Lost Insurance due to W Comp Injury
Started by Sonna250 , Mar 24 2014 12:52 PM
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Posted 24 March 2014 - 12:52 PM
A employee sustained an injury during work which we filed a workers comp claim. The employee had just completed his 90 probationary period and became full-time with health insurance benefits (employee pays a portion of the cost of insurance normally as a deduction from his payroll check) 3 days before the injury occurred. The employee has not returned to work per doctor instructions and that was 7 months ago. This employee has not paid one cent towards his health insurance. We have written reminder letters to him etc My question is whether we can terminate his coverage. I have asked the insurance company, employer attorney, Dept of Ins. etc. and cannot get a straight answer. We do not want a discrimmination case rise up if we do term coverage. Any suggestions?
Posted 24 March 2014 - 01:13 PM
What is unclear is why you haven't terminated the employee. If he'd only been working there 90 days, FMLA certainly wouldn't apply even if you're of the requisite size, and that's the only law under which I can think of that the employer would be obligated to continue health insurance coverage generally (and even then only for 12 weeks). (That doesn't mean the employer isn't obligated to cover cost of workers' comp-related injury, etc.)
"The employee has not returned to work per doctor instructions and that was 7 months ago."
So why haven't you fired him?
If the "employer attorney" doesn't know, then (s)he should be referring you to relevant counsel.
Sounds like employer doesn't have a good handle on regulatory compliance, and the insurer and state insurance folks aren't obligated to provide that kind of advice.
I'll echo PG's advisory "warning" with a twist: (Many) legal issues are complicated. Explanations and comments here might not fully identify or explain the ramifications of your particular problem. I do not give legal advice as such (and such is impermissible here at any rate). Comments are based on personal knowledge and experience and legal info gleaned over a quarter century, and every state has differing laws on and avenues to address most topics. If you need legal advice, you need to consult (and pay) a professional so that you may have someone to hold accountable. Acting on personal and informational advice from a stranger on the internet is a bad idea -- at least not without your own thorough due dilience/research and confirmation as it applies to your situation.
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