Victory! Lambda Legal Obtains Settlement for Oswego County Transgender Employee Denied Coverage for Transition-Related Care

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August 23, 2018
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Today, Oswego County and the Oswego County Department of Social Services settled the lawsuit brought by Lambda Legal on behalf of Sean Simonson, a retired transgender county employee who was denied health insurance coverage for his transition-related care.

The settlement remedies the harm done to Mr. Simonson by the refusal of health care coverage because he is transgender.

The settlement follows the county’s amendment of its health care policy and elimination of the exclusion that prohibited health care coverage of all transition-related care for county employees in November 2017, which occurred after a reasonable cause finding by the U.S. Equal Employment Opportunity Commission (EEOC) in Mr. Simonson’s case and the issuance of a right-to-sue letter.

“I am happy that Oswego County has acknowledged and resolved the harm done to me. 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,” Simonson 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.”

“While Oswego County finally rescinded its discriminatory policy in November 2017 after years of advocacy by Sean and Lambda Legal, the amendment to the County’s health plan did not fully address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” said Omar Gonzalez-Pagan, Senior Attorney and Health Care Strategist at Lambda Legal.

“It was wrong to ignore the suffering Sean endured over several years as well as the thousands of dollars depleted from his retirement savings to cover out-of-pocket medical expenses because of the County’s former discriminatory practices. Oswego County has now acknowledged and corrected these errors.

“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,” Gonzalez-Pagan added.

Simonson worked as a case worker for the DSS in Oswego County before retiring in October 2015. His record and reputation of being an exemplary employee for nearly 30 years of public service are undisputed. 

Diagnosed with gender dysphoria in February 2015, Simonson took steps to transition in a manner consistent with his gender identity, including a social and legal transition.

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, in October, 2015, Simonson filed a complaint with the EEOC.

In June 2017, the 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."

After obtaining a right-to-sue letter from the U.S. Department of Justice, Lambda Legal filed a federal lawsuit on behalf of Simonson alleging that the County’s policy and the resulting refusal of insurance coverage of Simonson’s care constituted sex discrimination and violated 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.

Mere days before the filing of Simonson’s lawsuit, and following Lambda Legal’s outreach to the New York Attorney General’s Civil Rights Bureau, the New York Attorney General’s office announced an assurance of discontinuance agreement with Oswego County to ensure that transgender employees and retirees have access to essential health care coverage through the employer-provided health plan.

As part of the agreement, Oswego County 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.

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

The Lambda Legal attorneys working on the case are: Omar Gonzalez-Pagan, Demoya Gordon and Richard Saenz.