WC, FMLA, & Insurance benefits

Yeseniayf

I read an article a couple of months ago that stated that it is O.K. for the employer to discontinue an employee's insurance coverage if they are off work on Worker's Comp. and have exausted their FMLA.

Do any of you have any knowledge of this?

Don D

Depending on your state comp laws, you may indeed not have to continue group medical coverage in that instance. What does your written policy state? Federal law requires the continuation of such insurance in FMLA situations, but, there's no Federal Work Comp Laws. Each state is stand-alone. If your state is silent on it it boils down to what your policy says coupled with you do in all other situations when ee's are out due to reasons not associated with FMLA.

kwelzel

I had a W.C. case last year, the ee "just turned pregnant" when the unwitnessed accident occurred. We maintained her insurance throughout her entire pregnancy. She had a scam doctor who stated she could not verify the extent of her back injury with x-rays because of her pregnancy. She never paid a dime on her portion of the premium.

When the insurance finally settled with her, post-partum, they convinced the court that the amount of money she failed to pay for her health coverage was deducted from her settlement.

It wasn't a large amount, in comparison, but it "felt good" knowing she didn't get it all!

Lesson: keep track of the medical coverage expenses if you maintain that coverage during the w.c. leave.

Yeseniayf

Thanks for the advise.

Don D

>I had a W.C. case last year, the ee "just turned pregnant" when the
>unwitnessed accident occurred.
That quote will wind up in a book somewhere.....just watch. I think anybody who gets pregnant by accident should do so unwitnessed. x:-)

njjel

She would be eligible for COBRA if your company is required to provide it. Therefore you would not terminate the coverage before offering her that right.

kwelzel

Offering her COBRA would have been the easy way to do it...but she refused to give us a current address, she gave us "bogus" phone numbers, all notifications were sent by registered mail and RETURNED undeliverable, the "doctor" would give her messages from us, but she would not comply with our requests. We basically had to wait it out for her to deliver her baby, then the W.C. insurance finally settled with her and now she is no longer our problem.

We were advised that it was probably better to maintain her health insurance coverage (single HMO) than drop her and end up in court over the entire matter.