Please help my disabled wife!

[aceshigh]

What is the name of your state (only U.S. law)? Florida

My wife was in an accident some years ago that has left her partially disabled. She needs to go on short term disability at her Dr.s request to undergo intensive physical therapy. Her employer was aware of her leaving for only a few weeks as she provided 2 weeks notice. Today (her last day) they notified her that if she is gone for more than 3 weeks they will drop her from the insurance coverage and she will be responsible to pay for it herself... Is that legal??? How can her employer who shes been failthful to for 5+ years and WE have always paid her portion (not cheap) of the insurrance coverage threaten to not cover her insurrance any longer? Its not like shes leaving, she was only going to be gone for 5-6 weeks anyway but now there is no reason to even leave since the therapy is going to take a minimum of 6 week...

 

[cbg]

It may or may not be legal. More information is needed.

1.) How long has she worked for this employer?

2.) How many employees does this employer have within 75 miles of her location? (If not known, is it over or under 50?)

3.) In the past 12 months, has she worked a minimum of 1,250 hours?

Let's start with these questions and go on from there.

 

[aceshigh]

Thanks for the reply

-Shes been working full time 40+ hours/week (as a salary employee) for more than 5 years for them.

-Total employees in the local office (inside 75 miles) is likely under 50 but over 50 if you count their Atlanta GA office.

-In the past year she has been a regular full time employee at 40 hours per week. The only time off under a 2080 per hour year would be regular company holidays, sick days, and vacation all which were inside company policies. So in short, yes more than 1,250 hours...

Its at the strong urging of her Dr. that she take this time off work to seek the treatment she needs, she should qualify for short term disability without any issues as she has in the past and her medical condition is rather severe. We cant afford for her to loose her insurance or even her job due to her disability though. They even asked her to clean out her desk as they will likey be replacing her position with someone else, and told her they would not guarantee she would have the same position if she tried to return to work...

How is this any differrent from being fired, demoted or loosing benifits due to something like maternity leave?

 

[cbg]

THIS IS VERY IMPORTANT.

Are you telling me that there are less than 50 employees within 75 miles? I don't care how many there outside; only inside that radius.

 

[aceshigh]

Yes, that is correct.

 

[cbg]

If there are less than 50 employees within 75 miles of her location, then FMLA does not apply. If FMLA does not apply, then they are not responsible for continuing her health insurance and they can legally drop her from the health insurance and offer her COBRA - assuming that the insurance plan document specifically and in so many words says that insurance ends any time an employee of her classification is off for three weeks or more.

She - not you, LEGALLY they are not obligated to talk to you and may even be legally prohibited from doing so - needs to contact them and ask for a copy of the plan SPD (Summary Plan Description). If there is wording in the SPD that says coverage ends under these conditions, that's the ball game, because there is no legal obligation for them to keep her on the insurance and they are legally bound to follow the plan document.

If the SPD indicates that coverage continues in these circumstances, however, then she - not you, same reason - needs to bring that matter to their attention. And if they fail to follow the plan document, she can contact - I'm not sure in your state if it's the DOL or the Division of Insurance.

Bottom line: the law does not obligate them to continue to cover her, though it will require that they offer her COBRA. The law does require that they follow their plan document.