SEATTLE (LN) — A Washington Court of Appeals panel on Monday reversed a trial court’s dismissal of a class-action lawsuit alleging that Kaiser discriminated against patients with obesity by denying coverage for prescribed weight-loss medication.
Kurt Herzog sued Kaiser on behalf of a putative class. He claimed the insurer violated the Washington Law Against Discrimination and the Consumer Protection Act by refusing to cover Victoza, a drug his doctor prescribed as medically necessary to treat his obesity.
The trial court had dismissed the case, ruling that state insurance regulations authorized Kaiser to exclude obesity treatments from its plan. The appeals court rejected that reasoning, holding that the regulations govern actuarial value calculations rather than establishing an exception to state anti-discrimination laws.
Under Washington law, obesity is a recognized disability. The court held that while insurers may exclude coverage for clinical or cost-benefit reasons, they cannot exclude coverage simply because the treatment addresses a specific disability.
The panel cited its decision in a companion case, Simonton v. HCA, issued the same day. That decision held that compliance with federal and state essential health benefit mandates does not guarantee compliance with nondiscrimination requirements.
Kaiser’s plan explicitly excludes “obesity treatment and treatment for morbid obesity for any reason,” including medications, except for bariatric surgery and screening services. The insurer denied Herzog’s claim for Victoza, stating that medications used for weight loss are not covered under his plan.
The court reversed the dismissal and remanded the case for further proceedings.