriminated against John Doe on the basis of disability and sexual orientation, in violation of Massachusetts law.
Why disability? The Massachusetts disability anti-discrimination law, like the federal Americans with Disabilities Act, covers people who do not have a health condition but are discriminated against based on myths, stereotypes, and irrational ideas about a health condition. While John Doe is HIV-negative, Mutual of Omaha made its decision based on myths and unscientific ideas about HIV and its transmission.
Why sexual orientation? Mutual of Omaha’s action was based on the unfounded assumption that gay male sexuality is inherently risky and unhealthy.
Why is John Doe taking Truvada? John Doe is taking Truvada in order to protect himself and others from HIV infection.
Why did John Doe apply for long-term care insurance? Doe’s experience caring for his own elderly parents, and his partner’s mother at the end of their lives, was eye-opening. He realized how costly long term care is, and how much is often provided by adult children, which he and his partner do not have.
Why is this case important? We are not going to end the HIV epidemic if we allow discrimination against people who act responsibly and use PrEP. It is critical to remove needless barriers to the use of this prevention breakthrough, which has the potential to end the epidemic.