STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

REGINALD WILSON, )

)

Petitioner, )

)

vs. ) CASE NO. 84-1491

) DOA CASE NO. A-84-21 STATE OF FLORIDA, DEPARTMENT )

OF ADMINISTRATION, )

)

Respondent. )

)

RECOMMENDED ORDER

Notice was given and a formal hearing was held on June 5, 1984, before Charles C. Adams, Hearing Officer with the Division of Administrative Hearings. This Recommended Order is being entered following the receipt and review of a proposed Recommended Order filed by the Respondent. To the extent that the proposal is consistent with the Recommended Order, it has been utilized. To the extent that the proposal is inconsistent with the Recommended Order, it has been rejected for reasons of relevance, materiality, or based upon inconsistencies with facts found.

APPEARANCES

For Petitioner: Reginald Wilson

623 Congo Road

Chattahoochee, Florida 32324 No Appearance

For Respondent: Donald J. Bradley, Esquire

Department of Administration

435 Carlton Building Tallahassee, Florida 32301

ISSUES

The issues concern the question of Petitioner's responsibility to pay additional insurance premiums related to Family I coverage in the State Employees' Group Health Insurance program for the period February 1981 through April 1982, based upon alleged underpayments of required premiums. See Section 110.123, Florida Statutes and Rule 22K-1.20, Florida Administrative Code.

FINDINGS OF FACT

1. According to the Florida law which has application in this dispute, when a husband and wife were employed by separate agencies of the State of Florida, cost of the Family I coverage under the State Group Health Insurance Plan was defrayed by those state agencies. This is as contrasted with the circumstance in which one spouse would be responsible for contributing to the cost of the Family I coverage under the State Group Health Insurance Plan,

   should the second spouse cease to be employed by the second state agency. The State of Florida, Department of Administration, has she responsibility for administering the State Group Health Insurance Plan, to include collection of necessary premium payments.

   
   

2. Both Petitioner and his wife had been reported in the records of the Department of Administration as employed by the Department of Corrections and Department of Health and Rehabilitative Services respectively, as employees entitled to participate in the spouse program for payment of health care, i.e., the program in which no contribution is made by the employees toward payment of health insurance premiums. On October 28, 1982, the Petitioner informed the Department of Administration on a form provided by the Bureau of Insurance of the Department of Administration that his wife, Caroline Wilson, had terminated her employment with Health and Rehabilitative Services effective March 23, 1982. This form was executed in cooperation with the Petitioner's employing agency. The second part of the form related to information to be provided by the wife and her employing agency on the question of her employment was not completed by the spouse nor signed off by her employing agency. A copy of this item or form may be found as Respondent's Exhibit No. 3, admitted into evidence. As a result of information he provided, Petitioner was informed of an underpayment of premiums for the period May 1982 through November 1982, related to his wife's lack of eligibility for contribution from her employing agency and the responsibility of the Petitioner to substitute as payor of those premiums. This referred to the point of departure identified by the Petitioner allowing for a grace month of April 1982, thereby making the period of underpayment May 1982 through November 1982. The amount of nonpayment was $280.06, which was eventually reimbursed by the Petitioner.

   
   

3. Subsequently, in January 1984, Respondent, Bureau of Insurance, in an attempt to ascertain why Health and Rehabilitative Services had not contributed the full amount of its share to the insurance related to Caroline P. Wilson in times before March 23, 1982, discovered that the wife, Caroline P. Wilson, had terminated her employment some time before March 23, 1982. As was revealed in the final hearing, the last day of employment with Health and Rehabilitative Services was January 3, 1981. After that date, Mrs. Wilson did not return to her job at the Florida State Hospital in Chattahoochee, Florida, and was eventually considered to have abandoned that job. (It was the first impression of the Department of Administration that she had last been employed in December 1980 and as a consequence this case pertains to the claim of the Department of Administration that there is an underpayment related to the family coverage which starts on February 1, 1981 and runs until April 1, 1982, allowing for a credit of overpayment in the amount of $48.46 for the month of September 1983, leaving a total claimed of $382.64. It is this amount that Petitioner took issue with and requested a timely formal Section 120.57(1), Florida Statutes' hearing to resolve.) Based upon the evidence adduced at the hearing, the date from which the responsibility of the husband to contribute the premiums share no longer being provided by Health and Rehabilitative Services would be January 1981, as opposed to December 1980. Allowing for the grace month of February 1981, the payments would be due for March 1, 1981, through April 1, 1982, allowing credit again for the $48.46 for the month of September 1983, leaving a total due and owing in the way of underpayment of $353.90.

   
   

   CONCLUSIONS OF LAW

   
   

4. The Division of Administrative Hearings has jurisdiction over the subject matter and the parties to this action per Section 120.57, Florida Statutes.

5. Respondent, Department of Administration, is granted the authority to administer the State Group Insurance Program to include health insurance. The authority for such administration is provided by Section 110.123(5), Florida Statutes. To effectuate the purposes of that law, the Department of Administration has passed Rule 22K-1.20, Florida Administrative Code, which relates to the collection of underpayment of premiums in the State Group Health Insurance coverage. In compliance with that provision, Respondent attempted to collect $382.64, which it claims the Petitioner owed based upon the fact of his wife's departure from employment with Health and Rehabilitative Services effective December 1980. Petitioner made a timely request for hearing of that issue. Based upon the facts as presented, and in keeping with the authority granted the Respondent, it is concluded that the Petitioner owes $353.90 in the way of underpayment pertaining to Petitioner's failure to contribute to the Family I Group Health Insurance coverage provided the Respondent and his family for that period, March 1, 1981 through April 1, 1982.

It is RECOMMENDED:

That a final order be entered which requires the Petitioner to pay the sum of $353.90 as underpayment for health insurance coverage for Petitioner and his family, and that 90 days be allowed for such submission. Finally, should Petitioner fail to pay that sum within the 90 days allowed, Respondent should cancel the coverage of Health Insurance.

DONE AND ENTERED this 26th of June 1984, in Tallahassee, Florida.

CHARLES C. ADAMS, 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 26th day of June, 1984.

COPIES FURNISHED:

Reginald Wilson 623 Congo Road

Chattahoochee, Florida 32324

Donald J. Bradley, Esquire Department of Administration

435 Carlton Building Tallahassee, Florida 32301

Nevin G. Smith, Secretary Department of Administration

435 Carlton Building Tallahassee, Florida 32301

Docket for Case No: 84-001491

Orders for Case No: 84-001491