I need opinions- cobra, benefits illegal issue's

mudnuri

<font color=deeppink>I HATE it when I miss somethi
Joined
Oct 21, 2003
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This might be long, but i want to get all the facts out.

Please tell me what you would do, or point me to where I should go, etc.

My mom has Cerebellar Ataxia, she has worked for the same organization for 20 years, in the accounting department. This is a non-profit mental health organization that is funded primarily from the state government.

On April 4th, she began using her accumulated sick/vacation time, and was officially released on long term disability the last Friday in August.

On April 5th she continued to work at said company 2-3 days a week- for 5-8 hours to assist the department in completing the work she use to do. She was paid cash under the table for this. This continued until Thursday October 27th....

1st Week of September, she completed her COBRA paperwork and sent it in. She called October 3rd to inquire about a bill, as she had not received one yet. COBRA woman told her they received her paperwork the 2nd week of September, but she had not sent in payment so she was not covered, and not going to be covered, nothing that she could do to change this.

October 27th and 7pm she fell, and broke her pelvic bone in 2 place, and hit her read, requiring 2 staples. She is still in the hospital. She is being released to HOME on Friday- due to lack of insurance. Medicaid will not cover her, as she has not been out of work long enough, is not on SSI Disability yet- due to the 6 month wait.

She was under the impression that she had to send her paperwork in within 60 days, and they would bill her the premium amount- back to the date of work ending...

I checked on the www.dol.gov website, and this is exactly what it says

What process must individuals follow to elect COBRA continuation coverage"

....plan participants and beneficiaries must be sent an election ontice no lter than 14 days after the plan administrator receives notice that a qualifiyng event has occured.....THE INDIVIDUAL THEN HAS 60 DAYS TO DECIDE WHETHER TO ELECT COBRA CONTINUATION COVERAGE. THE PERSON HAS 45 DAYS AFTER ELECTING COVERAGE TO PAY THE INITIAL PREMIUM"

Now, I believe she did this correctly....and when she called to inquire about the bill- she was STILL within her 45 days......she could have paid with a credit card at that time, had she been given an option.

What i'm planning on doing- is as follows....I am going to see the CEO of the company tomorrow- she is actually the person who has been taking the petty cash to pay my mom under the table every week....she is aware of what is going on with the cash... I will explain to her what I know, the facts etc. and who her the pages from www.dol.gov that I have printed out and highlighted the important parts of. I will ask her to have the COBRA coverage either reinstated, or do whatever she has to do to get her insurance back in place. If she feels as though this is not something she can do- i will bring up the fact that since April she has paid my mother under the table to work for a state/federally funded company, and I have no problems contacting the proper agency to let them know this.

My mother is okay with me doing all of this.....she is just disgusted by the whole mess...

What would you do?

Brandy
 
I'd get the Cobra.

Is she still within 45 days to do it on her own? (Just reread--so I guess the answer is no as it is already 11/2).

I would totally solicit help from the company. But in reporting them--you may also be reporting your mother. I'd be worried about the repercussions for her if you need to follow through on your threat. (And if the company knows and uses this as leverage to not help you).

But--I'd be inclined to do what I coudl to get the Cobra coverage.
 
mudnuri said:
This might be long, but i want to get all the facts out.

Please tell me what you would do, or point me to where I should go, etc.

My mom has Cerebellar Ataxia, she has worked for the same organization for 20 years, in the accounting department. This is a non-profit mental health organization that is funded primarily from the state government.

On April 4th, she began using her accumulated sick/vacation time, and was officially released on long term disability the last Friday in August.

On April 5th she continued to work at said company 2-3 days a week- for 5-8 hours to assist the department in completing the work she use to do. She was paid cash under the table for this. This continued until Thursday October 27th....

1st Week of September, she completed her COBRA paperwork and sent it in. She called October 3rd to inquire about a bill, as she had not received one yet. COBRA woman told her they received her paperwork the 2nd week of September, but she had not sent in payment so she was not covered, and not going to be covered, nothing that she could do to change this.

