possible ERISA violation?

[swag]

What is the name of your state? Ohio.
My husband was in a motorcycle accident aug of 2002. He was laid off at the time, but had health insurance available to him till Aug 31. According to the Summary Plan, short term disability, and accident/dismemberment is coincident with the health coverage. With this term COINCIDENT , what is the meaning of it ? Also the health coverage had paid a few of the bills then stopped because of subrogation issues. They denied his claims for short term disability and accident/dismemberment (loss of eyesight) due to the accident because of him being laid off at the time of the accident. He is totally disabled and blind. Our lawyer has tried since February of 2003 to get the complete health plan coverage documents with several certified letters, and phone calls. Are they in violation of ERISA ? It is now the end of June 2003.

 

[Beth3]

It is quite likely that the terms of the STD benefit require that an individual be an active employee at the time the disability commences or injury occurs. Nobody here can tell you for certain without seeing the Plan Doc but it all likelihood, the fact that your husband was not an active employee (i.e. he was on layoff) at the time of the injury disqualifies him for benefits.

STD is intended to replace wages when an illness or injury prevents the employee from working for a period of time. If the injured person is not working, there are no wages to replace.