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tdarling7

Insurance Canceled after asking for time off for surgery

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After working for my new employer in Michigan for three months I suffered a serious injury at work. I had worked their long enough to have just started on their health insurance plan. For the next 9 months I have been working one to two days a week as they were able to find work that fit my restrictions. During that time my employer had paid my health insurance premiums because I could not afford to pay them with the decreased wages I was receiving. A time came that I had to request time off for a surgery for personal reasons. Less than 24 hours of putting in my request (requested 1/22/2015 cancelled effective 1/23/2015) my employer cancelled my health insurance and offered me COBRA. When I got the cobra paperwork in the mail it said that I was being offered cobra because of "termination of employment". I questioned my employer about the reasoning for cobra and they stated that it was a mistake. They said that I was being offered cobra because my insurance was just simply cancelled. I questioned them about qualifying events, I said I thought the only way to be offered cobra was "termination of employment" or "reduction in hours worked" they said that it is also when insurance is simply cancelled. Can anybody advise me if my employers course of action against me is legal?

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Did you file a worker's comp claim?  Consult a local attorney.

He said the surgery was "for personal reasons."  Firing him because of a comp claim would be illegal.  But, he is not even sure he was fired.

 

COBRA FAQs are at:

 

http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html

 

Qualifying Events - Qualifying events are events that cause an individual to lose his or her group health coverage. The type of qualifying event determines who the qualified beneficiaries are for that event and the period of time that a plan must offer continuation coverage. COBRA establishes only the minimum requirements for continuation coverage. A plan may always choose to provide longer periods of continuation coverage.

The following are qualifying events for covered employees if they cause the covered employee to lose coverage:

  • Termination of the employee's employment for any reason other than gross misconduct; or
  • Reduction in the number of hours of employment.

 

But, the questioner also said the employer was paying his share of the cost of the insurance for nine months.  Without knowing for sure, it may be his participation in the health plan was terminated because he had not paid his portion of the premiums for the insurance.  That may require notice similar to, although not technically the same as, Cobra. 

 

Also, COBRA kicks in if his hours were reduced.  The questioner says he only works one or two days a week.  If that is due to the comp related accident, it may be he has a claim for retaliation due to the comp claim.

 

More information is necessary.  Consultation with local labor lawyer would be highly advisable.

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I asked if he'd filed worker's comp because his post wasn't clear.  If he had filed the claim, the comp should have picked up a significant part of the difference in his wages and covered the medical for that injury.  He does need to consult counsel though.

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Yes I do have a work comp attorney. My hours are reduced from 70 hours a week to 0-8 hours a week because of the work comp injury. I am still employed as my told me that my cobra being marked "termination of employment" was a mistake. My attorney has put a request in for a settlement just two weeks before all of this began. My employer is self insured so I am sure that when I told them I was having surgery for personal reason that they decided they did not want to pay for that. Hence the reason they cancelled my insurance as fast as humanly possible. My work comp attorney has not answered my question as to if this is something he covers or if I need to find another attorney that specializes is this situation.

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It sounds like FMLA does not apply because of the lack of hours and possibly tenure. If that is the case, you can be offered an unpaid LOA for your own surgery (which sounds unrelated to the work injury) and be required to pay the premiums for the health insurance. Only during FMLA is the employer required to maintain those benefits for you at the active employee rate.

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The timing is what weighs in favor of it being because you are off work under non-protected leave as opposed to some other reason. This is pretty routine and not illegal nor uncommon. Technically they don't even have to grant you the leave and could legally terminate.

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