STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF ADMINISTRATION, )

)

Petitioner, )

)

vs. ) CASE NO. 83-3238

)

WYATT WYATT, )

)

Respondent. )

)

RECOMMENDED ORDER

This case was heard on March 1, 1984, by R. L. Caleen, Jr., Hearing Officer with the Division of Administrative Hearings, in Orlando, Florida.

APPEARANCES

For Petitioner: Daniel C. Brown, General Counsel

Department of Administration

435 Carlton Building Tallahassee, Florida 32301

For Respondent: Wyatt Wyatt, pro se

Department of English University of Central Florida Post Office Box 25000 Orlando, Florida 32816

ISSUE

Whether respondent is obligated to remit to petitioner, administrator of the State of Florida Employees Group Health Self-Insurance Program, an alleged underpayment of insurance premiums in the amount of $435.81, covering the period from October, 978,through June, 1983.

BACKGROUND

On June 29, 1983, petitioner Department of Administration ("Department") notified respondent Wyatt Wyatt ("petitioner") of its determination that he had underpaid $435.81 in premiums under the State of Florida Employees Group Self- Health Insurance Program ("State Insurance Program") covering the period of October 8 through June, 1983. Instead of paying the alleged underpayment, respondent elected to request a Section 120.57 hearing to challenge the Department's determination.

The case was then forwarded to the Division of Administrative Hearings for assignment of a Hearing Officer, and hearing was set for March 1, 1984. At hearing, the Department presented the testimony of Shannon Addison and Deborah Evans. Respondent testified on his own behalf, Petitioner's Exhibit Nos. 1 - 2 and Respondent's Exhibit Nos. 1 - 2 were received into evidence.

Both parties waived filing posthearing proposed findings of fact and conclusions of law. No transcript of the hearing has been filed.

Based on the evidence, the following facts are determined: FINDINGS OF FACT

1. At all times material, respondent was employed by the University of Central Florida ("University") as an English professor and was a member of the State Insurance Program. In August, 1978, he was married and in September, 1978, he filed a Change of Information form with the university requesting that his coverage under the State Insurance Program be converted from individual to family coverage. Effective October 1, 1978, the change in coverage was accomplished and he became obligated to pay the appropriate family coverage premiums.

   
   

2. In May, 1980, his wife found a new job with an employer who provided her with complete health insurance coveage, without cost, as a job benefit. So respondent asked his secretary, Sue Gulick, to telephone the university office in charge of employee insurance benefits and have his insurance (under the State Insurance Program) converted from family back to individual coverage. Ms. Gulick made this call, then suggested that he send a confirming letter. He agreed, and dictated a letter restating his request. The letter was then typed. He assumes, but does not know that it was addressed to the appropriate university office, and that it was mailed.

   
   

3. There is no evidence, however, that this letter, was ever received in the office of the University's Division of Personnel, the office responsible for coordinating employees insurance coverage. The letter was not filed in respondent's personnel file, and its whereabouts are unknown.

   
   

4. When he failed to receive a new insurance card showing the change in coverage, he asked Ms. Gulick twice to check on the status of his request. He assumes, but does not know, that she carried out his request.

   
   

5. In August, 1980, payroll deductions of his health insurance premiums inexplicably stopped. It was not until April 1983 that he discovered that there was no record of his 1978 request for a change in coverage.

   
   

6. In November 1981, he and his wife were divorced. As a single man, with no children, he no longer had dependents eligible for family coverage. He notified the university's Division of Personnel of his change in marital status.

   
   

7. In June, 1983, he discovered that, despite his request, his family insurance coverage had never been reconverted to individual coverage. He then completed and submitted the required Change of Information form to the Division of Personnel. In October, he received a new insurance card, which, to his chagrin, reflected continued family coverage. He was, understandably, exasperated.

   
   

8. Respondent agrees that although unintentionally -- he underpaid his premiums to the State Insurance Program. This dispute involves only the amount of underpayment. He contends that since he did everything that could reasonably be expected of him in May 1980, to convert his coverage from family to individual, he should not have to pay for more than individual coverage from May, 1980, to November 1981, when his divorce effectively converted his coverage

   to single. He argues that he should not have to pay for someone else's clerical mistakes.

   
   

9. When he enrolled in the State Insurance program, respondent received a booklet describing, amoung other things, how to change insurance coverage.

   
   

   5. How to change coverage

   
   

   A. All changes in coverage must be made on the Change of Information form and the Medical Statement form (if required) and submitted to your personnel office or other appropriate

   agency personnel. The personnel office or other appropriate agency personnel will provide you with these forms when needed.

   
   

   (Page 6, Petitioner's Exhibit No. 2.)

   
   

10. It is uncontroverted that, in May, 1980, respondent did not comply with this requirement. He did not complete and submit the required Change of Information form with either the Division of Personnel or with the Department of Administration. Rather, he tried to have his coverage converted by dictating a letter which was never received by the personnel office, filed in his personnel file, or sent to the Department. He does not know to whom, he addressed the letter, and he never received a response.

    
    

11. From October 1, 1978, through September 30, 1981, he underpaid insurance premiums due for family coverage in the amount of $324.25. From October 1, 1981 (when his divorce made him ineligible for family coverage), to July 1, 1983, he underpaid insurance premiums due for individual coverage in the amount of $111.56. These underpayments total $435.81.

    
    

    CONCLUSIONS OF LAW

    
    

12. The Division of Administrative Hearings has jurisdiction over the parties and subject matter of this proceeding. 120.57(1), Fla. Stat. (1983).

    
    

13. The Department is charged with administering the State Insurance Program. A state employee who underpays insurance premiums may be required to pay the underpayment, failing which his insurance coverage may be cancelled by the Department. See, Rule 22Y-1.20, Florida Administrative Code; s. 110.123 Fla. Stat. (1983).

    
    

14. The Department has shown that respondent contracted for family coverage from October 1, 1978, to September 30, 1981; and that his family coverage converted to individual coverage on October 1, 1981, and continued to July 1, 1983. During this entire period, he underpaid premiums in the amount of

    $435.81, which amount is now due and owing. His earnest, though unsuccessful, efforts to change coverage in May, 1980, had no legal effect. He failed to file the necessary Change of Information form; and his letter was never received by the Department or university office responsible for coordinating changes in insurance coverage.

    
    

15. Under Rule 22K-1.20(5) Florida Administrative Code, if an underpayment of premiums is not paid within 90 days of notification (or prior to date of

termination of employment, whichever is earlier), the employee's coverage is cancelled and the underpayment is collected by certified deductions from any salary due the employee.

RECOMMENDATION

Based on the foregoing, it is RECOMMENDED:

That the Department enter a Final Order requiring respondent to remit

$435.81, for total insurance premium underpayments, within 90 days, failing which respondent's insurance coverage under the State Employees Insurance Program should be cancelled and the underpayment obtained through certified payroll deductions from any salary due the respondent.

DONE and ENTERED this 13th day of March, 1984, in Tallahassee, Florida.

R. L. CALEEN, JR. Hearing Officer

Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32301

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 13th day of March, 1984.

COPIES FURNISHED:

Daniel C. Brown, General Counsel Department of Administration

435 Carlton Building Tallahassee, Florida 32301

Wyatt Wyatt Department of English

University of Central Florida Post Office Box 25000 Orlando, Florida 32816

Nevin G. Smith, Secretary Department of Administration

435 Carlton Building Tallahassee, Florida 32301

Docket for Case No: 83-003238

Orders for Case No: 83-003238