Martha Garcia v. Pacificare of California, Inc.

This case involves a single issue: does an insurance company’s categorical exclusion of myoelectric prosthetics from a health insurance plan violate California Health & Safety Code § 1367.18? We have jurisdiction under 28 U.S.C. § 1291 and hold that such an exclusion does not violate this statute.

I. BACKGROUND

In 1989, eleven-year-old Martha Garcia (“Garcia”) contracted spinal meningitis, which necessitated the amputation of her hands at the wrists and her legs below the knees. From 1990 to 1996 she used body-powered/cable and harness upper-extremity prostheses. When she was a senior in high school she was fitted for myoelectric upper-extremity prostheses. The myoelectric prostheses “allowed [her] to live independently, obtain a college degree, and to work full time.”

Since 2006, Garcia has worked for the Regional Center of Orange County (“Regional Center”). When she began work at the Regional Center, she was included on her father’s Blue Cross health insurance policy that covered myoelectric prostheses. The Regional Center provided health care coverage through PacifiCare, which she selected because it allowed her to receive treatment from the same doctors and…