Is my employer responsible for insurance problems?

Question

My fiance started a new job last year and was told he would have benefits after 90 days. When his 90 days was up, we never received a card for his insurance, but his employer kept promising that he had insurance. Shortly after (my fiance suffers from severe GERD) we had to make a trip to the emergency room with a related problem. We now have a bill for $3,000.00 because it turns out the employer was lying and did NOT put my fiance on the insurance list. We took the bill to the employer and they said they would look at it, and possible make a payment plan. That was two weeks ago and they are still stalling. Aren't they at least partly responsible for this? If we took them to court for the charges, would we win?

Answer 1

You would win that case.

When an employer purchases a group health plan they are taking on the responsibility of adding each willing participant after the 90-day waiting period (or whatever other waiting period they choose, could be 30, 60 or 0 days as well).

They can't selectively choose who they sign up within that 90 days and who they do not, per employment law as it pertains to benefits that would be treating employees different.

This is clearly a violation by the employer of it's duty to it's employee and a clear failure to administer their benefits properly.

Put the pressure on them to pay up, if this ever goes to court this will turn into a much bigger issue for them than paying a $3,000 bill as the Commerce Department is going to take it up.

Answer 2

Well, from your very sketchy details, ESPECIALLY if the employer was taking money out of his paycheck, you would likely win.

This happens OFTEN enough that there is an insurance coverage to cover it, that the employer can purchase - Employee Benefits Liability Coverage.

You have two issues: 1. getting the insurance in place - which it doesn't sound like it's been done yet, and 2. getting the other bill paid. Oh, and if you see a lawyer about suing the employer for the payment, the third issue, 3. finding a new job and suing for wrongful discharge, might also come up.

Meanwhile, the fiance is responsible for the bill. It can go to collections and hurt his credit record. It's time to sit down with the boss, demand FULL payment (NOT a payment plan, where he can stop paying at any time!!), get the agreement in WRITING, and from the sounds of it, hire an attorney. Who will probably cost you about half the 3K.

Answer 3

Well I had this happen to my husband too...but we knew if we did not fill out any forms then we were not covered. You should have known that too..... To sign up for insurance it takes at least a minimal amount of paperwork and everyones social security numbers, so if you were not asked then you shouldnt have thought you were covered. How did you fill out the insurance forms at the hospital without an ID number? I dont think you would win in court either....The judge will say something like what I just said, you should have known better. He could slap a fine on the employer but probably he would just do nothing. It all depoends which state you are in though.....If you live in a more liberal state your odds are better for getting reinbursement. Employers are not obligted to give you insurance. For five years I have gotten my own through Aetna. I have a family of six and only pay $350 a month for copay of $20 so maybe look into them (I have dental too with that) and get your own insurance. Emploters giving out insurance is almost a thing of the past, you find it less and less.

Answer 4

Check your fiance's term of contract if there's a insurance clause. Chances are it is. Going to court will only make a lawyers happy. What needs to be fixed now is the payment thus I would suggest you cool down and have a friendly discussion with the company. See if you could derived at a win-win solution. Don't deviate from the issue. The issue is to pay the bill so forcus on that.

Answer 5

If you have written policy stating that he would be insured after 90 days employment, then it's the employer's problem for certain and you'd probably win a court case. Unfortunatly, getting the bill paid and getting fired won't help him much either. Gather documentation and be patient; too much pressure could get him fired as well.

Answer 6

If your fiancé has it IN WRITING that he will be entitled to health insurance after the stated period, then you can sue them with an excellent chance of success. If it was strictly a word-of-mouth thing, however, it's anybody's guess who will win.