Reversal Denial of Health Insurance Coverage

Client sought state law continuation coverage of her health insurance after being terminated from her employment to provide continuing treatment for a health condition. The entity that managed the plan gave her confusing and inconsistent information regarding the deadlines for her initial premium payments. Following the directions given as closely as possible, she sent in payment for the first two months, and then a subsequent payment immediately on receipt of an invoice. However, she thereafter received notice that her insurance was being terminated due to a failure to pay all premiums within the statutory timeframe. Upon calling for clarification, she was told that even if the plan manager had erred, there was nothing she could do about it.

Our firm initially asked the Florida Department of Financial Services to make an inquiry into the matter. The agency investigation concluded that, as the termination turned upon an internal policy regarding premium deadlines, the agency was not in a position to take enforcement action against the insurer or the plan manager. Subsequent negotiations with the plan manager included the presentation evidence of the inconsistent information on premium deadlines given to the client. The plan manager was given a period of time to consider the evidence before our firm filed suit. At the end of the allotted time, the plan manager reinstated the client’s insurance without a lapse and allowed her to make up all premiums to date.