Legal Question in Employment Law in District of Columbia

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 I checked with the employer, who told me that the Summary of Benefits was superseded by the contract (which they had refused to provide).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!


Asked on 5/27/04, 6:10 pm

2 Answers from Attorneys
Michael Hendrickson Law Office Michael E. Hendrickson

Re: employer misrepresented health insurance benefits

You have failed to clarify whether you ever finally secured a copy of the contract and reviewed it yourself in order to determine exactly what medical coverage was provided for you at that time or whether you simply have continued to rely on what someone may have told you regarding this important information and which might be partially or wholly incorrect.

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Answered on 5/27/04, 8:54 pm
G. Joseph Holthaus III Law Offices of G. Joseph Holthaus

Re: employer misrepresented health insurance benefits

It is possible that there may be something that you have overlooked. Health insurance and coverage matters can be complex. I would need to review the matters you brought forth and the responses as well as ascertain other factual matters. Depending on the circumstance, a stern letter may or may not be of benefit. If you would like assistance with this matter, contact me to discuss.

Joe Holthaus

(410) 799-9002

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Answered on 5/27/04, 6:19 pm


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