(704) 706-9292

EEOC holds Agency may be liable for a denial of insurance claim. Complainant filed an Equal Employment Opportunity (EEO) complaint alleging discrimination on the basis of sex when his insurance carrier denied him coverage of a gender reassignment surgery and the appeal of that decision. The Agency dismissed the claim arguing that Complainant was not aggrieved under EEOC regulations because he did not challenge Aetna’s denial of his claim with the Agency. Complainant appealed and argued the dismissal deprived him of an investigation of his claims.

On appeal, the EEOC’s Office of Federal Operations (OFO) reminded the parties that they have long held that insurance coverage is a fringe benefit of employment and denial of insurance falls under the EEOC’s jurisdiction. The Court also held that the Agency administering the insurance program is responsible for an insurance carrier’s denial of benefits. The OFO further held that the Complainant’s failure to use or exhaust the process for Agency review of an insurance carrier’s decision does not preclude an employee from asserting a viable claim in the EEO process. The Agency’s final decision was reversed and the case remanded.

Darin B. v. Office of Personnel Management, EEOC Appeal No. 0120161068 (Mar. 6, 2017) https://www.eeoc.gov/sites/default/files/migrated_files/decisions/0120161068.txt

Kirk J. Angel represents federal employees in claims throughout the US. You can set a free 15 minute consultation with him on this website if you are a federal employee.