Metro Weekly

New York’s Oswego County settles with transgender employee who was denied health care coverage

Going forward, transgender employees and retirees will be able to obtain coverage for medically necessary care

Sean Simonson – Photo: Lambda Legal.

An upstate New York county has settled a lawsuit brought against it by a retired transgender county employee who was denied insurance coverage for transition-related care.

Oswego County and the Oswego County Department of Social Services have agreed to compensate Sean Simonson, a former case worker for the county, for out-of-pocket medical expenses he incurred after the country’s health insurance plan refused to cover his gender confirmation surgery.

Simonson 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 placed on hormone replacement therapy and urged to receive a double mastectomy.

However, Simonson was denied coverage because of a discriminatory exclusion in his county-provided health insurance plan — which has since been eliminated — that refused to cover the cost of hormones or gender confirmation surgery, deeming them cosmetic rather than medically necessary. Both Simonson and his doctor appealed to the insurance company, which rejected the appeals, and Simonson eventually filed a complaint against the county with the U.S. Equal Employment Opportunity Commission.

In June 2017, the EEOC issued a determination finding reasonable cause to believe that Oswego County and its Department of Social Services had discriminated against Simonson due to his gender identity, which constituted a form of  sex discrimination under Title VII of the Civil Rights Act of 1964.

After obtaining a right-to-sue letter from the U.S. Department of Justice, Lambda Legal filed a federal lawsuit alleging that Oswego County’s policy and its denial of coverage violated several federal and state laws prohibiting sex-based discrimination. In its rationale for the lawsuit, Lambda Legal argued that the health insurance plan’s exclusion on transition-related care was discriminatory because, had Simonson been a cisgender woman urged by her personal doctor to receive a mastectomy, the procedure would have been covered.

In agreeing to settle the lawsuit, Oswego County agrees to compensate Simonson, not only for his out-of-pocket medical costs, but for the emotional distress, suffering, embarrassment, humiliation, pain and anguish, stigmatization, and loss of dignity he suffered when he was denied care that his doctor has deemed medically necessary. The county also agrees to cover Simonson’s attorneys’ fees and other legal costs as part of the settlement.

Just days before Simonson filed his lawsuit, the New York Attorney General’s Office announced an agreement, under which Oswego County ensure that, going forward, transgender employees and retirees would be entitled to have their transition-related care covered through their employer-provided health plan. That agreement required the county to eliminate the exclusion in the health care plan, provide training to county employees and employees of its benefits administrator on the new policy, and address any complaints or hindrances that transgender employees or retirees might encounter when trying to get medically necessary procedures covered.

However, the agreement did not provide compensation for Simonson or others who had been denied care, which prompted Lambda Legal to follow through with the lawsuit. The county eventually determined that it was in its best interest to agree to a financial settlement with Simonson rather than pursue a drawn-out court battle.

“While Oswego County finally rescinded its discriminatory policy in November 2017 after years of advocacy by Sean and Lambda Legal, the amendment to the County’s health plan did not fully address the harms imposed by the discrimination against Sean nor did it acknowledge the County’s legal responsibility to not discriminate against transgender employees,” Omar Gonzales-Pagan, a senior attorney and health care strategist at Lambda Legal, said in a statement, adding that the county’s previous refusal to acknowledge the harm done to Simonson was “wrong.”

“Importantly, as part of the settlement, the County has now acknowledged, both within the settlement agreement and on the record in open court, that current federal and state law prohibit discrimination against transgender individuals in their compensation and other terms, conditions, and privileges of employment, including the terms of municipal health benefit plans,” Gonzales-Pagan added.

Simonson said in a statement that he was happy that the county acknowledged its error and was taking steps not to repeat it

“I am proud of the role I played in changing the county’s policy so that no other transgender employee will ever be denied coverage for transition-related care, like I was,” he said. “I am also proud of my 30-year career as an Oswego County case worker for the Department of Social Services. Helping the communities I am a part of is, and always has been, very important to me.”

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