Metro Weekly

Transgender retiree sues New York county for denying insurance coverage

Lawsuit claims exclusionary health care plan violated various federal and state nondiscrimination laws

Sean Simonson – Photo: Lambda Legal.

A retired transgender employee of a county in upstate New York is suing the county for denying him health insurance coverage for his transition-related care.

Sean Simonson, a former case worker for the Oswego Department of Social Services for nearly 30 years, was diagnosed with gender dysphoria in February 2015, after which he began taking steps to transition, including legally changing his name. As part of his doctor-recommended treatment for gender dysphoria, Simsonson was to be placed on hormone replacement therapy and receive a double mastectomy.

However, Simonson was denied coverage because of a discriminatory exclusion in his county-provided health insurance plan that prohibits money from being used for treatments like hormones or gender confirmation surgery. Simonson and his doctor appealed to the insurance company, and eventually filed a complaint with the Equal Employment Opportunity Commission.

The EEOC subsequently issued a determination in June finding reasonable cause to believe that Oswego County and the Oswego Department of Social Services had discriminated against Simonson “due to his sex (transgender status/gender identity) in violation of Title VII.” Lambda Legal, on behalf of Simonson, notified the New York Attorney General’s Civil Rights Bureau, which launched an investigation into the case.

In November, New York Attorney General Eric Schneiderman announced a settlement with Oswego County to ensure that transgender employees and retirees have access to medically necessary health care coverage through their employer-sponsored health plan. As part of that settlement, Oswego County has agreed to eliminate the exclusion of transition-related care from the health plan, extend a new benefit covering transition-related care for county employees and retirees, and provide annual training for county employees and employees of its benefits administrator concerning the new benefit.

Unfortunately, the agreement does not include compensation for current and former employees who have already been denied coverage under the old policy. As a result, Simonson and his lawyers from Lambda Legal filed a lawsuit to recoup some of the out-of-pocket costs he was forced to bear.

The lawsuit, which was filed in federal court, alleges that the county’s policy and the resulting denial of insurance coverage constitutes sex discrimination and violates federal and state laws, including the Fourteenth Amendment to the U.S. Constitution, Title VII of the Civil Rights Act, a portion of the Affordable Care Act, and New York’s nondiscrimination law.

“For years, Oswego County failed to comply with its legal obligation to treat its transgender employees with dignity and without bias. While Oswego County has finally rescinded its discriminatory policy, it simply is not enough to make up for the years of suffering Sean endured and the thousands of dollars he paid out-of-pocket from retirement savings because the County discriminated against him,” Omar Gonzalez-Pagan, a staff attorney and health care strategist at Lambda Legal said in a statement. “Oswego County needs to acknowledge and remedy the damage that has been done.

“Everyone should have access to health insurance that makes medical care affordable and accessible, especially when it has been promised as part of our employment compensation,” Gonzalez-Pagan added. “Unfortunately, transgender employees of Oswego County have been denied this right and instead been consigned to second-class-citizen status. Through this case we look to make it clear that such discriminatory treatment has consequences and can’t be tolerated.”

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John Riley is the local news reporter for Metro Weekly. He can be reached at jriley@metroweekly.com