No Stop-Loss Coverage Where Employer Failed to Provide COBRA Notice Following Qualifying Event
Under COBRA, an employee who loses health insurance coverage as a result of a qualifying event must be given an opportunity to continue coverage at his or her own expense. The employer generally is responsible for identifying when a qualifying event occurs and providing the employee with a timely COBRA election notice. Continuing an employee's coverage as an active employee outside of COBRA after a qualifying event may leave the employer paying out of pocket for medical expenses incurred by an employee.
For example, as a result of a Tennessee federal district court's decision in Clarcor, Inc. v. Madison Nat. Life Ins. Co., an employer will pay over $250,000 in uninsured medical expenses for an employee who was not given proper COBRA election notice when she was unable to return to work following the expiration of her FMLA leave. When the employee did not return to work after FMLA leave, contrary to the terms of the medical plan, the employer continued her medical coverage as an active employee while she was on short-term disability leave for another six months, at which time it offered her COBRA coverage.
The employer submitted a claim to its stop-loss carrier for reimbursement of medical expenses incurred by the employee while on STD leave. In turn, the carrier refused to reimburse the employer for expenses incurred after FMLA leave, on the grounds that the employee should have been offered COBRA upon the expiration of her FMLA leave, and that the policy excluded expenses where COBRA notice was not timely provided. The court agreed with the stop-loss carrier, holding that the employee was ineligible for coverage after her FMLA leave ended except through COBRA, and held that the stop-loss carrier did not have to pay the claim.
This decision highlights the importance of being familiar with and following the provisions of medical plan language with respect to eligibility for coverage in order to identify qualifying events, and to avoid exclusions of coverage under either stop-loss contracts or fully insured medical plans when an employee remains employed, but is no longer eligible for coverage outside of COBRA
Parker Poe, EmployNews, Issue 641, October 14, 2011
If you need assistance with your COBRA administration, please contact The Whitford Group or your agent immediately. TheWhitfordGroup@aol.com 704 298-2115
Saturday, October 15, 2011
Wednesday, October 12, 2011
The 4 Most Serious Sins of Documentation
NOTE: Don't miss "Jan's Tips" at the end of this article.
Rule number one in documentation, says attorney Allison West, is to include all the details, but you have to ignore that rule because of rule number two—be concise.
When doing your documentation, it's important to offer up all the facts, says West. Paper is cheap, she adds. However, at the same time, don't be so wordy that you ignore rule number two, which requires documentation to be concise.
West, principal at Employment Practices Specialists in Pacifica, California, offered her suggestions at SHRM's annual conference and exhibition, held recently in Las Vegas. Here are her tips on bulletproof documentation:
Avoid 'As you know' Memos
When you write "As you know," you're skimping on the details because you have previously discussed issues. That's dangerous, says West. "As you know" memos are typically vague and ambiguous, and they are open to interpretation. Bulletproofing documentation means including details and important facts each time you write. For example:
"As you know, we have discussed your attendance on numerous occasions. Each time you stated you would try harder."
This is a typical "as you know" memo. It means something to the sender, but not to other readers (like juries or federal agents).
It needs details, says West.
•What were the problems?
•When were the discussions?
•What expectations were discussed?
•What follow-up was planned?
Avoid sarcasm
Sarcasm is never going to look good to later reviewers of your documents. For example:
•You might actually be the only person in the history of our company to never get a performance bonus.
•Clearly you don't care.
•Do you really want to work here?
•I am not surprised by the poor quality of your work product.
Out of context, these comments just look mean. It's always better to write a straightforward presentation of the facts of the situation.
Avoid Starting Sentences with 'You'
When you start sentences with "you," it's probably not going to be a straightforward presentation. For example:
•You don't carry your load.
•You are not committed to your job.
A better approach from West: "I noticed on three occasions your team members asked you to assist them with updating the newsletter mailing list. Each time you refused. You may not realize that each time you say "no" without any explanation or fail to carry an even workload, the team members get frustrated and are forced to take on extra work. How would you feel in their shoes?"
Avoid Editorializing
Again, it's better to stick with the facts, says West. For example, say Beth explained she was late, again, because of car problems. You write:
•Beth is late again. More lame excuses.
Or say that Jorge is struggling to understand the new accounts payable software.
You write:
•Jorge is unwilling to put in the time to master the software.
Editorializing hurts the writer's credibility, shows bias, and indicates that the writer is uncaring about the employee's issues or success. "The jury will snarl at you," West says.
Instead:
•Stick with the facts
•Stick to a chronological time line
•Neutralize your tone
•Keep emotion out!
Summarized from Today’s HR Tip, written by Allison West, Attorney at Law
Jan’s Tips:
1.Avoid the use of acronyms unless you have identified their meaning with the first usage in the write up. People outside of your industry won't know what they mean and may skip over those entries or decide against you because your write up is too hard to understand. Believe me, it happens!
