STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

JACKSON GREEN )

)

Petitioner, )

)

vs. ) CASE NO. 86-3788

) DEPARTMENT OF ADMINISTRATION, ) OFFICE OF STATE EMPLOYEES' ) INSURANCE, )

)

Respondent. )

)

RECOMMENDED ORDER

A formal hearing was held on December 15, 1986 pursuant to notice in Tallahassee, Florida, by Stephen F. Dean, assigned Hearing Officer of the Division of Administrative Hearings. This case arose upon notification of Mr. Greene by the Department of Administration that deductions for his family health insurance coverage had been insufficient and that he owed the State $1168.22 for coverage provided. Greene thereupon requested a formal hearing pursuant to Section 120.57, Florida Statutes, and the matter was referred to the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Jackson Greene

1303 Ocala Road, Apt. 7

Tallahassee, Florida 32304

For Respondent: Augustus D. Aikens, Jr., Esquire General Counsel

Department of Administration

435 Carlton Building Tallahassee, Florida 32399-1550

ISSUES

The issues which developed were:

1. Did Jackson Greene receive the coverage as asserted by the Department of Administration, and

   
   

2. What deductions were made from Greene for the coverage, and

   
   

3. What deductions were required for the coverage, and

   
   

4. Did Greene owe any additional sums for the coverage?

FINDINGS OF FACT

1. Mr. Jackson Greene was employed by the State of Florida, Department of insurance, on October 15, 1983.

   
   

2. When he was employed, Greene became eligible for participation in the state's health insurance plan. He applied for coverage on October 17, 1983, filling out and signing the application form, Petitioner Exhibit 1.

   
   

3. Mr. Greene indicated he desired Family I Coverage, insuring himself and his wife, Evelyn Greene, who was not a State employee. See Petitioner Exhibit 1.

   
   

4. Family I Coverage was provided by the State as indicated by issuance of an insurance card. Although the Greenes never had occasion to make a claim against the insurance, the insurance was in effect from the date of acceptance into the program through the date of this hearing.

   
   

5. The State erroneously failed to deduct the correct amount for insurance premiums from Greene's salary. From November 1983 through July 1984 the State should have deducted $48.46 per month. However, the State deducted only $13.28 per month. From August through April 1986, when the error was caught and corrected, the State should have deducted $55.64/month. However, only $15.18 per month was deducted by the State.

   
   

6. From November 1953 through July 1984 the State failed to deduct $316.62 ($48.46 - $13.28 X 9 = $316.62).

   
   

7. From August 1984 through April 1956 the State failed to deduct $849.66 over 21 months ($55.64 - $15.18 X 21 $849.66)

   
   

8. Over the entire term of coverage (30 months) there is a computed total due of $1,166.28 based upon Respondent's Exhibit 2.

   
   

   CONCLUSIONS OF LAW

   
   

9. This order is entered pursuant to Section 120.57(1) Florida Statutes. The Department of Administration administers the State's health insurance plan.

   
   

10. The facts reflect Mr. Greene applied for Family I Coverage, received Family I Coverage, and would have been entitled to the benefits of Family I Coverage had he or his wife had a claim. The State failed to deduct enough premiums between November 1983 and May 1986 for the Family I Coverage provided Mr. Greene, and the State therefore claims $1,166.28.

    
    

11. Mr. Greene suggested the State is barred from making the claim by laches. However, for laches to apply, Mr. Greene would have to suffer some detriment. Mr. Greene demonstrated no detriment which he or his family suffered. He received the coverage for which he bargained. Now, he must pay.

    
    

12. The Department of Administration is authorized to arrange for the repayment of the moneys owed in installments. The repayment of this money over the same length of time as the period of insufficient payment effectively doubles the current premium which is a financial hardship. Therefore, it is recommended that the installments be made over 60 months and that any unpaid portion of the indebtedness be collected from any amounts owed Petitioner for unused sick and annual leave should he leave State employment.

RECOMMENDATION

The State should recover $1,166.28 from Jackson Greene for underpayment of insurance premiums in 60 equal installments and any unpaid portion be deducted from moneys owed Petitioner for unused sick and annual leave if Petitioner leaves State employment.

DONE and ORDERED this 9th day of January, 1987, in Tallahassee, Florida.

STEPHEN F. DEAN

Hearing Officer

Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 9th day of January, 1987.

APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-3788

The Respondent's Findings of Facts were adopted. The Petitioner's Findings of Facts are not specifically identified; however, both parties agree to the basic facts. The Petitioner's contention is that the state is barred from recovering the unpaid premiums on equitable principles. This legal argument is rejected because Petitioner has suffered no detriment except having to pay higher premiums due to repayment. This detriment is diminished by the extend repayment period recommended.

COPIES FURNISHED:

Jackson Greene

1303 Ocala Road, Apt. 7

Tallahassee, Florida 32304

Augustus D. Aikens, Jr., Esquire General Counsel

Department of Administration

435 Carlton Building Tallahassee, Florida 32399-1550

Gilda Lambert, Secretary Department of Administration

435 Carlton Building Tallahassee, Florida 32399-1550

Docket for Case No: 86-003788

Orders for Case No: 86-003788