Shoulder Surgery on WC CALIF

[Debbysue64]

Hi ,
My first time here. I had a shoulder injury on Sept 28th 2010. I had to unload a truck by myself, I told the store manager 2 days prior that we dont have anyone to unload the truck but myself and she said ok. I let it go till the next day ( The day before the truck ) I told our manager under our store manager we need someone else to help I cant do this myself! He said ok and well you guessed it they didnt get anyone ( well they did but he didnt come in til 7 am 2 hours after the truck got there and I had already hurt myself!) I went to PT and they realized that wasnt helping so they sent me for an MRI and I needed SLAP Tear repair. I work the overnight shift and our Loss Prevention guy came in and saw something was wrong with me, I told him what happened and that I could barely move my arm and he said go to the dr in the mornign and he left. I told my manager in the morning I needed to go to the dr and she didnt even know what to do! So I had to figure it all out. Finally after going to 2 different places and they couldnt help me cause my manager didnt know what they wanted, I finally went to a place that helped me out with my WC and a dr. So I am seeing the dr and working with restrictions from Sept 28th 1020 till the morning of Nov 9th 2010, they decided I needed to go out on disability, since Christmas was here and we get busy and they thought I couldnt do my job. So I go home on disability, our wc insurer has been paying and approving everything in a timely manner. I had surgery on Jan 14th 2011 and am doing PT again. Well one of my questions is very important, I need to go to my regular dr. I am on thyroid meds and migraines meds, need refills. I get a letter in the mail 3 days ago saying my health insurance has been canceled due to my TERMINATION! They want me to pay Cobra 315 a month and then 63 a month for my prescriptions and then 25 a month for my dental. Then Saturday I got a letter telling me I need to pay off my stock or sell it since I have left the company! I havent left I was never told I was fired! They coded me as Terminated on Nov 22nd 13 days after they told me to go out on Disability! Is this legal? If I was supposed to still pay for my insurance shouldnt they have let me know? This is the first I have found out about my insurance! I had just went into my store to ask one of the managers in charge if I still had health insurance and he said yes of course you do! I said good cause I need to see the dr! Are they supposed to keep your insurance going? They are keeping my spot open for me or so I am told. Another manager called me the other day asking when I was coming back I told him I had already talked to the other manager and told him I wont know anything til March 2nd when I see my dr again! He said well I may have to let you go and find someoe else for your spot! I am so stressed out, I dont know what to do where to turn! I actually feel as though I am being retaliated against for complaining about a manager, since that was what Loss Prevention was in for on the night I was hurt. Everyone who complained were either transferred or have been treated badly. Just dont know if I should get a Lawyer or not. I need my health Insurance! Thanks! I hope this makes sense! Debby

[1171]

you get 12 weeks of job protection when leave your job for qualifying reasons including workers compensation disability.
more information about your rights under the Family & Medical Leave Act
http://www.dol.gov/whd/fmla/index.htm

[Debbysue64]

I followed your link but it tells me nothing about my health insurance. I need to know how they can just stop my healthcare insurance without even giving me the chance to pay it myself if need be. Thanks for your reply

[1171]

sorry you don't understand.
workers comp does not pay your share of your health insurance.
there is no place that lists all the things workers comp doesn't pay for.

when you don't make your payments it stops unless your employment is covered by FMLA in which case you get 12 weeks coverage.
when 12 weeks is up so is your coverage.
the link explains that.
the link also explains that the employer is required to notify you within 5 days when you become eligible for FMLA. if they fail to notify you. you can protect your job retroactively for 12 weeks.

[Debbysue64]

Sorry, I guess I am just so upset by this that I didnt understand! Thank you for your help.
They have never sent me anything for FMLA I didnt know anything about it!
So they dont have to let you know that your healthcare insurance is going to be canceled? That just doesnt seem right.

Thanks again for your help!

[1171]

sorry you were caught off guard.
many are surprised about happens when you are injured on the job.
too often it's after the fact and when they are not prepared.
when you are healthy and working many don't think about what happens when you're not.
employers are required to post information about FMLA.
many include it in employee handbooks or with new hire information.
they may have dropped the ball some place.
you can file a complaint with the dept of labor.

[UndercovrAngel]

1171,

It may be possible that the company doesn't have to offer FMLA if any of the following apply, and that is why it wasn't offered.

To be eligible for FMLA benefits, an employee must:

work for a covered employer;
have worked for the employer for a total of 12 months;
have worked at least 1,250 hours over the previous 12 months; and
work at a location in the United States or in any territory or possession of the United States where at least 50 employees are employed by the employer within 75 miles.

Debby,

If any of the above are not applicable (say you had only worked for the employer for 9 months out of 12) that would explain why you weren't offered FMLA. However, if all are applicable, then you could go back retro-actively and have your job protected for 12 weeks as well as your health insurance. Void of having any kind of short term disability through work (which would be offset by your WC benefits) which would continue to cover your personal insurance, once put on a leave of absence, they (employer) does not have to continue paying your insurance premiums.

As for whether you were terminated, if you received a letter stating so, who was it from ?? Do they have the authority to hire/fire employees??
If you were terminated, they will have to turn in paperwork to their insurance, who will then send you paperwork in regards to your cobra. This can all take up to 90 days. If you are offered cobra, you will have to pay all premiums (cobra) from the time you were terminated to the date you accept the coverage. So if it takes 3 months, you would have to be able to pay out close to a grand (you said they wanted $315 a month x 3 months). Now it could be that what they are quoting you is what it costs them.. and your cobra premiums could be even higher.

IE: company I worked for paid just under $400 a month for my insurance (I paid $63 bi-weekly for my share) when I got my cobra paperwork, my cobra payments (had I been able to make them) would have been over $1300 a month. A big difference, because the employer got a group discount that isn't part of the cobra insurance.

Angel ^j^

[ca/wa what next]

I was living in CA when injured on the job, the company I work for paid my Cobra for 6 months then I had the option to pick it up at the group rate. My payments were 893.10 monthly for a year. I received a letter in late October that the contract with the Health plan had expired in July and the premium was an additional 193.00. And I owed the company 755.00. The company excepted my regular payments and I believe that keeping the Medical coverage at the higher premium should of been an option instead of the retro charge. Good Luck

[LeglEgl]

(12-01-2011 06:01 AM)ca/wa what next Wrote:  I was living in CA when injured on the job, the company I work for paid my Cobra for 6 months then I had the option to pick it up at the group rate. My payments were 893.10 monthly for a year. I received a letter in late October that the contract with the Health plan had expired in July and the premium was an additional 193.00. And I owed the company 755.00. The company excepted my regular payments and I believe that keeping the Medical coverage at the higher premium should of been an option instead of the retro charge. Good Luck

Please post your own thread, rather than hijacking an old one. You stand a better chance of getting response related to your situation, rather than confuse the flow of what's already been posted.