Employer Cancelled My Benefits

[luvlife]

I am still off work due to my WC injuries and WC doctors determination. Still "technically with the company" and now recieved notice that they have terminated all of my benefits, medical, dental everything. WC attorney filed a 132a on my behalf and I have opened a complaint for disibility discrimination with EEOC. have been on WC off and on for just a little over a year. HR says they do not know what happened however it has been weeks now and they still have not "fixed" the problem. Hmmmm... any suggestions? I think it is time for me to email my HR headquarters and quit fooling around with my local HR that never replies back.

[BvIA]

Under HIPPA/FMLA rules you may be eligible for leave up to 12 weeks, and the ER cannot terminate you or cancel your benefits... after that 12 FMLA weeks...there is no law that prevents the ER from canceling any of your benefits...though they are required to offer you COBRA...

Cancelling your benefits is not 'harrassment' or 'discrimination'...

Here is information on FMLA/WC...http://www.claimline.com/articles/lpa6.html
This is actually for ERs, but valid for IW's as well..http://www.ppspublishers.com/articles/fmla.htm
Additional sites are here...http://search.aol.com/aol/search?que...s+Compensation

The law allows for FMLA to run concurrently with your WC/TTD...subject to notification.

[Charles Stevens]

Cancellation of medical and other benefits has been the subject of MUCH debate in the Applicant Attorneys arena....the last I heard, if the medical benefits that were cancelled do not fall under ERISA, then it very well might be illegal for the ER to cancel them.

Luvlife, since you DO have an attorney, at this juncture, it is NOT wise for you to have ANY contact with your Employer! Since your Employer is now being sued by you, ANYTHING that you say can and WILL BE USED AGAINST YOU! And you certainly do NOT want your words "twisted" and taken out out of context!

In my humble opinion, your attorney should be the one who contacts/writes your ER/HR department regarding your medical benefits, and any OTHER issues, for that matter. Similarly, now that you are represented by an attorney, NO ONE from your Employer or the IC handling your WC claim should have any direct contact with YOU!! This is for YOUR protection, and as inconvenient as it may be to have everything go through your attorney, it really is the for the best!

Therefore, it would be prudent to ALWAYS CHECK WITH YOUR ATTORNEY BEFORE you initiate ANY CONTACT whatsoever with your ER/HR, and/OR the IC CA handling your WC claim!

However, IF your attorney says it is ok for you to contact HR, do it IN WRITING, and run your letter by your attorney FIRST....then, when he has approved it, send it via US Mail RETURN RECEIPT REQUESTED, so that there can be NO dispute that HR received it!

Also, be VERY wary about "friendly and concerned" CO-WORKERS who might be contacting you to "see how you are doing"! Unfortunately, many Employers involved in litigation, and KNOWING that THEY are not to have contact with you, WILL USE CO-WORKERS to FIND OUT EXACTLY WHAT'S GOING ON WITH YOU! So, be EXTREMELY CAREFUL, and you should NOT DISCUSS your cases with ANYONE!

Always DOCUMENT EVERYTHING, and save ANY and ALL messages that may be left on your phone by your ER and/or those "friendly and concerned" co-workers!

Good luck, and keep us posted!

[Pokeno]

Hi Charles:

I hope you don't mind me jumping in here to ask for clarification.

Could you please expand on

Cancellation of medical and other benefits has been the subject of MUCH debate in the Applicant Attorneys arena....the last I heard, if the medical benefits that were cancelled do not fall under ERISA, then it very well might be illegal for the ER to cancel them.

Where can I (and others) get more information about this subject?

Thank you very much in advance

Pokeno

[oppsifell]

I can only tell you what my experience was as far as health and life insurance policy went and hope this helps you!

I was injured at work and I did have to pay what my employer was taking out of my paycheck every pay directly to my employer every month to keep my insurance going. Lets say it was $180 per month. Then after 12 months I recieved a letter stating I was no longer an employee (from the life ins co) Supposedly a misunderstanding, but since I had been out for 12 months I was no longer entitled to life insurance! Then I recieved a letter I now had to pay the full amout of the health insurance (not the amount my employer charged me) this would also be paid to my employer. $380.00 per month which would only be avial. for 6 months then if I qualified for medicare I could pay 150% for an additional 18months! I am now still an employee of this company, and still listed on time sheets still gets discounts towards purchases but not entitled to any benefits.

