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    LTD -HR gag

    Just curious if anyone ever experienced this. I am in the process of appealing denial to insurance carrier. My lawyer asked about getting something from employer to discuss in general, the occupation, my specific role, and their I put on my work.

    Bosses were willing, but HR told them they can only provide job description. Has any one ever experienced this? Trying to understand why they would do that, as they have already paid the premium and they are not self insured.

    Any ideas?

    Lawyer said if they won't then he will prepare something and them up to insurance company to refute it.
    Kathy
    DX 01/06, currently on Tysabri

    #2
    SOP anytime an employee/former employee has legal representation.

    Any notes you have in your possession from work, your desk calender, memos from supervisors, etc., might help you build credibelity and help document additional job duties not included in the job description provided by HR.

    Also, your employer's premiums are rated based on prior year claims, so next year premiums could increased based on claims paid this year.

    Also there's the possibility HR's behavior is completely unrelated to claims, and more of a reflection of something else, for instance if you are percieved as a difficult employee, a 'high maintainence' employee with expensive med/health claims, LOA, FMLA, etc.

    Good luck

    Comment


      #3
      I don't definitely was not considered problem, even HR said I was the kind of employee a company hates to lose.

      Talked to my lawyer. He reached out to HR. He has a feeling that they could be afraid I would use it and try to sue the the company for some other act, maybe violation of ADA act. So he has reassured them it will only be for LTD, and I will sign doc to that extent.

      We will see.

      Thanks MSW. Will let you know how it plays out.
      Kathy
      DX 01/06, currently on Tysabri

      Comment


        #4
        Originally posted by MSW1963 View Post
        if you are percieved as a 'high maintainence' employee with expensive med/health claims, LOA, FMLA, etc.
        I'm confused here. I thought employers had no way of finding out if you are a high cost employee due to your meds (unless it's like a 5 person operation) or you told the employee.

        I visited this thread a little while back when I was interviewing for a professor job. I didn't get it but I had concerns about how to proceed (IF I had gotten it) when I had to sign up for their health insurance and folks here said no way they could track you down to being the "high cost" employee in mid-medium sized college.

        I am now going to start part time temp admin work at same school, long story, but due to my success as a finalist in the professor stage. I know I am not being offered ins. at this time (and still don't have it and can't afford ACA even with small subsidy as I fall in small crack of making too much but live in high cost area and have student loans).

        But there's a chance they could promote me and I could get health insurance. I'm nervous reading some of these stories here.

        Since i have not had insurance hardly at all, when I sign up will I have to put MS on my sign up sheet or just see the dr when I need to and get the meds I need?

        How do people find out about what's on Ins. formularies for prospective employers if you google it and can't find it. Like, I'm looking at the schools HR/Benefits page but can't seem to find the formulary list which would let me know if my drug is covered.

        Sorry to be long winded but there are some cracks in the "no one can be denied due to preexisting" la la thing with the ACA and the real life situations that happen with people with chronic illness and their meds and coverage which make me very confused.

        Comment


          #5
          Orange metal,

          Not sure, but I think you may have replied to a wrong post?

          My employer knew about my MS by my disclosure when I needed an accommodation. Subsequently, I went out on STD and then was denied LTD which is under appeal.


          It appears you are questioning health insurance and Rx coverage and what an employer is entitled to. If so, you may want to start a new thread.

          Here is my understanding. Your employer is not entitled to your health records or your Rx information. That being said, there is usually a plan administrator who may be involved on disputes, etc.. This person nay wind up with info on Rx, tests run, etc.. However, they are not allowed to discuss, include in your HR file, or use this in any way other than to be involved in benefit related disputes, etc.. I had to appeal an Rx denial and know this person was involved. But that was 4 Years before O disclosed and I never had any issues.
          Kathy
          DX 01/06, currently on Tysabri

          Comment


            #6
            Hi Orang metal,

            Realize now right thread. I guess I should have went to bed last night

            With MSW's response, I had used FMLA and STD. This paperwork for both referenced MS. For FMLA, my boss and my HR rep saw the paperwork. For STD, it was administered by an outside company, but the plan administrator saw the paperwork, similar to the health insurance administrator.

            In all cases, it is illegal for them to use this knowledge against me. I didn't have any issues and to the opposite, they worked with me to try to keep me working. But other people have not been as fortunate. And it is hard to prove violation of ADA unless very explicitly stated.

            As far as formularies, I did not get this information until covered by health insurance. This was provided by the insurer.

            Wish you luck.
            Kathy
            DX 01/06, currently on Tysabri

            Comment

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