Simonson v. Oswego County

Sean 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.

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.

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.

In August of 2018, Lambda Legal obtained a settlement for Sean Simonson. The settlement remedied the harm done to Mr. Simonson by the refusal of health care coverage because he is transgender. The settlement followed 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.

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.