Lambda Legal Sues Oswego County, NY for Refusal to Cover Medically Necessary Health Care for Transgender Employee

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November 30, 2017
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Lambda Legal client Sean Simonson.

Today, Lambda Legal filed a lawsuit against Oswego County and the Oswego County Department of Social Services (DSS) on behalf of Sean Simonson, a retired transgender county employee. Mr. Simonson was denied health insurance coverage for his transition-related care by his county-provided health insurance plan because of a discriminatory exclusion that prohibited coverage of all transition-related health care.

Following the filing of a charge of discrimination against Oswego County in October of 2015, the U. S. Equal Employment Opportunity Commission (EEOC) issued a determination finding reasonable cause to believe that Oswego County and DSS discriminated against Simonson “due to his sex (transgender status/gender identity) in violation of Title VII” on June 26, 2017.

Following the EEOC’s filing and Lambda Legal’s notification of this matter to the New York Attorney General’s Civil Rights Bureau, Oswego County recently agreed to remove the exclusion of transgender-related health care from their employee health insurance plan as part of an agreement with the New York Attorney General’s office.

The agreement, however, did not include compensation for current and former employees already denied coverage under the policy, including Sean Simonson.

“Every person deserves to be treated with dignity and respect by their government and their employers. This is especially true for public servants, like Sean Simonson, who devoted their life to serving those most marginalized in our communities," said Omar Gonzalez-Pagan, Staff Attorney and Health Care Strategist at Lambda Legal. "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“While Oswego County has finally rescinded its discriminatory policy, it simply is not enough to make up for the years of suffering Sean endured and the thousands of dollars he paid out-of-pocket from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," Gonzalez-Pagan added. "Oswego County needs to acknowledge and remedy the damage that has been done.”

Filed in in the U.S. District Court for the Northern District of New York, the lawsuit alleges that the county’s policy and the resulting refusal of insurance coverage of Sean Simonson’s care constitutes sex discrimination and violates federal and state laws, including the Fourteenth Amendment of the United States Constitution, Title VII of the Civil Rights Act of 1964, Section 1557 of the Patient Protection and Affordable Care Act and the New York State Human Rights Law.

“I loved being a case worker and helping the people of Oswego County for more than thirty years,” said Simonson. “During that time, I devoted myself to my job and the people we served, with the expectation that the county would provide me with medical insurance that covers the care I need, just like it does for my colleagues. I’m proud to be a part of changing the county’s policy so that none of my former coworkers or anyone else who commits themselves to our community suffers the same discrimination I have.”

An exemplary employee and public servant for nearly 30 years, Simonson worked as a Case Worker for Oswego County’s Department of Social Services before retiring in October of 2015.

Upon being diagnosed in February of 2015 with gender dysphoria, Simonson began taking steps to transition in a manner consistent with his gender identity, including legally changing his name. As part of his transition and ongoing medical care, Simonson’s doctor determined that it was medically necessary for him to be placed on hormone replacement therapy and receive a double mastectomy.

However, coverage for this care was denied because of the plan’s policy of excluding coverage of transition-related care, despite the same care being covered for non-transgender patients. After both Simonson and his doctor appealed the refusals through the insurance’s appeal process, Simonson filed a complaint with the EEOC.

“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.”

Earlier this month, New York Attorney General Eric T. Schneiderman announced a settlement with Oswego County to ensure that transgender employees and retirees have access to essential health care coverage through the employer-provided health plan. The settlement was the result of an investigation launched in June by the Attorney General’s Civil Rights Bureau, prompted by Lambda Legal’s notification to the Attorney General’s Civil Rights Bureau of the County’s discriminatory policy and Simonson’s pending claim with the EEOC.

As part of the settlement, Oswego County has agreed to eliminate the exclusion of care related to gender transition from its health insurance plan; implement a new benefit to employees and retirees covering treatments, procedures and prescriptions for gender transition; develop and provide annual training for county employees, and employees of its benefits administrator, concerning the new benefit; and monitor for complaints concerning implementation of the new benefit for the next five years. However, compensation for current and former employees already denied coverage while the policy was in place was not part of the agreement.