A federal appeals court has upheld a lower court’s ruling that a Georgia county illegally discriminated against a sheriff’s deputy by failing to pay for her gender-affirming surgery.

In its ruling Monday, the U.S. Court of Appeals for the Eleventh Circuit said it was tasked with determining whether a health insurance provider can be held liable under the Civil Rights Act of 1964 for denying coverage for a procedure because an employee is transgender. The three-judge panel decided in a 2-1 vote that it can and that the lower court had ruled correctly.