Legal Question in Employment Law in California

Delinquent COBRA Administration

I've paid all my premiums on time, yet after 3 months I am still without benefits.

On 01-Nov-2000 I terminated my employment. On 17-Nov-2000 I received COBRA coverage information from the company that administers the COBRA plan for my previous employer. I immediately enrolled and paid my first months premium.

The COBRA Administrator received that payment on 28-Nov-2000 and has received all subsequent payments from me (on-time) for coverage from 02-Nov-2000 until the end of this month (February). Yet, I still do not have coverage from my insurance providers.

I have made six calls to the COBRA admin company and they keep telling me they will take care of it and check with my providers in three days. It has been over one month since I started contacting them and still I have made no progress. They are blamimg my previous employer for the delay.

What rights do I have? I have paid close to $1000 in premiums, and have over $3000 in medical expenses that I have had to pay out of pocket since 01-Nov-2000.

Thanks!


Asked on 2/12/01, 6:45 pm

1 Answer from Attorneys

Keith E. Cooper Keith E. Cooper, Esq.

Re: Delinquent COBRA Administration

First of all, if you've paid your premiums to the right place, you have coverage and, when this gets straigtened out, you should be reimbursed for any medical expenses you have incurred during this period. Just be sure you are within the guidelines for your coverage. For instance, if you are in an HMO plan, keep going to the same doctor in the same group, with the same type of referral, etc. If for some reason you lose coverage because of your former employer's mistake, by law the employer indemnifies you for any loss (i.e. has to pay for anything the insurance would have covered).

Under California law, an employer is required to notify a terminated employee about COBRA coverage within 14 days, which evidently they did in this case. The employee is required to notify the COBRA administrator in writing that he/she accepts this coverage within 60 days of that notification, which evidently you did in this case. An employee then has an additional 45 days after accepting coverage to actually make the first premium payment. (Which is to say that a terminated employee may have almost 3 months to actually make the first COBRA or CAL-COBRA payment, depending upon how quickly the notifications are given.)

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Answered on 3/27/01, 8:07 pm


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