Transgender Client Denied Access to Cancer Screenings Secures Insurance Coverage

April 27, 2012

On April 27, 2012, Cleary Gottlieb secured a favorable settlement for its pro bono client Ms. Scott, a transgender woman who had been denied coverage for a mammogram because of an exclusion in her employer’s insurance policy related to “changing sex or sexual characteristics.”

Cleary Gottlieb challenged the application of this exclusion to Ms. Scott’s mammogram on the grounds that the mammogram was not intended to change a sex characteristic, but instead constituted medically necessary care for a transgendered patient. As part of the settlement, Ms. Scott’s employer not only clarified its reading of the existing health plan language to ensure benefits to Ms. Scott for mammograms and similar procedures, but also committed to amend the health plan to be trans-inclusive. The insurance company that processes claims for Ms. Scott’s employer has reimbursed Ms. Scott for the mammogram and has agreed to assign a liaison who will be informed about Ms. Scott’s rights under the amended policy to ensure that she will not be denied the coverage to which she is entitled.

Cleary Gottlieb represented Ms. Scott in partnership with the Transgender Legal Defense & Education Fund.