District of Columbia | Employment Law
Legal Question
employer misrepresented health insurance benefits
I accepted a job that offered health insurance. I asked several times for complete information about what health conditions were covered, excluded, and copayments, etc. I was provided a Summary of Benefits which stated that the plan covered health service A. I asked for a copy of the contract, b/c the Summary says it's not complete or accurate. The company repeatedly said the contract was not written yet and they could not provide me with a copy.
A few months later, when I attempted to get authorization for the medical service, I was told my plan excluded that service. I checked with the employer, who told me that the Summary of Benefits was superseded by the contract (which they had refused to provide).
I have been through all the appeals with the insurer, who says I should have been provided the contract when I asked, but says they can do nothing. I am out several thousand dollars as a result of this misrepresentation of benefits. It was an ERISA fully-funded insurance plan. Also, DOL says they can do nothing.
I think I just need help writing a stern letter to the company's HR or legal dept, and help ''closing the deal,'' but I'm not sure if there's anything else I can do. Any advice is much appreciated.
Thanks!
Share This On:
