Long term insurance refuses to pay

[turnip01]

What is the name of your state (only U.S. law)? PA
My son had back surgery in March 08 and was on short term disability thru his employer. After it was determined that he would not be able to return as soon as they thought, he was to go on long term disability. Long term refused to pay stating that this was a preexsisting conditiion. The Dr. feels he was born with this problem and it got worse by the heavy lifting at his job. I thought since they paid him short term they would have to pay him long term. He has not gotten anything since August 08 from the insurance. ALso how long will his employer be legally obligated to pay his health insurance? They have not terminated him but I don't think they can as long as he is still unable to return to work. Any advice you can give would be appreciated.

[moburkes]

Originally Posted by turnip01

What is the name of your state (only U.S. law)? PA
My son had back surgery in March 08 and was on short term disability thru his employer. After it was determined that he would not be able to return as soon as they thought, he was to go on long term disability. Long term refused to pay stating that this was a preexsisting conditiion. The Dr. feels he was born with this problem and it got worse by the heavy lifting at his job. I thought since they paid him short term they would have to pay him long term. He has not gotten anything since August 08 from the insurance. ALso how long will his employer be legally obligated to pay his health insurance? They have not terminated him but I don't think they can as long as he is still unable to return to work. Any advice you can give would be appreciated.

I'm not sure why you thought that. What does the insurance policy state about pre-existing conditions? They could have terminated him as soon as he stopped working for them for 12 weeks, in most cases (FMLA). No, they are not legally obligated to pay for his insurance, unless they pay for the insurance of other people in his line of work for the same length of time (he can't be singled out). They will termiante him soon, believe me. At this point, it appears that they are providing benefits to him, but he is unable to provide benefits to them (ie WORK).

[cbg]

I thought since they paid him short term they would have to pay him long term.

Not at all. They are two separate policies and can have two different sets of eligibility requirements.

ALso how long will his employer be legally obligated to pay his health insurance?

Their legal obligation to pay his health insurance ended several months ago. If he was on FMLA, and it is not clear if he was or not, they were only legally obligated to pay it for the duration of the FMLA, which runs for 12 weeks. On week 13, day 1 of his leave, they had no further legal obligation to pay his health insurance unless there is something in the plan document that specifically says otherwise. If FMLA was not involved, then they had no legal obligation to pay it at all unless the plan document specifically says so.

They have not terminated him but I don't think they can as long as he is still unable to return to work.

This is one of the myths of employment and benefit law. You are mistaken. There is NOTHING in the law that says an employee cannot be terminated for the duration of a medical leave. FMLA, as mentioned above, runs for 12 weeks. If he was on FMLA, then once again on week 13, day 1, they can legally terminate him. If FMLA was not involved, then they would only be obligated to hold his job for as long as their company policy says. Under no circumstances does the law require an employer to hold an employee's job indefinitely.

[Dougthegreat]

Originally Posted by cbg

Under no circumstances does the law require an employer to hold an employee's job indefinitely.

The scary part is that people like the OP vote.

[ecmst12]

It is NEVER scary when people vote. Everyone should vote. I may disagree with someone's politics but that doesn't mean I would want to prevent them from speaking out.

[cbg]

I think that was a little out of line, Doug. The OP doesn't understand how the policies work, but why should she if she doesn't work with them? And quite a lot of people misunderstand the difference between being fired because they are disabled under the ADA (which is illegal) and being fired while they are collecting disability benefits (which is not).

There are posters I've felt that way about and even said so. But this isn't one of them. You want to see scary, go over to Small Claims and check out a poster who calls himself ImtheNicest. Now THAT'S scary.