Employer lied about benefit eligibility
- Thread Starter JaneD
- Start date
army judge
Super Moderator
The only time the law is concerned with TRUTH, is when one is under oath in court, or when attesting under oath to some legal document.
Employers probably lie daily to their employees, as do employees to their employers.
Of course many prospective employees lie as to their qualifications, fitness, work history, or even their educational achievements to obtain employment.
Lies haven't been completely outlawed, YET!
adjusterjack
Super Moderator
What did the employer say about eligibility that was a lie?
Please give some more details about what the lie was. Also is their std plan part of a Section 125 plan? If not, it might not really be a regulated employer benefit -- that is it might not have nondiscrimination or eligibility issues or have to have standard offerings. And it would allow employers a lot of flexibility
cbg
Super Moderator
I know you want a Yes or a No answer, but it isn't that simple. Details matter. Please provide some.
Employee went to ER for health issue (non work related) then off to another hospital for a full week and 2 days for further observation and testing. Employer was informed the day of ER visit and upon admission at hospital and was told employee will not be reporting for duty due to a health issue being investigated. Employer was asked for std forms and employer replied that employee was not eligible. Employees HR portal clearly shows the coverage and ins company who holds the policy - this was communicated to the employer yet still they replied employee is not eligible. Employee called ins company and placed the claim themself and was reassured coverage is there and has been started. Even after the insurance company started the claim the employer re stated several times they've re -checked and the employee is not eligible. Is it illegal to blatantly lie to employee about short term benefit eligibility? Employee handbook clearly states eligible at 91 days but employee was told not eligible for short term disability until employed for 1 full year. Employee has been employed with the company for 6 months.
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This doesn't sound so much a lie as a mistake, and those are always allowed. Either the company policy changed and the portal wasn't updated or the person you spoke with was misinformed as to when the policy kicks in. Employee handbooks are not contracts. What governs is the actual policy itself. Sounds like the employee applied and is receiving a benefit from the insurance company. Is there some other problem? How was the employee actually harmed by being given potentially incorrect information?
adjusterjack
Super Moderator
No.
People lie all the time. Although in this case I'd be more inclined to believe ignorance as most people, including business people, are clueless about the insurance they buy.
You read the handbook and filed your claim, which is what you were supposed to do in the first place, and you'll get your benefits.
You want to go take your anger out on your boss, be my guest. All that will get you is fired.
cbg
Super Moderator
I agree. This doesn't sound like a "blatant lie"; this sounds like a mistake.
If the claim has been approved and is in process, in what way do you think pursuing this is going to benefit you?
If the claim has been approved and is in process, in what way do you think pursuing this is going to benefit you?
army judge
Super Moderator
This is simple.
Here is what one insurance company says about their disability product in general.
Before you begin reading it, know this, there are several things that DISQUALIFY std from kicking in, all other things being enforce:
Your disability won't be covered if it doesn't meet the definition of disability in your plan.
Under certain circumstances, some disabilities that otherwise would meet the disability definition may not be covered. The list of circumstances may vary based on your employer's specific plan, but your disability is typically not covered if it:
Is due to any act of war (declared or undeclared)
Results from committing or attempting to commit a criminal act
Results from driving an automobile while intoxicated ("intoxicated" means the blood alcohol level of the driver meets or exceeds the level at which intoxication would be presumed under state law)
Is due to insurrection, rebellion or participation in a riot or civil commotion.
Is due to intentionally self-inflicted injury
Is an occupational disease or injury (except for sole proprietors or partners who cannot be covered by workers' compensation law)
Also, benefits aren't payable for any period of disability during which you're confined in a penal or correctional institution for conviction of a criminal or other public offense.
Now, what an insurance company says:
AETNA
Here is what one insurance company says about their disability product in general.
Before you begin reading it, know this, there are several things that DISQUALIFY std from kicking in, all other things being enforce:
Your disability won't be covered if it doesn't meet the definition of disability in your plan.
Under certain circumstances, some disabilities that otherwise would meet the disability definition may not be covered. The list of circumstances may vary based on your employer's specific plan, but your disability is typically not covered if it:
Is due to any act of war (declared or undeclared)
Results from committing or attempting to commit a criminal act
Results from driving an automobile while intoxicated ("intoxicated" means the blood alcohol level of the driver meets or exceeds the level at which intoxication would be presumed under state law)
Is due to insurrection, rebellion or participation in a riot or civil commotion.
Is due to intentionally self-inflicted injury
Is an occupational disease or injury (except for sole proprietors or partners who cannot be covered by workers' compensation law)
Also, benefits aren't payable for any period of disability during which you're confined in a penal or correctional institution for conviction of a criminal or other public offense.
Now, what an insurance company says:
AETNA
