Question
What is the name of your state? Georgia
I'll try to keep this brief.
I am seeking advice to help my mother. She was disabled by a stroke in 1997. She worked for a large company and had great insurance benifits, however, they recently sent her a letter stating a "qualifying event" as "termination".
The letter is dated 7-19-06, and the termination is dated 12-31-05. She has been offered COBRA continuation insurance (if requested before 9-19-06) for up to 18 months after the 12-31-05 date, which, if she accepts now, would end in less than a year from this date.
My questions are numerous.
Is it legal for them to have not notified her sooner? The date was more than 6 months ago, which is more than 1/3rd of the extension period offered.
By waiting this long to give her this option, they have pervented her from effectively having any choice. If she now decides to decline the COBRA continuation, the lapse would date back to 1-1-06, and could prevent her from aquiring any substantive insurance for her future medical needs.
I am also concerned about the "termination" event listed in the letter. It does not clarify if the termination refers to the end of insurance coverage, or if this is somehow related to her previous job, and termination from that. She did not quit, or get fired. She became disabled and was unable to return to work. She has not been contacted by her employer for several years.
Another point of interest may also be her recent birthday. She turned 60 this month, only a few weeks before this letter arrived, and I have to wonder if if the two events are somehow related.
I am curious to know what legal rights she may have, and if any of those rights were violated by this extended notification process, and the retroactive termination of her coverage.
She has been treated by her doctor during the last 6 months, as well as having maintained her medication, and if I understand it correctly, electing to decline the COBRA continuation would result in her being billed for all services after the 1-1-06 date. Is that correct?
Is it just me, or is this akin to extortion?
It's an illusion of choice that I am quite unhappy about.
Any advice is appreciated.
Thanks for your time.What is the name of your state?
Answer
This was handled very, very poorly and she does have some recourse. But first of all I just want you to understand that her employer was entirely within their rights to terminate her; they held her job and continued to offer her benefits for YEARS longer than the law required. If she was disabled and has been unable to work since 1997, she could have been terminated any time in the last eight years and it would have been entirely legal. Barring a bona fide contract or state law that says otherwise (and Georgia does not have one; nor does any state have one that would have protected her longer than six months) the LONGEST her employer was required to hold her job and pay her benefits was twelve WEEKS. It doesn't matter what her medical condition; there is no law anywhere in the US that entitles her to indefinite employment protection or benefits protection. She got nine YEARS of full coverage. I don't know what prompted them to change her status now; whether it was based on her birthday or not, but she has NO recourse for the termination unless she has a bona fide contract that protects her employment and benefits even when she is unable to work. She's EXTREMELY lucky she got benefits for as long as she did.
That being said, the COBRA continuation cannot be retroactive to the degree they are claiming. They can cancel her coverage effective 7-19-06 until she elects COBRA and sends in her first payment, but since they didn't notify her until 7-19, they can't make it retroactive any further back than 7-19. They, not she, are responsible for anything between 12-31-05 and 7-19-06. If they persist in this, she can contact the US DOL which is the regulatory agency for COBRA.
If she declines the COBRA AS IT STANDS, yes, she would be responsible for any payments that have been made IF the insurance carrier chose to reverse them. They don't always, and I say that as one who worked for a national carrier for five years. (It's also possible, or even probable, that the insurance carrier will refuse to retroactively cancel the coverage that far back; I know we would have, and I know the carrier I currently work with would. But don't tell them I told you. ) But, as above, a six month retroactive cancellation is not legal under the COBRA statute. Don't worry about her being charged for six months worth of medical bills; it isn't going to happen.
It IS possible that her birthday triggered this, but it will depend on the disability policy. It is legal to have long term disability benefits cancel on an age-related basis but it goes by policy. 60 is a fraction young in my experience, but without having read the policy I can't say for certain. In any case, her disability benefits (not her health insurance benefits) almost certainly would have continued even after her employment was terminated - almost all are specifically written to cover that, and the fact that her employer chose to continue her employment and benefits for nine years after she became disabled does not change the legality of a termination now. It is a myth - a widely believed myth, but a myth just the same - that someone who is disabled to the point of being unable to perform their job duties (or someone who is collecting disability benefits) is protected from termination.
I hope your mother is doing well.