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Mossinger v. State

Superior Court of Delaware, Sussex

April 17, 2015

Mossinger
v.
State

Ruth L. Mossinger Pro se Plaintiff

Andrew G. Kerber Deputy Attorney General Delaware Department of Justice

Dear Parties:

Before the Court is claimant Ruth Mossinger's ("Claimant") appeal from the State Employee Benefits Committee's ("SEBC") determination that she is not entitled to short-term disability benefits ("STD benefits") for the period of February 21, 2014 to April 29, 2014 (the "Period"). After reviewing the record and the decisions of the State of Delaware's ("the State") insurance carrier, The Hartford ("Hartford"), and the State itself, the Court agrees with the decision to deny Claimant STD benefits for the Period. As such the determination of the SEBC is AFFIRMED.

PROCEDURAL POSTURE

The relevant procedural history regarding Claimant's STD benefits claim is as follows. Claimant left work on December 23, 2013 due to a disability.[1] Hartford granted Claimant's request for STD benefits for a period beginning on December 23, 2013. On January 22, 2014, Hartford sent Claimant's therapist, Dr. Faye Bibee-Friedman ("Friedman"), a request for additional information regarding Claimant's continued eligibility for STD benefits. Hartford requested additional information on February 26, 2014, after Friedman's responses on the January 22, 2014 questionnaire spurred further questions.

On March 4, 2014, Hartford contacted Claimant via a letter. Hartford indicated that upon its review of Claimant's STD benefits claim, Claimant was no longer eligible for STD benefits. Claimant filed a timely appeal with Hartford, requesting it review its decision pursuant to 29 Del. C. §5258. On March 25, 2014, Hartford again contacted Claimant via letter, explaining that its appeals unit conducted a review of her claim separate and apart from those that made the initial decision to deny her STD benefits. Hartford stated its determination remained the same.

Claimant filed a timely appeal with the State of Delaware by filing an appeals request with Delaware's Statewide Benefits Office ("SBO"), a sub-branch of the Office of Management and Budget ("OMB"). On July 2, 2014, the appeals administrator of the SBO contacted Claimant by letter stating the SBO had carried out a complete review of her disability file and interviewed Claimant with regard to her disability and eligibility for STD benefits. However, the letter explained the SBO agreed with Hartford's determination to deny Claimant benefits for the Period.

Claimant then filed a timely appeal with the SEBC. In accordance with 29 Del. C. §5258, the SEBC designated SBO's director as a hearing officer to hear evidence presented by Claimant and to determine whether Hartford's denial of STD benefits comported with the State's applicable disability plan. A hearing was held on August 11, 2014. On September 3, 2014, the SEBC released a written decision accepting the hearing officer's final report, which advised that Claimant's appeal should be denied and that the SEBC should affirm the decision of Hartford.

On October 2, 2014, Claimant filed a timely appeal to this Court. Briefing has since concluded and the issue is ready for decision.

FACTS

Claimant has been employed by the State since 2001. Her most recently held position was a Child Support Specialist III. As an employee of the State ("state employee" or "employee"), Claimant is entitled to STD benefits provided she meets the statutory and insurance policy requirements.

Claimant began experiencing problems several years ago; some work related and some exclusively personal. In 2009, Claimant had a dispute with one of her supervisors[2] at work. The conflict resulted in Claimant's arrest for terroristic threatening. Claimant was allegedly taken to jail and stripped searched, which resulted in her development of PTSD. This event has led her to feel bullied at her current position as a Child Support Specialist III in the Sussex County Office (alternatively "the Sussex office"). She believes her supervisor selectively reprimanded her and frequently conspired to get her in trouble.

Meanwhile, Claimant was also dealing with mortgage and foreclosure issues. Apparently, Claimant has been fighting foreclosure and seeking a mortgage modification for approximately five years.[3] The stress of potentially losing her house was exasperated by the little to no family ...


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