October 27th and 7pm she fell, and broke her pelvic bone in 2 place, and hit her read, requiring 2 staples. She is still in the hospital. She is being released to HOME on Friday- due to lack of insurance. Medicaid will not cover her, as she has not been out of work long enough, is not on SSI Disability yet- due to the 6 month wait.

She was under the impression that she had to send her paperwork in within 60 days, and they would bill her the premium amount- back to the date of work ending...

I checked on the www.dol.gov website, and this is exactly what it says



Now, I believe she did this correctly....and when she called to inquire about the bill- she was STILL within her 45 days......she could have paid with a credit card at that time, had she been given an option.

What i'm planning on doing- is as follows....I am going to see the CEO of the company tomorrow- she is actually the person who has been taking the petty cash to pay my mom under the table every week....she is aware of what is going on with the cash... I will explain to her what I know, the facts etc. and who her the pages from www.dol.gov that I have printed out and highlighted the important parts of. I will ask her to have the COBRA coverage either reinstated, or do whatever she has to do to get her insurance back in place. If she feels as though this is not something she can do- i will bring up the fact that since April she has paid my mother under the table to work for a state/federally funded company, and I have no problems contacting the proper agency to let them know this.

My mother is okay with me doing all of this.....she is just disgusted by the whole mess...

What would you do?




Brandy


I'd be careful making a threat like that, it sounds like blackmail...
 
never thought of blackmail........

crap........now what do i do

Brandy
 

I used to work at a hospital doing patient accounts. It has been 7 years but at that time you did have 60 days to pay for Cobra coverage. I hope you have the name of the woman who told you it was to late to get coverage. I think you need to deal with the person who handles the insurance, plus your mother should have gotten a bill from Cobra.
 
mudnuri said:
never thought of blackmail........

crap........now what do i do

Brandy


I didn't think of that either.

I would just ask and see if they can do anything. Maybe they can.

You might also look into if the hospital has an uninsured rate.

I am getting PT for knee surgery and I am maxed out on PT for my insurance. so instead of getting rejected on the insurance and being obligated for the full amount, I got the uninsured rate--which ends up being equivilant to what insurance companies usually pay--50% of what they really charge.

If anything--it reduces your mother's liability.
 
mudnuri said:
never thought of blackmail........

crap........now what do i do

Brandy

I'd talk very nicely to the CEO and hope they will help you..
 
be very careful. if her job was funded by government funds and she submitted sick leave while (1)able to work (as evidenced by her working under the table) and (2) while receiving pay: it can be construed as fraud and misuse of government funds (same goes for getting double paid for vacation accruals on days you work and are paid). penalties can be stiff for both the employee and the employer (and whoever set up this arrangement for her is likely not going to go out on a limb for her). by willingly participating in this act, your mother is no less guilty than her employer. it is also social security fraud to use the april date for her begining date of disability.

her cobra dates may be messed up because the "qualifying event" occured back in april (even though she still had vacation/sick leave on the books that she could use). was the employer notified in april that the disability was long-term? if so, i suspect that is the date being used.
 
barkley said:
be very careful. if her job was funded by government funds and she submitted sick leave while (1)able to work (as evidenced by her working under the table) and (2) while receiving pay: it can be construed as fraud and misuse of government funds (same goes for getting double paid for vacation accruals on days you work and are paid). penalties can be stiff for both the employee and the employer (and whoever set up this arrangement for her is likely not going to go out on a limb for her). by willingly participating in this act, your mother is no less guilty than her employer. it is also social security fraud to use the april date for her begining date of disability.

her cobra dates may be messed up because the "qualifying event" occured back in april (even though she still had vacation/sick leave on the books that she could use). was the employer notified in april that the disability was long-term? if so, i suspect that is the date being used.

No, the disability date wasnt until the last Friday in August...that's what all the paperwork says. The policy at this place is if you get done, you lose your sick time...thats why they did it this way, she used up all of her sick and vacation time, then on the lsat friday in august, was out on LTD, per her doctors orders....her LTD insurance kicked in from then

Brandy
 
The "under the table work" could have been "contract work" and they will issue a 1099 for that. They don't have to take taxes out of that up to a certain amount or something like that.
 
You may want to contact a lawyer versed in Cobra law. You need some guidance and need to know what your options are. Good luck.
 


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