Health Insurance Contract

[Ricki]

We live in Florida. My brother's employer gave him an insurance benefit book dated Sept 1999 when he began employment in June 2000 and had him sign a statement "certifying he rec'd a copy of ..."

The benefit booklet stated his out of pocket costs carried over into the next year if incurred w/in the last 3 months of the year.
The insurance company and the employer now state that the booklet he recd was for the PRIOR year and that carry over benefit didn't apply for the year 2000. They stated he rec'd an outdated booklet and there is nothing they can do about it.

Is the employer obligated to make good on this benefit because they gave him that book and had him sign a statement?

The oop of pocket cost is $2500.00. Is it worth acquiring an atty?

Thank you!

 

[ALawyer]

I doubt there is much he can do legally, possibly absent some real "detrimental reliance" on the terms in the 1999 booklet. In other words what did he do differently that he wouldn't have done if he knew about the change? This is just one of the many things that employers have been doing to hold down the rapidly risning costs -- to them -- of health care for employees.

Also, my experience is that trying too hard may cost a person his job if he makes a pain of himself.

Of course if he had coverage in 2000, the company should pay for the expenses he incurred in 2000.