George v. Doe

Background

Jason George and Timothy Gillen sued on behalf of the Operating Engineers Local #49 Health and Welfare Fund. The Fund maintains a self-insured, multiemployer employee welfare benefit plan that provides health and welfare benefits. John Doe is a Fund beneficiary and Plan participant.

Doe sought reimbursement of $6,442.73 for expenses incurred after his adult dependent, who was covered by the Plan, received an outpatient bilateral mastectomy and nipple graft surgery to treat gender dysphoria. The Plan denied the request under exclusions for expenses related to transgender treatment and diagnosis and for sex transformation. Doe appealed the denial to the Fund’s Board. The Board appointed an Appeals Committee, whose members included the plaintiffs, but no final decision had been issued when the plaintiffs filed this lawsuit.

Doe argued that the exclusions violated several state and federal antidiscrimination laws, including Title VII of the Civil Rights Act, the Americans with Disabilities Act, Section 1557 of the Affordable Care Act, and the Minnesota Human Rights Act. The plaintiffs sought declarations about the exclusion’s enforceability and the laws’ applicability, a ruling about their fiduciary duties in administering the Plan, and injunctions concerning the Plan’s exhaustion provision, possible claims against the Fund, and limitations periods.

Ripeness of Counts I and II

The court analyzed whether the first two counts were ripe, meaning sufficiently developed for a court to decide. The court explained that a declaratory-judgment claim requires a real and immediate dispute, not one dependent on future events that may not happen. Ripeness has two parts: whether the issues are fit for judicial decision and whether withholding review would cause hardship.

The court found that the issues were not fit for decision because the plaintiffs had not yet made a final decision on Doe’s appeal. The plaintiffs were seeking an advisory opinion about hypothetical events that might occur if they later denied the appeal. The court also found no sufficient hardship. The possibility that Doe might eventually sue was speculative, particularly because he would first need a right-to-sue letter from the Equal Employment Opportunity Commission. The court therefore dismissed Counts I and II without prejudice because they were not ripe.

Injunctive Relief in Counts III and IV

Counts III and IV sought injunctions against Plan participants and John Doe. The court held that these requests depended on the court exercising jurisdiction over Counts I and II. Because Counts I and II were dismissed as unripe, the requested injunctive relief was moot, meaning it no longer presented a live dispute for the court to decide. The court dismissed Counts III and IV without prejudice.

Disposition

The court granted John Doe’s motion to dismiss under Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6). It ordered that the matter be dismissed without prejudice and directed that judgment be entered.