Leon FL Lawyers | Sonja P Mathews -- eLawyers

12-000535 MEGAN HOTCHKISS vs DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE (2012)

Division of Administrative Hearings, Florida Filed: Feb. 09, 2012

The issue is whether Respondent properly denied payment of certain charges related to out-of-network surgical procedures pursuant to the State Employees’ PPO Group Health Insurance Plan.Petitioner is entitled to payment for the second side of a bilateral procedure, but otherwise failed to prove that payment for services was not consistent with the terms of the State Employees' PPO Plan.

11-003269 ALEXANDER HALPERIN vs DEPARTMENT OF MANAGEMENT SERVICES (2011)

Division of Administrative Hearings, Florida Filed: Jun. 27, 2011

The issue is whether Respondent is entitled to recovery of overpayments of disability benefits resulting from the alleged failure to reduce such payments by offsetting social security benefits.Respondent demonstrated that Petitioner's state disability benefits should have been reduced by Social Security disability benefits and was, therefore, entitled to recovery of overpayment.

11-003961 JOHN ISAACS vs DEPARTMENT OF MANAGEMENT SERVICES (2011)

Division of Administrative Hearings, Florida Filed: Aug. 05, 2011

Whether Petitioner should receive a refund for an alleged overpayment of dental insurance premiums.Petitioner did not establish that he was entitled to a refund for overpayment of dental insurance premiums.

11-002997 DONNA M. GOERNER vs DEPARTMENT OF MANAGEMENT SERVICES (2011)

Division of Administrative Hearings, Florida Filed: Jun. 15, 2011

Whether Petitioner is entitled to a refund of $1,256.09 for a COBRA premium payment made for the month of January 2011.Petitioner failed to satisfy her burden of proving entitlement to reimbursement of COBRA premium payment.

10-008928 MARY ANN STEADMAN vs DEPARTMENT OF MANAGEMENT SERVICES (2010)

Division of Administrative Hearings, Florida Filed: Sep. 08, 2010

The sole threshold issue in this bifurcated proceeding is whether Petitioner has met her burden of proving grounds for equitable tolling as a defense to the admitted untimely filing of Petitioner's request for an administrative hearing. Consideration of the merits of Petitioner's challenge to the initial agency action was deferred, pending the threshold determination of whether the challenge can be heard.Petitioner did not meet her burden of proving that claimed "diminished mental capacity" constituted an extraordinary circumstance preventing timely filing of the request for administrative hearing.

09-004187 MARTHA L. KENERSON AND DAVID R. KENERSON, JR. vs DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE (2009)

Division of Administrative Hearings, Florida Filed: Aug. 04, 2009

The issue is whether Petitioners, as beneficiaries of their deceased father's life insurance policy, are entitled to a payment of $7,500 in addition to the $2,500 benefit already paid. As set forth more fully herein, since Florida's statutory and rule framework do not require that notice provided to the Division of Retirement be shared with the Division of State Group Insurance, Petitioners did not demonstrate that they are entitled to the additional benefit.Petitioners' father, a deceased former State of Florida employee, did not update his address of record with the DSGI and was, therefore, not notified of a change in life insurance benefits, through no fault of DSGI. The Petition for Relief is dismissed.

10-000036 KARINA VELASQUEZ vs DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE (2010)

Division of Administrative Hearings, Florida Filed: Jan. 05, 2010

The issue is whether the MRI of Petitioner's cervical spine performed on April 8, 2009, was medically necessary and, therefore, covered under the state employee group health plan.Petitioner showed medical necessity for cervical spine MRI before Rx for PT/exercises because she was already exercising. Respondent failed to show that reviewers were aware or considered Petitioner's existing exercise routine.

09-006961 CAMILLE V. CATO vs DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE (2009)

Division of Administrative Hearings, Florida Filed: Dec. 21, 2009

Whether Petitioner was initially enrolled in her current dental plan as a result of an error and, therefore, should be allowed to cancel the current enrollment and retroactively enroll in the desired plan.Petitioner can not make a change to her dental insurance plan, except during a QSC event. No evidence was presented that DSGI made the inital mistake. Recommend dismissal.

09-005530 ROBERT SKINNER vs DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE (2009)

Division of Administrative Hearings, Florida Filed: Oct. 09, 2009

The issue is whether Petitioner is entitled to payment of benefits for a medical procedure.Petitioner did not prove that Respondent should pay the cost of an investigational/experimental medical procedure.

10-000098 DETRICK MURRAY vs DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE (2010)

Division of Administrative Hearings, Florida Filed: Jan. 11, 2010

Whether Petitioner is entitled to a refund from the State of Florida Group Health Self Insurance Plan of pre-tax supplemental insurance premiums in the amount of $47.46 or $47.45 a month that were deducted from his pay for the 2007 and 2008 insurance plan years.Peitioner failed to cancel state-sponsored supplemental insurance when he contacted the insurance company, but not People First. He is not entitled to a refund of premiums deducted from his pay.

Sonja P Mathews