Insurance coverage terminated while on short term disability

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Latest post 02-01-2012 1:20 PM by adjuster jack. 12 replies.
  • 01-31-2012 10:09 PM

    • mattam
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    Insurance coverage terminated while on short term disability

    I have an approved leave of absence from my company to get a rotator cuff surgery on 11.22.11 The recovery and rehabilitation process was estimated by the surgeon to be 4-6 months. This was communicated to my employer as well. I am now on Short-Term Disabilty, which will terminate on 2.28.12, unless I qualify for the Long-Term Disability.

    I was laid off on 1.20.12 while I'm about 2 months into my rehab. The reason given for my lay off was the company's poor sale performance.

    Now I'm told that my health insurance coverage will expire on 2.20.12, and I will have to get my own insurance coverage to pay for the remainder of my rotator uff surgery rehabilitation.

    I just don't think this is right! Do I have any relief under the law, either from the insurance company, or my ex-employer.

    Thank you,

    Matt from Mass

  • 01-31-2012 10:13 PM In reply to

    • cbg
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    Re: Insurance coverage terminated while on short term disability

    Contrary to popular belief, short term disability benefits (or, for that matter, long term disability benefits) do not provide any rights to employees with regards to job protection or insurance coverage.

    Nothing in either Federal or Massachusetts law requires your employer to continue your health insurance after your employment ends, regardless of whether you are collecting disabilty benefits or not.

    You WILL be eligible for COBRA. That's as good as it gets.

    Sorry.

  • 01-31-2012 10:25 PM In reply to

    • mattam
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    Re: Insurance coverage terminated while on short term disabi...

     

    @CBG,

    Thank you for the insight, but I just read somewhere else on the forum that I may have recourse under the FMLA, since I was terminated short of the 12 weeks requirement?

    Matt from Mass

  • 01-31-2012 10:40 PM In reply to

    Re: Insurance coverage terminated while on short term disabi...

    mattam:
    I just read somewhere else on the forum that I may have recourse under the FMLA, since I was terminated short of the 12 weeks requirement?

    It might not be that simple.

    FMLA allows an employer to terminate an employee within the 12 weeks for legitimate business reasons if the employee would have been terminated at that time if he wasn't on leave.

    If you feel that the termination was in violation of FMLA I suggest you seek compliance assistance from the DOL:

    http://www.dol.gov/dol/topic/benefits-leave/fmla.htm

    Meantime, do not let the deadlines and requirements for COBRA pass you by.

    If you pay for your own coverage and it takes several months for your DOL complaint to be resolved you might get reimbursed by your employer if successful.

    But if you go without the coverage, you will not get reimbursed for uninsured medical costs.

    Information on COBRA can be found at:

    http://www.dol.gov/dol/topic/health-plans/cobra.htm

     

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • 01-31-2012 10:55 PM In reply to

    • mattam
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    Re: Insurance coverage terminated while on short term disabi...

    Thank you Adjuster Jack.

    I will definitely check the DOL and COBRA. Definitely good advise.

    "They press you, wring you and spit you out in the end"

    Matt from Mass

  • 02-01-2012 9:04 AM In reply to

    Re: Insurance coverage terminated while on short term disabi...

    mattam:

    "They press you, wring you and spit you out in the end"

    I like that.

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • 02-01-2012 9:28 AM In reply to

    Re: Insurance coverage terminated while on short term disability

    mattam:

    I was laid off on 1.20.12 while I'm about 2 months into my rehab. The reason given for my lay off was the company's poor sale performance.

    Now I'm told that my health insurance coverage will expire on 2.20.12, and I will have to get my own insurance coverage to pay for the remainder of my rotator uff surgery rehabilitation.

    Jack was correct in suggesting a possible FMLA violation but based on your statement that I quoted above there isn't one.  Based on your surgery date (and the fact that Jan/Dec have 31 days AND this is a leap year) your FMLA job protection would expire on 2/20/2012.

    Under FMLA your employer must keep your benefits intact for the 12 weeks unless you are terminated for a legal reason.  Once you were laid off they could stop your benefits but did not.  It appears they are keeping them intact until the FMLA time period expires.  That is VERY generous on their part and they were not legally required to do so.  They could have put you on COBRA on January 20th.  

    mattam:
    Do I have any relief under the law

    You are entitled to COBRA coverage for 18 months.  The employer can charge up to 102% of the cost to you to maintain your health insurance.  Your other option is to purchase an individual policy.  I did that instead of COBRA at half the cost.  

    The other thing to be aware:  if the employer stops providing health insurance all together then there is no COBRA coverage either.  As long as the employer maintains a policy and you are within the 18 months you are eligible to purchase the COBRA coverage.  If the employer stops the benefit for all employees that includes those on COBRA too.

     

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • 02-01-2012 9:52 AM In reply to

    • Drew
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    • Joined on 03-30-2000
    • PA
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    Re: Insurance coverage terminated while on short term disability

    Agree--you must make sure you have insurance via cobra in place and pay it as required--otherwise you are out in the cold.

