Whittemore v. Cigna Health & Life Ins. Co., 2026 WL 777418 (1st Cir. 2026)
The First Circuit has affirmed the dismissal of a lawsuit challenging a health plan’s exclusion of weight-loss drugs, holding that a participant did not plausibly allege she had a disability simply by stating she had been diagnosed with obesity and prescribed medication to treat it. The participant filed a proposed class action lawsuit against a health insurer, alleging disability discrimination under Affordable Care Act (ACA) Section 1557. The participant asserted that her obesity was a disability and that the insurer discriminated against her by designing and administering health plans that categorically excluded coverage for prescription weight-loss medications. (Section 1557 prohibits discrimination on grounds specified in several federal laws, including Section 504 of the Rehabilitation Act, which bars discrimination based on disability.) The district court dismissed the case, ruling that the participant had not plausibly shown that she was disabled merely as a function of her body mass index, nor that the insurer had ever regarded her as disabled.
The First Circuit affirmed the dismissal, but on different grounds. The court explained that to state a disability discrimination claim, the participant had to show she was disabled as defined by the Americans with Disabilities Act (ADA). The ADA defines disability as a physical or mental impairment that “substantially limits one or more major life activities.” The participant’s complaint alleged that her obesity substantially limited her in major life activities such as walking, standing, and sleeping. The court, however, concluded that these allegations were conclusory “threadbare recitals of the elements of a cause of action.” The court also rejected the participant’s argument that any individual diagnosed with obesity and prescribed medication for it is, by definition, substantially limited in the operation of major bodily functions, reasoning that such general statements about obesity’s potential health impacts do not plausibly support an inference that every person in that category is disabled under the ADA.
EBIA Comment: This case illustrates that a medical diagnosis alone does not automatically equate to a disability under Section 1557. An individual must demonstrate that the condition results in a substantial limitation of a major life activity under the ADA. While this ruling provides a potential defense against broad, factually unsupported discrimination claims related to plan exclusions, employers should continue to carefully review their plan terms for compliance with the ACA’s nondiscrimination rules and the ADA. For more information, see EBIA’s Health Care Reform manual at Section XXXIV.A (“Section 1557 Nondiscrimination: Grounds Prohibited Under Federal Laws”) and EBIA’s Group Health Plan Mandates manual at Section XXI.M.1 (“Interaction of Title VII and Affordable Care Act Section 1557”). See also EBIA’s Self-Insured Health Plans manual at Section XIII.D.5 (“Section 1557 Nondiscrimination: Nondiscrimination in Health Programs and Activities”).
Take your tax and accounting research to the next level with Checkpoint Edge and CoCounsel. Get instant access to AI-assisted research, expert-approved answers, and cutting-edge tools like Advisory Maps and State Charts. Try it today and transform the way you work! Subscribe now and discover a smarter way to find answers.
