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Out of work after surgery North Carolina

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  • Out of work after surgery North Carolina

    I had surgery back in June of 2010 - I was told by the owner that they were covering my short term disability and would continue paying me, that my long term disability which was on my insurance program would then be paid by the insurance company. Now the owner told me that I was being paid my salary like he was when we both worked at a different company which was he was paid his regular salary. I had to go back into the hospital in early August,got out a couple days later at which time the owner told me, I am glad you are home, and you have received your last paycheck, stating that I had used up all of my 90 days of STD. I asked for documentation, which I have yet to see. Also I told them my understanding of STD is that it is consecutive days and not a accumulation of days which still would not have been 90 days.
    Anyhow I recieved a certified letter from the company with their "new standards" and are basically stating I was overpaid by industry standards, so they are offering me the "industry standard" for the remaining time, but they are backdating everything prior to the letter with the new documented operating procedure. Now I am ok with the change from the date of them having developed a policy, but I am not ok with them trying to backdate when that was not the deal I was told I had.
    They are not paying me now, and also expect me to sign a release with them in order to get it. Are they allowed to hold monies owed me, and do I have to accept an after the fact policy for the time before?

  • #2
    I am very uncomfortable commenting on insurance company documents that I have not read, so this is going to be a VERY soft answer. I would read the documents and call up the information company directly. See what they say compared to what the employer is saying. But unless the state of NC some how wrote or mandated the exact wording of the policy (not my state, anything is possible), then no one here would know what your policy says.

    Also, if you do not get a good answer here, you might try the BenefitLinks website. That is a hardcore benefits professional website, and IMO you are more likely to find someone with a good answer there.
    "Reality is that which, when you stop believing in it, doesn't go away".
    Philip K. **** (1928-1982)

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    • #3
      The STD is being paid by the company, not through the insurance company. The owner of the company told me that they were paying my short term within the company, I had long term through the Insurance.
      Thank you for your reply DAW

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      • #4
        Definately outside my area of expertise, especially in your state. Try the BenefitLinks board if you do not get an answer here.
        "Reality is that which, when you stop believing in it, doesn't go away".
        Philip K. **** (1928-1982)

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        • #5
          Sounds as if your STD is self-insured, and your LTD is fully insured. Quite legal and not uncommon.

          However, no one who has not read your plan document can say if what the employer is doing is right or wrong, or whether you are correct that it is 90 consecutive days, or 90 days overall. This is not set by law in 45 states, including NC; it is a product of the specific policy. ONLY someone who has read your specific policy in full can answer.
          The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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          • #6
            Assuming that there is a plan document. STD is not inherently ERISA. Things can get interesting once we take 3rd party provider and ERISA out of the loop.

            Certainly, if there is a plan document, the OP should read it.
            "Reality is that which, when you stop believing in it, doesn't go away".
            Philip K. **** (1928-1982)

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            • #7
              While I agree that STD is not inherently ERISA, in 30+ years of managing employer sponsored benefits, I have yet to see an STD policy that did not have a plan document.
              The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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              • #8
                I have. Past that point, the OP says that the employer is talking about "new standards" and "industry standards" and has already said that the employer has refused to provide any documentation. One of the whole points of ERISA is not just the documentation requirement, but the requirement that the employer actually is required to show the documentation to the employee.
                "Reality is that which, when you stop believing in it, doesn't go away".
                Philip K. **** (1928-1982)

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