Transgender N.C. Woman Challenges Insurance Company Over Short-Term Disability Claim

A transgender North Carolina woman who was denied short-term disability benefits after she had facial feminization surgery has settled with her insurance company.

Lina Kok, 47, had the surgery in Nov. 2010 as part of her transition. She submitted a short-term disability claim to Prudential, the company that administers her health insurance plan, because she had expected that she would not be able to work for three weeks after she underwent the procedure. Prudential denied her claim, arguing that reconstructive facial feminization surgery was a cosmetic procedure that was not medically necessary.

The company rejected Kok's two subsequent appeals, but it finally approved her claim on Sept. 30.

"My doctor and I both believed that this surgery was absolutely medically necessary for my well-being," said Kok. "Since adolescence, I struggled with seeing my face become more and more male. Now the outside matches, which makes me feel whole. For the first time in 47 years, I feel like the world sees me as the woman I am."

In its settlement with Prudential, the Transgender Legal Defense and Education Fund pointed out that the World Professional Association for Transgender Health acknowledges facial plastic reconstruction and other sex reassignment procedures are "medically necessary" to treat gender dysphoria, which is also known as Gender Identity Disorder. The U.S. Tax Court upheld this standard in 2010 when it ruled that trans-specific surgery is tax deductible

The Minnesota Supreme Court in 1977 struck down state Medicaid's blanket exclusion for sex reassignment surgery, but state lawmakers subsequently passed a law in 2005 that barred SRS coverage. State Medicaid still covers therapy and hormones.

The California Court of Appeals ruled in 1978 that the state's Medicaid program must cover SRS because it cannot be as a cosmetic procedure. The Eighth U.S. Circuit Court of Appeals struck down Iowa's blanket exclusion for sex reassignment surgery in 1980. State lawmakers subsequently passed another regulation that excludes SRS, but covers hormones. A New Jersey judge ruled in 1992 that the Garden State's Medicaid program must cover the procedure.

Lambda Legal and the American Civil Liberties Union filed a federal lawsuit in 2006 on behalf of three incarcerated trans women who challenged Wisconsin's law that barred access to hormone therapy, sex reassignment surgery and other trans-specific procedures while in custody. The Seventh U.S. Circuit Court of Appeals in Chicago in August upheld a lower court's ruling that the law was unconstitutional.

"Transgender-related health care is medically necessary care, and it should be treated that way in all respects," said TLDEF staff attorney Noah Lewis. "No one should be denied benefits based on the incorrect view that transgender-related health care is optional or cosmetic. Transgender employees simply want the same benefits as any other employee."