2.Avoid as much “he said, she said” as you can and still get the point across. People who do write ups often fail to identify the “he and she” to whom they are referring as the write up goes on. It’s confusing to the reader and quite frankly, boring.
3.Follow a chronological time line when detailing events.
4.Ensure you cite specific policy and procedure violations (employee handbook, job descriptions, etc.) and the impact the violation had on the company.
5.If this is not a terminating event, ensure you develop (with your employee) an action plan for improvement. Be specific, make it measurable and please, please follow up!
6.FOLLOW UP. Write ups are worthless without follow up. Not only will this employee not take you seriously your other employees won’t either.
7.Remember, it is highly unlikely that you and your employee will be the ONLY ones to read this write up. Regulatory agencies, attorneys and courts may also read it at some point. Make sure it will make sense four or six months from now.
If you or you know someone who needs assistance with any type of corrective action or other HR issues, contact The Whitford Group at TheWhitfordGroup@aol.com or 704 298-2115.
Rule number one in documentation, says attorney Allison West, is to include all the details, but you have to ignore that rule because of rule number two—be concise.
When doing your documentation, it's important to offer up all the facts, says West. Paper is cheap, she adds. However, at the same time, don't be so wordy that you ignore rule number two, which requires documentation to be concise.
West, principal at Employment Practices Specialists in Pacifica, California, offered her suggestions at SHRM's annual conference and exhibition, held recently in Las Vegas. Here are her tips on bulletproof documentation:
Avoid 'As you know' Memos
When you write "As you know," you're skimping on the details because you have previously discussed issues. That's dangerous, says West. "As you know" memos are typically vague and ambiguous, and they are open to interpretation. Bulletproofing documentation means including details and important facts each time you write. For example:
"As you know, we have discussed your attendance on numerous occasions. Each time you stated you would try harder."
This is a typical "as you know" memo. It means something to the sender, but not to other readers (like juries or federal agents).
It needs details, says West.
•What were the problems?
•When were the discussions?
•What expectations were discussed?
•What follow-up was planned?
Avoid sarcasm
Sarcasm is never going to look good to later reviewers of your documents. For example:
•You might actually be the only person in the history of our company to never get a performance bonus.
•Clearly you don't care.
•Do you really want to work here?
•I am not surprised by the poor quality of your work product.
Out of context, these comments just look mean. It's always better to write a straightforward presentation of the facts of the situation.
Avoid Starting Sentences with 'You'
When you start sentences with "you," it's probably not going to be a straightforward presentation. For example:
•You don't carry your load.
•You are not committed to your job.
A better approach from West: "I noticed on three occasions your team members asked you to assist them with updating the newsletter mailing list. Each time you refused. You may not realize that each time you say "no" without any explanation or fail to carry an even workload, the team members get frustrated and are forced to take on extra work. How would you feel in their shoes?"
Avoid Editorializing
Again, it's better to stick with the facts, says West. For example, say Beth explained she was late, again, because of car problems. You write:
•Beth is late again. More lame excuses.
Or say that Jorge is struggling to understand the new accounts payable software.
You write:
•Jorge is unwilling to put in the time to master the software.
Editorializing hurts the writer's credibility, shows bias, and indicates that the writer is uncaring about the employee's issues or success. "The jury will snarl at you," West says.
Instead:
•Stick with the facts
•Stick to a chronological time line
•Neutralize your tone
•Keep emotion out!
Summarized from Today’s HR Tip, written by Allison West, Attorney at Law
Jan’s Tips:
1.Avoid the use of acronyms unless you have identified their meaning with the first usage in the write up. People outside of your industry won't know what they mean and may skip over those entries or decide against you because your write up is too hard to understand. Believe me, it happens!
2.Avoid as much “he said, she said” as you can and still get the point across. People who do write ups often fail to identify the “he and she” to whom they are referring as the write up goes on. It’s confusing to the reader and quite frankly, boring.
3.Follow a chronological time line when detailing events.
4.Ensure you cite specific policy and procedure violations (employee handbook, job descriptions, etc.) and the impact the violation had on the company.
5.If this is not a terminating event, ensure you develop (with your employee) an action plan for improvement. Be specific, make it measurable and please, please follow up!
6.FOLLOW UP. Write ups are worthless without follow up. Not only will this employee not take you seriously your other employees won’t either.
7.Remember, it is highly unlikely that you and your employee will be the ONLY ones to read this write up. Regulatory agencies, attorneys and courts may also read it at some point. Make sure it will make sense four or six months from now.
If you or you know someone who needs assistance with any type of corrective action or other HR issues, contact The Whitford Group at TheWhitfordGroup@aol.com or 704 298-2115.
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