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  1. #1
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    Jan 2011
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    Creston, North Carolina, United States
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    Default I Lost My Health Benefits While Out of Work on Worker's Comp

    My question involves workers compensation law for the state of: North Carolina.
    I was injured on the job in May of last year and have been out of work ever since. I just recently found out that my health benefits through my work had been terminated due to nonpayment. Seems I was expected to pay them out of pocket even though I was injured on the job due to the negligence of another employee. The company I work refuses to work with me as far as a payment plan so that my benefits can be reinstated. What can I do? My husband and I both have medical problems that require regular medications and visits to the doctor.

  2. #2
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    Sep 2005
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    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    If your employer falls under COBRA, you should have received proper notice of your right to continue coverage. If you did not receive proper notice you may be able to reinstate your benefits. In some states you may be eligible for a COBRA subsidy.

    So, is this a COBRA issue? If so, were you given notice of your rights? If so, when in relation to the termination of your employment?

    If you are asking if you can compel your employer to offer you a payment plan rather than charging COBRA payments as they become due, sorry but the employer doesn't have that obligation.

  3. #3
    Join Date
    Jan 2011
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    Creston, North Carolina, United States
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    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    My employment has not been terminated. As soon as my injury heals, and I just had surgery to correct it, I will return to work.

  4. #4
    Join Date
    Jun 2006
    Location
    Massachusetts
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    17,942

    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    How long had you worked for the company when you were injured? Are they expecting you to pay the full health care costs or the same portion you would pay if you were working? If the former, for how far back?

    I'm going somewhere specific with this, but the answers to all three questions are necessary to give you a complete answer.

  5. #5
    Join Date
    Jan 2011
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    Creston, North Carolina, United States
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    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    I have been with this company for two years. They expect me to pay the same portion as I was paying before and all the way back to the date of the injury which is May 21, 2009.

  6. #6
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    17,942

    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    They absolutely are allowed to require that you pay the same portion as if you were working. I'm surprised that they haven't had you making those payments all along. It would be nice of them to allow you a payment plan under the circumstances but the law does not require it of them.

  7. #7
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    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    When you say you are "out of work", that's reasonably construed as "unemployed" as opposed to being "off work" or "on leave".

    I expect that the issue is the same - you're on leave and your employer doesn't provide full benefits during extended periods of leave. Would that be a correct inference? So we're back to COBRA.

  8. #8
    Join Date
    Jun 2006
    Location
    Massachusetts
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    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    Actually, no, not necessarily. They haven't cancelled her benefits (yet); she is still covered. They have not transferred her to COBRA (yet). They are requiring that she continue to pay her portion of the premiums.

    For whatever portion of her leave was covered under FMLA (which is why I asked the questions I did; to see if FMLA applied) the law expressly gives them the right to require this, but NO MORE than this. Once FMLA expired (which would have been after 12 weeks) they are no longer obligated to provide coverage at all. They COULD HAVE required that she pay both the employer portion and the employee portion. She COULD HAVE been put on COBRA, which would mean she would have to pay the employer portion, the employee portion, and a 2% administrative fee, and COBRA would be running out by now. As it is, they are going to continue to cover her (which they do not have to do any more by this time) and ask only that she pay the same portion of the premium as she would if she were working, which is FAR less than COBRA would be. This is, in my mind, exceptionally fair under the circumstances.

    I do understand the employee's position with regards to their refusal to set up a payment plan. Since they are doing far more than the law requires regarding keeping her covered, I can only imagine that there is more to this portion of the story than we are being told.

  9. #9
    Join Date
    Sep 2005
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    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    Our answers are out of sequence because she ignored the rule against double-posting and her two threads were merged. My post was made without the benefit of her answers to your earlier exchange. Which isn't to say that your answer isn't better than mine.

  10. #10
    Join Date
    Jun 2006
    Location
    Massachusetts
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    Default Re: I Lost My Health Benefits While Out of Work on Worker's Comp

    This is exactly what I do 35 hours a week...

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