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  1. #1
    Join Date
    Jan 2009
    Posts
    36

    Question Can Employer Stop Your Health Insurance?

    If this is a duplicate thread, i am sorry. I didn't find it while looking around.

    Can your employer cut your health care insurance while you are still out on T.T.D. after the 2 year mark?

    My employer is threating just that. They claim i'm on long term disability, which is not true. When pressed for documentation on my "LTD" im suddenly in a grey area, and the refuse to produce it. Even though the employer has insisted no less than 20 times that i had to fill out the short/long term paper work, i refused to sign. They say i'm the first person to do that. I doubt it.

    Employer is self insured. Im currently still out. I am on T.T.D. Injured in 05' fought intill late 07' to have recinstructive surgery. I now need 2 more surgeries due to the length of time it took for the first surgery, and the additional damage that the time it took has caused. They are fighting me on that. No shocker, as everyone who reads this will understand. Hey, i haven't lost one yet!

    Bottom line, the employer informed me that at the 2 year mark, they will cut me from there health care plan. As of right now, other than the overall cost, nothing has changed. Instead of my share coming out of my bi-weekly pay check, i pay it monthly directly to or benifits resource. Same place, some company, same insurance.

    Can an Ohio employer remove you from the family madical coverage after being out for 2 years on T.T.D? Yes my claim is current/active. No i have not been M.M.I'ed (and there not happy about that)and i am currently seeking additional allowances.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Can Employer Stop Your Health Insurance?

    Bottom line, the employer informed me that at the 2 year mark, they will cut me from there health care plan. As of right now, other than the overall cost, nothing has changed. Instead of my share coming out of my bi-weekly pay check, i pay it monthly directly to or benifits resource. Same place, some company, same insurance.
    Yes... and the ER has gone past the time they are required to keep your ER benefits intact. Unless there is a collective bargining contract in place, FMLA only requires the ER to keep your benefits, and pay for them, for 12 weeks/annum.

    FMLA also requires the ER to notify you in writing if you are eligible for FMLA benefits, and can run those leave periods concurrently with WC leave, if you have been properly notified.

    Many IC's providing health care under a ER plan require the EE to work a pre determined number of hours per month...eg 32 hours is generally considered full time employment. If those requirements are not met, the IC can drop you from the plan. You must be offered COBRA benefits if you qualify.

    Even though the employer has insisted no less than 20 times that i had to fill out the short/long term paper work, i refused to sign
    As your ER is self insured, they may have purchased STD/LTD coverage for the EE's in the event of industrial/non-industrial leaves. All costs to a comp claim come directly from the ER when self insured, the STD/LTD policy may be just to limit their financial exposure. Why did you refuse to sign those applications ?

    Some guidelines for ER's and FMLA/ADA/WC issues are here...http://www.ppspublishers.com/articles/fmla.htm

  3. #3
    Join Date
    Jun 2008
    Posts
    257

    Default Re: Can Employer Stop Your Health Insurance?

    i was also injured in 05 and my employer is self-insured!!! It has really sucked nothing but a uphill battle the entire way.... As far as the insurance for the first year I only paid what i paid weekly before the accident then at 12 months I had to pay what they said was half of the costs then I was entitle to keep it but at 18 month I had to pay the emtire amount... then if I was medicare elligble at that time I could continue but I would have to [pay 150%... the was through cobra... and keep in mind the entire time I am still considered am employee of this company and if and when I am ever able to RTW I am expected to return here without any animosity? This is part of the game they get away.

  4. #4
    Join Date
    Jan 2009
    Posts
    36

    Default Re: Can Employer Stop Your Health Insurance?

    Thanks for reply BvIA.

    I did not sign the paper work because unlike most, i actually read it. I won't go into the long drawn out version of all the gory details. I will say had i signed it, i would have only got 50% of my pay for the first 6 mos, then 66 2/3% (only because i paid extra for that premuim) for the next 12 mos. After that, you arer SOL. It somehow cuts the EOR out of it, and your on your own. It has been so long since i read it i can't remeber the finer details, but it was the most obsurd "contract" i have ever seen.
    I felt much better when my lawer told me i would be crazy to sign it. The sad part is, that there standard std/ltd plan for all. There just mad because i not only read it, but told all who would listen about the devil in the details.

    Bubba,
    thats what i find so hard to believe. We are still employee's. Most of us have been out as long as we have purley because of the games they play, and the time it takes. I waited 6 mos for an MRI approval. The next surgeries i am going to have to have done are because of the amount of time all the delays, and appeals, and bogus Dr's they made me go see. Had everything done the way it should have, i would have got cut on in the fall of 05', back to work in early 06', and then they could have laid me off in the fall of 08', like most who work there. Instead, im still an "employee" even though they called me in Nov. 08' to tell me my job was eliminated (was filled by someone else, not eliminated) and that i was not eligible for the package being offered to everyone who was let go, i was again in a "grey area" and mine was yet to be determined. Which included health insurance for a certain period of time and cash.
    Last edited by Notgonnasay; 04-21-2009 at 07:06 PM.

  5. #5
    Join Date
    Jun 2008
    Posts
    257

    Default Re: Can Employer Stop Your Health Insurance?

    I still have a hard time understanding why they do this because it cost them as well as us more in the long run.... ex if they would of approved my surgery in may of 05 as thier own doctor recommended (IME) which is quiet expensive instead of paying for aquatics, PT, then pain managaement more consultations with neurosurgeons and an ortho then sent me back for another round of aqautics and another round of PT and this time gave me masotherapy oh and i forgot the injections at 3000 a piece which did nothing and the MRI's EMG's Myelogram lots of meds and bought me a alphastimulator and 2 tens units went 2 about 16 IME's and the industrial commission many times all this adds up to well over 300,000. And this was prior to surgery!!! I finally got my surgery 3 years after the accident, then my second just about 2 months ago... now because they delayed this it is costing me and i am not talking monitary!!! Alls i can say is Sedgewick sucks!!!!

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