Kessler v. Dept. of Management Services, No. 1D09-0583.

• Court: Court of Appeal of Florida (US)
• Citation: 17 So.3d 759
• Docket Number: No. 1D09-0583.
• Parties: Stuart W. KESSLER, Appellant, v. DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE, Appellee.
• Decision Date: 31 July 2009

17 So.3d 759 Stuart W. KESSLER, Appellant,
v.
DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE, Appellee. No. 1D09-0583. District Court of Appeal of Florida, First District. July 31, 2009. Rehearing Denied September 3, 2009.

Stuart W. Kessler, pro se, Appellant.

Sonja P. Mathews, Assistant General Counsel, Tallahassee, for Appellee.

BENTON, J.

Stuart Kessler appeals the final order of the Department of Management Services (DMS) cutting off his benefits under the State Group Disability Income Self Insurance Plan (Plan) on grounds his termination from state employment rendered him ineligible to receive disability insurance benefits. We have jurisdiction. See § 120.68, Fla. Stat. (2008); Fla. R.App. P.

17 So.3d 760

9.030(b)(1)(C). Unable to agree with DMS's interpretation of pertinent rules, we reverse and remand with directions to reinstate Mr. Kessler's benefits.

The relevant facts are uncontroverted. Mr. Kessler was working for the Florida Department of Revenue (DOR) as a Selected Exempt Service employee when he became disabled. Diagnosed with acute, myelogenous leukemia, he was granted medical leave and began receiving disability insurance benefits under the Plan in the fall of 2007. Effective June 20, 2008, however, when DOR terminated his employment, DMS cut off his disability insurance benefits.

Mr. Kessler has never questioned DOR's decision to discharge him and replace him with somebody able to do the job. But he did request reinstatement of disability insurance benefits up to the allowable maximum of one year. When DMS denied his reinstatement request on the basis that his termination from employment rendered him ineligible to receive any further disability insurance benefits, Mr. Kessler filed a petition seeking an informal hearing in order to contest the agency's decision.

At the informal hearing, Mr. Kessler contended, as he does on appeal, that the rules do not condition eligibility to receive benefits under the Plan on continued state employment. But Sandie Wade, a benefits administrator with the Division of State Group Insurance, testified that she interpreted the rules as predicating eligibility for disability insurance benefits on the disabled person's retaining salaried employment in the state Senior Management Service or Selected Exempt Service.¹ Adopting her view, DMS entered a final order denying Mr. Kessler's request to reinstate disability insurance benefits.

Florida Administrative Code Rule 60P-6.0075(4)(c) directs the state to "pay for ... insurance coverage for each full-time member of the ... Selected Exempt Service[:] ... [including o]ne hundred percent of the premium for the state individual disability insurance policy." The Plan, set forth in Florida Administrative Code Chapter 60P-9.005, describes the amount and duration of state individual disability insurance benefits:

If an employee, while insured under the Plan and as a result of sickness or injury, becomes totally disabled, the Plan will pay biweekly benefits to the employee for the period of such disability. Such benefits are payable in an amount of sixty-five (65) percent of the employee's basic daily earnings at the date of disability. Benefits are payable from the first benefit day of any one continuous period of disability up to a maximum of one year (364 days)....

Fla. Admin. Code R. 60P-9.005. Under this provision, Mr. Kessler contends, he was entitled to receive disability insurance benefits for the maximum one-year (364-day) period, and cutting benefits off prematurely on June 20, 2008, violated governing language in the Plan, and was not required by any duly promulgated administrative rule adopted pursuant to authority conferred on DMS by section 110.123(5), Florida Statutes (2008).

We reject DMS's argument that a rule definition of "employee" trumps the

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plain language of the benefits provision, when read as a whole. An "[e]mployee" is defined as "an individual holding a salaried Senior Management Service or Selected Exempt Service position with any state agency." Fla. Admin. Code R. 60P-9.001(3). Only employees so defined have disability insurance coverage under the Plan, to be sure. See Fla. Admin. Code R. 60P-9.009(1) ("The date of termination of coverage will be ... [,][i]n the event of termination of employment, the employment termination date."). When a covered employee becomes disabled, moreover, the amount of the disability benefit depends on "the employee's basic daily earnings at the date of disability." Fla. Admin. Code R...