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Same-Sex Benefits Claim

March 6, 2015 | Posted In Family Law - Family Law

Same-sex couples have been fighting battles for equality across the board, for everything from the right to get married to the right to share in their spouses’ benefits. Although many state courts have been shifting their views on same-sex rights and privileges, some sticking points remain. In the case of John Sacchi and Stephen Simoni, a New Jersey couple who has been married since 2009, health care coverage is critical, but the courts have not ruled in their favor. Now, Sacchi and Simoni are taking their cause to the Third Circuit.

The Facts

Sacchi and Simoni got married in Connecticut in 2009. The following year, Simoni lost his job as a nurse at the Jersey Shore University Medical Center in Neptune. According to Sacchi’s lawsuit, Meridian Health System should have sent out paperwork for the Consolidated Omnibus Budget Reconciliation Act (COBRA) within 44 days of Simoni’s termination. However, Meridian never sent the COBRA paperwork which would have included notices for open enrollment, and Sacchi and Simoni were left without health care options when Sacchi suffered a stroke in the fall of 2011. After his stroke, Sacchi and Simoni both claimed they requested COBRA notices from Meridian but never received them.

Two years after Simoni lost his job, COBRA sent a notice of eligibility for benefits which were to be applied retroactively. The same year (2012), both Simoni and Sacchi received forms for open enrollment, but did not fill them out or send them in. Sacchi filed a lawsuit against Meridian, claiming that the company had denied him his COBRA health benefits. According to the lawsuit, Meridian should have provided Sacchi with a notice of benefits eligibility after his husband lost his job and not doing so violated COBRA’s requirements.

Lawsuit Dismissed

In February, U.S. District Judge Freda Wolfson dismissed Sacchi’s lawsuit. She said that because Simoni did not add Sacchi as a legal beneficiary on his health insurance plan while he was employed, Sacchi had no grounds to file a lawsuit under COBRA. Sacchi argued that his husband would have added him on the plan and he should be considered an eligible dependent who could qualify as a beneficiary if designated. Wolfson called this a “novel but meritless” theory in her statement.

What Happens Next?

Under COBRA, an employee who has lost eligibility for medical insurance coverage due to voluntary or involuntary employment termination (or through another qualifying event) can retain insurance coverage for himself and his immediate family members who had been covered previously for up to 18 months in most cases. This is the legal statute cited by both Sacchi and Simoni in their lawsuit and is the basis of their appeal to the Third Circuit.

Simoni, who is a lawyer as well as a nurse, said of Wolfson’s dismissal: “I feel Congress intended for employees on COBRA to be able to add their spouses and children at any point during the coverage period and employers should not be able to defeat that.”

At Helmer, Conley, and Kasselman, PA, our New Jersey family lawyers are keeping up with the changing legal rights for same-sex couples as the laws continue to evolve. For more information, contact an HCK attorney today. 

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