1. Case Name: J. Doe v. Trustees of Indiana University et al., United States District Court, S.D. Indiana, July 3, 2013; Cause No. 1:12-cv-1593-JMS-DKL
- Counsel for Plaintiff:
- Counsel for Defendant:
3. Format: Published Memorandum and Order.
4. Outline: Plaintiff is the adult child of an employee of Indiana University who struggles with mental health disorders, including suicidal ideation and self-harm. Plaintiff brings this individual action against Defendant large employer health insurance plans that denied over $100,000 worth of insurance claims for Plaintiff’s care at several inpatient facilities including mental-health hospitals and non-hospital specialized inpatient facilities. The denials were not based on medical necessity but rather a categorical exclusion in the health plan denying coverage for residential treatment care. Plaintiff argues the categorical exclusion violates federal and state mental parity laws, anti-discrimination laws and breaches plan contracts. Additionally, Plaintiff claims that Defendant health insurer failed to provide required disclosures regarding the exclusion. Plaintiff seeks declaratory judgments, an injunction directing the Defendants to stop applying the exclusion and to make the disclosures, and monetary damages.
5. Legal Pointer: In this case, the Plaintiff filed a motion to proceed under a fictitious name, J. Doe. Plaintiff argued, and submitted an affidavit from her treating provider in support, that Plaintiff would suffer substantial harm if not permitted to proceed under the false name. Plaintiff argued that her mental health is not substantially recovered and that being identified would be detrimental to her treatment and her personal safety. The Defendants argued they would be prejudiced if Plaintiff proceeded under a false name.
6. Legal Issues and Causes of Action: Plaintiff alleges that Defendant’s actions violated federal and state mental health parity laws, anti-discrimination laws and breach of contract. Plaintiff filed a motion to proceed under a fictitious name which is the basis of the memorandum. Defendants argue that proceeding under a fictitious name would prejudice their defense.
- Ruling: The Plaintiff’s Motion is Granted in part and Denied in part.
7. Narrative Case Description: Plaintiff is an adult child covered under her parent’s insurance policy through their employer, Indiana University. Plaintiff suffers from mental illness with suicidal ideations and self-harm. Plaintiff received treatment at inpatient mental-health hospitals and residential treatment facilities. The claims for this treatment was denied based on Defendant’s categorical exclusion of treatment at residential facilities. Plaintiff filed a motion to proceed under a fictitious name in order to protect against potential harm that may result from being identified. Defendant challenged this motion arguing that they would be prejudiced if Plaintiff was permitted to move forward.
In considering whether to grant Plaintiff’s motion, the Court considered the following factors: 1) whether the plaintiff is challenging governmental activity; 2) whether the plaintiff would be required to disclose information of the utmost intimacy; 3) whether the plaintiff would be compelled to admit his or her intent to engage in illegal activity; 4) whether the plaintiff would risk suffering injury if identified; 5) whether the party defending against a suit would be prejudiced; 6) whether the interest of children are at stake; and 7) whether there are less drastic means of protecting legitimate interests. These factors are to be considered with an emphasis towards transparency.
Here, the Court found that the Plaintiff could move forward under the false name due to the substantial risk of physical and mental harm that could result. Defendants argued that their defense would be hindered in that Plaintiff must prove that Plaintiff is an individual with a disability and that Defendants intentionally discriminated against Plaintiff. However, the Court found that Defendants had not argued any facts on how the Plaintiff’s anonymity would hinder the defense. The Court did find that the Plaintiff did not show a need to seal Plaintiff’s gender or nature of the mental illness involved in the case and cautioned that the balancing of the interests could shift as the case progressed.
8. Additional Comments: The Court was wary to grant the Plaintiff’s motion based on the involvement of mental illness only. In other words, the Court cited Blue Cross & Blue Shield United of Wisconsin, which held that “the fact that a case involves a medical issue is not a sufficient reason for allowing the use of a fictitious name…” That case found that even where the medical issue involved mental health that the disorder was “not such a badge of infamy or humiliation in the modern world that its presence should be an automatic ground for concealing the identity of a party to a federal suit. To make it such would be propagate the view that mental illness is shameful.”
10. Practical Implications and Lessons Learned: As stated above, the key factor in granting the Plaintiff’s motion appears to be that it was argued Plaintiff had a substantial risk of harm.
11. All Legal Theories Presented in Case: Violations of MHPAEA, state mental health parity
12. Successful Legal Theories in Case: MHPAEA and state mental health parity claims were not discussed in depth