The problem arises since I have been out of work for so long thanks to the ER's IC I not only dont have any health insurance but also cany find anyone willing to insure me. If you have only been out for a year start looking for a new health insurer now only because once you have been out as long as I have vene though I kept my insurance all insurance companies will deny you because of the inability to work and they will also want a complete physical. Who will pass a phycal after being out with any total disabilty for 3-4 years?

If you have a spouce try to get on to thier insurance ASAP!

[Charles Stevens]

Pokeno, I may have gotten it "backwards"...if under ERISA, then I think the ER can NOT cancel medical benefits. This is a VERY confusing area of the law, but here is a link that may be of interest:

http://www.boltonco.com/boltonco/hot...ntinuation.asp

There may be State-specific laws about an ER cancelling your medical benefits while out on worker's comp. It may also depend on if you are a State, Federal or County employee....the bottom line is, many argue that NO ER should have the right to cancel medical benefits of an IW just because they are off work due to an industrial injury!

As I stated previously, this issue as to whether or not an ER can in fact cancel your medical benefits is HOTLY contested...therefore, If you think that your ER has possibly cancelled you medical benefits illegally, you MUST CONSULT with several Labor Law attorneys as well as Insurance Law attorneys.

[BvIA]

5. Does an employer have to pay for health insurance for an employee on WC leave?

If the employee qualifies for FMLA leave and the employer normally pays for health insurance, the answer is yes. Although most state WC laws do not require employers to pay for health insurance during a WC leave, the FMLA requires the continuation of health insurance benefits during an FMLA leave. Typically, the state WC laws cover the employee’s medical costs related to the work injury but do not mandate continued coverage under, or payment for, a health insurance plan. However, under the FMLA, employers must provide the same health benefits during an eligible employee’s FMLA leave that it would have provided if the employee worked throughout the leave. Thus, if the employer normally pays 80% of an employee’s health benefits premium, it must continue to do so during the employee’s FMLA/WC leave.

http://www.ppspublishers.com/article...n%20WC%20leave
While the above site is actually for employers, the information can provide some insight to how those ER's handle the various laws/regs...eg FMLA/ADA and the relationship to WC.

This one offers more light on this subject...http://www.claimline.com/articles/lpa6.html

The U.S. Dept of Labor also offers information on WC...http://www.dol.gov/esa/owcp/dfec/reg...ance/wc.htm#CA

[Pokeno]

Charles and BvIA: Thank you very much for the links. You guys are wonderful.

I can't believe that other people are having the exact problems I am running into!

You both helped me with problems and my employer. I met with the company owner this week about continuing my health benefits. They are telling me I either have to start working 30 hours to keep all my benefits, or I have to buy them through COBRA, which no way can I afford them.

Luvlife: Thank you for starting this thread. Are you basing your discrimination complaint because they are denying your medical, dental etc? If so, I would like to know how that is going. I am having a similar problem with my employer.

Charles: Can you expand on your comment

As I stated previously, this issue as to whether or not an ER can in fact cancel your medical benefits is HOTLY contested...

I live in California. Is this where it is being hotly contested? Who is contesting it? I can really use any and all information you have about this, as I am talking to the company owner about whether or not they can do this to me.

Before I seek out an attorney, I would like more information, so that when I talk to one, I know something about what I want and why I think it is illegal.

I very muchly appreciated the links, I have been pouring over them all afternoon. I can't tell yet whether or not I will have to pay for the COBRA benefits. Thanks why all the specific information you can give me about California law on this subject is so timely for me.

Luvlife: I found when I went to the Owner instead of the personnel director, it helped alot. He was very interested in my situation. The problem around my benefits and COBRA is that he is getting his information from the personnel department. They gave him an article that says they can deny my medical and dental benefits, that was written in 1995.

Is your complaint with the EOCC about denying benefits too?

