An employer let my friends health insurance laspe

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An employer let my friends health insurance laspe

Trying to help a friend out. An employer let my friends health insurance lapse
without notice. My friend went in for a physical assuming her insurance was
valid and later got a bill for somewhere between 200.00-300.00. She made some
calls to find out why bills were coming to her and found out from her employer HR
that let her insurance lapse without notice even though they we’re taking out
premium payments every paycheck. What recourse does she have legally? I think
they should pay for her doctors visit and reimburse he all premiums paid prior to
them letting her policy lapse. Please advise.

Asked on December 30, 2016 under Employment Labor Law, Colorado

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 years ago | Contributor

She can likely either get them to return her premiums OR to cover her procedures--not both. (I.e. if you get coverage, you have to pay for it, of course; you are not entitled to coverage without paying premiums) Based on what you write, however, she should be entitled to one of these options, and possibly to the reinstatement of her policy going forward under the same terms as it had been. They have no right to take the money without providing the agreed upon coverage, so it is clear that she has legal rights to some compensation here--it's a matter of which is most appropriate. Your friend could sue them for the premiums or the coverage; if the amount at stake is less than the limit for small claims court, she shold probably sue in small claims, as her own attorney or "pro se," to minimize costs; if the amount is greater than the small claims limit, she would retain an attorney to help her.


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