Legal Question in Medical Leave in California

Thank you for taking a moment to read my concern. My wife has been suffering from back pain for about three years now or so. Recently they diagnosed her with fibromyalgia. She has been out on disability for 3-4 months now. One of her doctors misdiagnosed her. She has an appointment to see the doctor to correct what he put on her medical papers. We just got a letter from her company insurance saying they are denying her insurance coverage. I am not sure exactly why. I'm sure if we have to make payments on it will be forever and an astronomical bill. Is this legal? Even though she is on disability and under doctors care to discontinue us? I feel there just trying to see if she'll come back to work which she is trying to do so. Also their just trying to get out of paying the therapy and doctors charges. Any help is greatly and humbly appreciated. Would we have legal grounds to sue them and can she still work for them if we do so?


Asked on 9/16/11, 12:17 pm

1 Answer from Attorneys

Terry A. Nelson Nelson & Lawless

If your CA employer has at least 50 employees, and you are employed for at least 12 months, have at least 1,250 hours worked in the 12 months prior to the leave, then you would be eligible for twelve (12) weeks of unpaid FMLA / CFRA medical leave when you are unable to work because of a ‘SERIOUS health condition’, continuation of group health benefits, restoration to the same or an equivalent job upon return to work, with accrued benefits. The employer can require you to use all accrued unused vacations and leave[s] as part of the 12 weeks, so as to make that portion 'paid'. If you are out longer than those guarantees, they can terminate you.

Upon termination from employment, you are entitled to COBRA conversion of your medical benefits [if any], allowing you to pay for and retain your insurance coverage.

If you think you can prove they failed to follow those rules, feel free to contact me.

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Answered on 9/16/11, 2:05 pm


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