## Facts

- Mutual of Omaha sold health insurance policies with a $1,000,000 lifetime maximum for most conditions.
- The policies imposed AIDS/ARC-specific lifetime caps of $25,000 in one policy and $100,000 in another.
- Plaintiffs John Doe and Richard Smith, individuals with HIV/AIDS, alleged the AIDS-specific caps provided them materially lower coverage than other insureds.
- Plaintiffs also alleged Mutual refused to reinstate AIDS-related benefits after the AIDS cap was exhausted, even though it would restore lifetime maximum benefits in other circumstances.
- Mutual conceded that HIV/AIDS is a disability under the ADA.
- On appeal, Mutual stipulated it had not shown and could not show the AIDS caps were consistent with sound actuarial principles, actual or reasonably anticipated experience, bona fide risk classification, or state law.

## Issues

1. Whether Title III of the ADA regulates the content of insurance policies, including disability-specific limits on coverage.
2. Whether AIDS-specific lifetime caps constitute discrimination “on the basis of disability” in the “full and equal enjoyment” of a public accommodation’s goods or services under 42 U.S.C. § 12182(a).

## Decision

- The Seventh Circuit reversed the district court and directed entry of judgment for Mutual of Omaha.
- The court held Title III primarily guarantees nondiscriminatory access to places of public accommodation and the ability to obtain offered goods and services, not judicial regulation of insurance policy terms.
- Because Mutual did not refuse to sell policies to individuals with AIDS and plaintiffs could purchase the same policies offered to the public, the challenged caps were treated as product design outside Title III’s reach.
- The court did not treat the absence of actuarial justification as dispositive because it found Title III did not cover the challenged policy terms.
- Judge Evans dissented, concluding Title III’s “full and equal enjoyment” can reach discriminatory coverage limits that single out a disability.

## Legal Principles

- Title III, 42 U.S.C. § 12182(a), principally prohibits exclusion of disabled persons from public accommodations and unequal access to the offered goods and services.
- Title III does not, without more, require a seller to alter the substantive content of the goods or services it offers to equalize outcomes for disabled customers.
- In the insurance context, allowing disabled individuals to purchase available policies on the same basis as others satisfies Title III’s core access requirement, even if policy terms differentiate among medical conditions.

## Conclusion

The Seventh Circuit held that ADA Title III does not authorize courts to invalidate disability-specific insurance coverage caps as discriminatory policy content where the insurer does not deny disabled individuals access to purchase its insurance products.


Doe v. Mut. of Omaha Ins. Co., 179 F.3d 557 (7th Cir. 1999)