11-003961 John Isaacs vs. Department Of Management Services Status: Closed Recommended Order on Tuesday, November 15, 2011.

Summary: Petitioner did not establish that he was entitled to a refund for overpayment of dental insurance premiums.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

JOHN ISAACS , )

)

Petitioner, )

)

vs. ) Case No. 11 - 3961

)

DEPARTMENT OF MANAGEMENT )

SERVICES )

)

Respondent. )

__________________________________)

RECOMMEN DED ORDER

A hearing was conducted in this case pursuant to s ections

120.569 and 120.57(1), Florida Statutes , 1 b efore Administrative

Law J udge Jessica Varn of the Division of Administrative

Hearings (DOAH). The hearing was held on October 19 , 2011 , by

tele phone conference at sites in Miami and Tallahassee, Florida.

APPEARANCES

For Petitioner: John Isaacs, pro se

13021 S . W . 116th Street

Miami, Florida 33186

For Respondent: Sonja Mathews , Esquire

Depa rtment of Management Services

4050 Esplanade Way, Suite 160

Tallahassee, Florida 32399 - 0950

STATEMENT OF THE ISSUE

Whether Petitioner should receive a refund for an alleged

overpayment of dental insurance premiums .

PRELIMINARY STATEMENT

By letter dated April 1 8 , 2 011 , th e Department of

Management Services (Department) advised John Isaacs (Isaacs) of

its denial of his request for a retroactive change to his dental

coverage, and for reimbursement for an overpayment of dental

insurance premiums.

On or about April 27, 2011 , Isaacs filed a letter

requesting a formal hearing . The matter was referred to DOAH on

August 5 , 2011 , for the assignment of an administrative law

judge to conduct a formal hearing and to submit a Rec ommended

Order to the Department .

Pursuant to notice , the final hearing in this case was

conducted on October 19 , 2011 . At the hearing, Isaacs offered

E xhibits 1 - 3 , and testifie d on his own behalf. The Department

offered the testimony of James West and Sandy Wade; Respondent 's

E xhibits 1 - 14, and 6B , were admitted into evi dence. By request

of the Department , and over IsaacÓs objection, the undersigned

took Official Recognition of a Senate Staff Analysis and

Economic Impact Statement of CS/SB 1814 , House of

Representatives Staff Analysis and Economic Impact Statement of

CS/HB 3123 (April 27, 1990), House of Representatives Staff

Analysis and Economic Impact Statement of CS/HB 3123 (June 22,

1990), and s ection 110.123(4), Florida Statutes.

No t ranscript of the pr oceeding wa s filed with DOAH .

Isaacs did not file a post - hearing submission. Over objection,

the Department requested and received an extension of time in

which to file its P roposed F indings of F act and C onclusions of

L aw, which was considered in the preparation of this Recommended

Order.

FINDINGS OF FACT

1. The Division of State Group Insurance (Division) is the

executive agency within the Department of Management Services

(Department) that is responsible for the administration of the

State Group Insurance Program (Program).

2. Isaacs w as first employed with the State of Florida in

1993, and remained employed with the Stat e until March 2011,

when he retired.

3. According to Isaacs, w hen he originally signed up for

dental insurance, there were only two options available for

employees; an employee could sign up either for ÐemployeeÑ

coverage or for Ð employee plus familyÑ coverage. Isaacs chose

Ðemployee plus familyÑ dental coverage, so that he and his

spouse would have coverage.

4. During his tenure as a State employee, Isaacs was

marrie d and had no children.

5. At all times material to the instant case, Isaacs

resided, and received his mail, at 13021 S . W . 116th Street,

Miami, Florida, 33186.

6. On January 1, 2005, the State of Florida started using

an online system called ÐPeople FirstÑ to manage State of

Florida employee payroll and benefit packages. Every employee

and retiree was given a username and password to access the

online system. Each employeeÓs payroll information , leave

balances, and benefits information could be seen online.

7 . Pursuant to section 110.123(3)(h), every year there is

a finite period of time during which State employees can sign up

for benefit plans, or chan ge their existing benefit plans, for

the upcoming calendar year. This period is called Ðopen

enrollment.Ñ

8 . Prior to open enrollment every year, People First mails

out, to every State employee, a packag e which contains a

personalized benefits statement and a Benefits Guide, which

contains information as to all the b enefit plans that are being

offered for the upcoming calendar year. The benefits statement

informs employees of the benefits they currently have and will

continue to have during the upcoming calendar year, unless they

make changes to their insurance or co verage level.

9 . On September 7, 2007, the Di vision mailed each

participant in the dental insurance program a letter explaining

significant changes to the dental program.

10 . This letter was mailed by first class mail to the

address of record for each em ployee who was then enrolled in the

dental program . Isaacs ' address of record in People First was

his mailing address: 13021 S.W. 116th Street, Miami, Florida,

33186. Isaacs claims tha t he never received this letter. T he

undersigned finds this testimony to not be credible, given that

Isaacs ' address has not changed in 33 years, and he was unaware

of any other problems with delivery to this address .