Thanks to everyone and have a very good weekend


Pokeno

[BvIA]

In many instances, the EE is required to work a minimum number of hours ..say 30, in order to qualify for the health coverage per the policy... the IC issuing the coverage.. not necessarily the ER/Owner providing the ''benefits''...the premium is based on the EE qualifying for the benefits per the terms of the policy in effect...

So, if you are not working the 30 hours mandated by the IC...you don't qualify for the coverage...
IC's do this to mitigate their exposure... ''health coverage'' provided by your ER, is to cover non work related injury/illness... IF you are working 30 or more hours per week... the exposure is reduced... any injury/illness you sustain during those 30 hours is presumed to be covered by your ER's WC coverage/plan.
If there is a IC providing coverage for both ''regualar health benefits'' and the ER's WC coverage... the IC has more control over medical treatment for WC than they do for regular health coverage...

It does get confusing for an EE/IW... but it always comes down to the exposure...money the IC is going to spend to cover the claim.

What COBRA does basically, is allow you/EE/IW to purchase health coverage in the group policy and at the group rate as provided by your ER.. the difference is... you pay the entire premium... vs the ER paying their ''share'' of the cost, and the EE paying their share...
The whole premium could be over the total amount..up to 150% of the group benefit or more....the benefit is, the IC cannot deny you coverage under COBRA for 18 months once you are eligible...

I live in California. Is this where it is being hotly contested? Who is contesting it?

AA are attempting to get the issue of ER provided benefits ressolved in favor of the EE/IW... and there is a lot of discussion in the AA community... there will always be an arguement about the issue of continuing provision of benefits while an EE is out on a TTD/work related injury... FMLA provides some relief...
But you always have to pose the question... 'how much is the ER actually liable for?".. .IF the EE/IW is not producing for the ER due to an extended period of disabiltiy, and there is no expectation of a timely RTW... how long should benefits be provided...? Indefinately...? 12 weeks...as FMLA provides.. 6 months..9 months...? The duration of TTD...?
IF the ER continues providing benefits for a year or more, and the IW is determine unable to RTW, or there is no job that fits the restrictions ... is the ER liable for a YEAR or more of the cost of health, retirement, other benefits package as provided while an EE is actively producing for the ER/company.,..?

[Pokeno]

Hey BvIA and Charles:

This info is so timely, it is fate or something that this issue is coming up now. I have an meeting set for Tuesday morning with the Company Owner to discuss my benefits and what the company can offer me and my familiy as I recover from my surgery and limited hours.

Thanks for the info. Now I hate to keep harping on where the info that benefits are a "hot issue" is coming from. I really appreciate that the issue is getting much attn and you guys are willing to share that.

But...If I am going to make a point of discussing this with the company owner, I need some more hard facts than a couple of very knowledgeable guys on a an Internet Forum say it is an up and coming issue, if you know what I mean.

I would rather err on the side of caution and not raise it at all, than risk losing credability with the owner, when he asks where I am getting my info and all I can say is a couple of terrific and expert guys on an Injured Workers Forum say so.

I understand if you can't share where you got your info and I in no way want to pressure you into sharing something you can't. But....

It would help tremendously if I had a cite I could look up in the next day or so. I don't expect you two to spoon feed me info, but if you could just point me in the right direction and I will take it from there.

BvIA you said

But you always have to pose the question... 'how much is the ER actually liable for?".. .IF the EE/IW is not producing for the ER due to an extended period of disabiltiy, and there is no expectation of a timely RTW... how long should benefits be provided...? Indefinately...? 12 weeks...as FMLA provides.. 6 months..9 months...? The duration of TTD...?
IF the ER continues providing benefits for a year or more, and the IW is determine unable to RTW, or there is no job that fits the restrictions ... is the ER liable for a YEAR or more of the cost of health, retirement, other benefits package as provided while an EE is actively producing for the ER/company.,..?

Luckily, this doesn't have anything to do with me

Thanks again guys, I hope not to cause trouble if you could provide a cite or 2 about the AA's who are pursuing this critical issue for us injured workers.

Pokeno and Family