    If you find a new job which provides group coverage and you qualify for same --address your new options when you have them in hand.

    Its perfectly legal to lay off folks  while on FMLA is they would have been laid off anyway for some legitimate reason--such as downturn in business  or large reorganization.

    It becomes problematic if your layoff was a pretext  to get somebody else into that slot or to get you off the health insurance rolls --if the layoff smells as a bit way to convenient you might be smart to review your view of issues with competent people as to FMLA matters 

    Assuming you are available for work and able to work and seeking work  I presume you have filed for UC--if not--do it-sort out issues later.

     



  • 02-01-2012 9:55 AM In reply to

    • Drew
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    Re: Insurance coverage terminated while on short term disability

    If employer is being NICE to carry you  on insurance you might be smart to get surgery safely covered  before you make any moves which might alter their view of Nice?



  • 02-01-2012 10:00 AM In reply to

    Re: Insurance coverage terminated while on short term disability

    Drew:
    It becomes problematic if your layoff was a pretext  to get somebody else into that slot or to get you off the health insurance rolls --if the layoff smells as a bit way to convenient you might be smart to review your view of issues with competent people as to FMLA matters

    Pretext for what?  They kept paying the benefits and are keeping him on the insurance until FMLA expires even though he is no longer employed.  He wasn't working due to having the surgery and is on short term disability so it isn't salary either.  Getting him off their insurance?  He isn't off: they are still paying even though not obligated to.  They even went so far as to give him almost a month notice so that he can be ready.  Some employers wait until that day and the employee is financially caught off guard.  

    There is no "pretext" here the employer in this case has done far more than most would do in this economy for an employee who no longer works for them.

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • 02-01-2012 11:18 AM In reply to

    • mattam
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    Re: Insurance coverage terminated while on short term disability

    Clydesmom:

    I posted to the forum to get advice on insurance coverage issues that, as most laymen workers, I do not understand fully. The replies have been most helpful in that regard.

    It seems that it may have been "NICE" of them to continue my coverage even after my termination date, but as in most cases there are always more to the story. I was refering to FMLA as a job-protection issue, and not about the insurance coverage. I was wondering if I have any recourse against them laying me off while on FMLA. And I was salaried, if this has any bearing here, and had been with co. for 16 years.

    As to the pretext, they did slide in somebody new into my "position". I know this since I visited them yesterday 1.31.12. This by no mean is saying  that I'm going to get to the nearest lawyer. This NICE co also had in the past couple years laid off a supervisor the very week that his wife was to start cancer treatment. Nice indeed.

    It just seem to me that we the working stiff gets STIFFED after all the years of contributions. That's my belief, and I'm sticking to it!! ;)

  • 02-01-2012 11:55 AM In reply to

    Re: Insurance coverage terminated while on short term disability

    mattam:
    I posted to the forum to get advice on insurance coverage issues that, as most laymen workers, I do not understand fully.

    No one disputes that.  

    mattam:
    I was refering to FMLA as a job-protection issue, and not about the insurance coverage. I was wondering if I have any recourse against them laying me off while on FMLA.

    If they laid you off BECAUSE you were on FMLA:  yes.  If the decision to lay you off would have been made regardless of your being on FMLA:  no.  FMLA does not stop the employer from taking any action that they would take even if the employee was actively working and not using FMLA.  

    mattam:
    And I was salaried, if this has any bearing here, and had been with co. for 16 years.

    Exempt or non-exempt has no bearing and your length of employment means you were qualified for FMLA protection based upon length of service.  Neither affords you any extra protection.

    mattam:
    As to the pretext, they did slide in somebody new into my "position".

    Laying you off doesn't mean that no one does your job at all.  If they consolidated positions then someone new would be doing your job.  If your job is to polish widgets and they need to reduce numbers due to low widget sales they can combine the job into polishing and manufacturing widgets.  If you only polish they can lay you off and put someone new in the job who can do both tasks.

    mattam:
    This NICE co also had in the past couple years laid off a supervisor the very week that his wife was to start cancer treatment. Nice indeed.

    Is there a convenient time for lay offs?  While on the surface it looks cruel it may in fact be only business and if business is suffering they can't keep EVERYONE on the payroll because of his wife's condition to the point that the business closes it's doors and all the employees lose their jobs.  If there was something nefarious going on as to your termination I highly doubt they would continue to pay your benefits until the 20th.  They would simply cut you off with no advance notice.  As I said before they went much farther than they were legaly required to and gave you more notice than many employers would.  You will still have coverage, you will just have to use COBRA and pay out of pocket.

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • 02-01-2012 1:20 PM In reply to

    Re: Insurance coverage terminated while on short term disability

    It might just be that there was nothing nefarious going on in your case.

    But it costs you nothing to have the DOL look into the "layoff" to make sure it was legit.

    Might not get you anything if the employer adequately justifies the layoff, but at least you'll know that the employer was tasked with properly documenting it, if that's any consolation.

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
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