11. The September 2007 letter advised employees that there

would be new coverage levels offered in 200 8. I t stated, in

pertinent part:

There will be new coverage levels

offered in 2008. You may currently be

enrolled in a coverage level that will not

be offered. The new coverage levels are:

° Employee Only

° Employee Spouse

° Employee Child(ren)

° Famil y

You will have the opportunity during

the upcoming Open Enrollment to cancel

coverage, change your coverage level, or

switch to another dental plan. Any change

you make will be effective on January 1,

2008. If you take no action, your dental

coverage may be changed automatically for

2008. If you are currently enrolled in a

coverage level that will not be offered in

2008, you will be enrolled in Family

coverage.

12. People First sent Isaacs open enrollment packages in

2007, 2008, 2009, and 2010. Th e 2008 package , sent on

September 17, 2007, included a Benefits Guide which contained

all the information as to the change in the dental insur ance

program. Employees were placed on notice that except for

employees who had previously been enrolled for ÐEm ployeeÑ

coverage, all coverage levels would be moved to ÐFamilyÑ

coverage unless the employees made changes during open

enrollment. The package included instructions on ho w to make

the coverage changes, and how to verify that those changes had

been proper ly made.

13. Isaacs never changed his dental plan coverage;

therefore, he was defaulted to the ÐFamilyÑ coverage as of

January 1, 2008. Due to his failure to act, he remained in that

coverage until he retired.

14 . The open enrollment packages sent to Isaacs for years

2009, 2010, and 2011 included information as to the dental

coverage tiers, and a personalized Benefits Statemen t which

indicated which benefit plans Isaacs was enrolled in , and his

coverage level . Every year, he could have made ch anges to his

dental insurance coverage, but failed to do so.

15 . As of People First going ÐliveÑ in 2005, all State

employees could review their benefits and coverage levels online.

Thus, Isaacs, on his state - issued desktop computer, had access to

People First, and could have reviewed his coverage levels and

benefit plans.

16 . Isaacs admitted at hearing that he did not review the

open enrollment packages he received every year beca use he was

under the impression, based on advice he was given, that he need

not review the information if he was not making any changes to

his coverage levels or benefit plans. He added that he was not

sure if he even opened all the open enrollment packag es that

were sent through the years.

17 . Isaacs had the responsibility to open , review, and

carefully read the open enrollment packages and all

correspondence sent to him by his employer.

18 . Isaacs was advised of the changes to the dental plan,

but did not review the information sent to him. He had ample

notice of the change to the dental plan coverage levels, but

failed to review the information, and failed to avail himself of

the many opportunities he had to adjust the coverage level. He

paid fo r mor e coverage than he needed because he ignored all the

information sent to him, which gave him specific instructions on

h ow to avoid that exact circumstance .

CONCLUSIONS OF LAW

19 . DOAH has jurisdiction over the subject matter of this

proceeding and of the parties hereto pursuant to sections

120.569 and 120.57(1), Florida Statutes.

20 . Isaacs , as Petitioner, has the burden of establishing

by a preponderance of the evidence that he is entitled to a

refund for the dental insurance premiums he overpayed . Florida

DepÓ t of Transp. v. J.W. C. Co. , 396 So. 2d 778, 788 (Fla. 1st

DCA 1981 ).

21 . A preponderance of the evidence has been defined as

Ðthe greater weight of the evidenceÑ or evidence that Ðmore than

likely than notÑ tends to prove a certain propositio n. Gross v.

Lyons , 763 So. 2d 276, 280 n.1 (Fla. 2000).

22 . Proof of mailing raises a rebuttable presumption that

mail was received. Such a presumption only arises where there

is proof that the mail was sent to the correct address. Brown

v. Giffen Indu s., Inc. , 281 So. 2d 897, 900 (Fla. 1973); Star

Lakes Estates AssocÓn, Inc. v. Auerbach , 656 So. 2d 271 (Fla. 3d

DCA 1995).

23 . In the ins tant case, the evidence established that all

mailings to Isaac were sent to his address of record, which had

not changed in over 30 years. Isaacs offered no credible

evidence to rebut the presumption that the September 2007 letter

was received, or that the open enrollment packages were received

every year.

24 . All of the mailings contained ample notice of the

chan ges to the dental insurance plan, and the consequences of

inaction. If Isaacs had r eview ed the September 2007 letter, or

the annual benefit statements, or the annual Benefits Guides, he

could have averted any overpayment of premiums.

25 . Isaacs failed to prove by a preponderance of the

evidence that he is entitled to a refund for his overpayment of

dental insurance premiums.

RECOMMENDATION

Based upon the foregoing Findings of Fact and Conclusions

of Law, it is hereby RECOMMENDED that the Department of

Management Services enter an order denying Isaac s ' request for a

refund for his overpayment of dental insurance premiums .

DONE AND ENTERED this 15th day of November , 2011 , in

Tallahassee, Leon County, Florida.

S

___________________________________

JESSICA E. VARN

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

t his 15 th day of November , 2011.

ENDNOTE

1 / Unless otherwise noted, all references in this Recommended

Order to Florida Statutes are to Florida Statutes (2011 ).

COPIES FURNISHED :

Sonja Mathews , Esquire

Department of Management Services

4050 Esplanade Way, Suite 160

Tallahassee, Florida 32399 - 0950

John Isaacs

13021 S . W . 116th Street

Miami, Florida 33186

Jason Dimitris , General Counsel

Department of Management Services

4050 Esplanade Way, Suite 160

Tallahassee, Florida 32399 - 0950

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this recomm ended order. Any exceptions

to this recommended order should be filed with the agency that

will issue the final order in this case.