Question

What should I do when my employer refuses to prove me short term or long term plan documents?

Asked on February 20th 2015 by Julie B.
My 7 day STD waiting period for colitis was over on 01-04-15, my forms filed the 12th by my employer, and a voicemail message received (and saved) Jan. 28 from MetLife my check was mailed that day, but that contact from MetLife came only after I forced my employer, Bioscrip, to get involved. In the interim, before involving my employer, I received a letter from MetLife indicating my pay rate was omitted from the forms, but no one there seemed to know anything about it hence why I got my employer involved. First, that portion of the form was for completion by my employer whose policy it is to submit the initial STD forms themselves, secondly, it was NOT missing cause I kept a copy and could see it on page 1 of the form. They finally cut a check, held it from mailing till January 31, and was for benefits through 01-26-15, then my second check was for benefits through 02-02-15 and had more forms to be completed by my doctor and returned by February 9; the letter was dated 01-27 and held from mailing so not received by me until 02-02-15. Luckily, my doctor completed the forms quickly and were faxed 02-06-15. I involved my employer again on 02-16-15 because I still had no additional contact or check from MetLife. I was told in email by my employer the forms were received the 10th and that MetLife had 5 days to review them..isn’t the 16th more than 5 days? By yesterday, 02-19-15, still nothing and my employer tells me in email that MetLife just started working on my claim again; also more than 5 days since the paperwork was received. My GI doctor rep has called the Insurance CM, but she doesn’t return calls, including my own. And the supposed confusion with the paperwork is their questions ask what I’m capable of at work so my doctor wrote working 8 hours in intervals, but the fifth and last page asks WHEN can I return to work..he clearly wrote April 15, 2015. His intent was to describe the goals of my remission and provide a date he expects to achieve that, obviously because I have a copy of the paperwork sent. My employer refuses to provide me the short or long term plan documents, MetLife tells me I have to get them from Bioscrip, and as soon as I gave a complete accounting in email to my employer of all the malicious acts MetLife had committed and all with their permission I was told to stop contacting Bioscrip and referred to their lawyer. I’m in the third week of no money, bills definitely coming due, and no one to help me. I’ve exhausted “loans” from friends in these 2 months, and am exhausted from doing all this. I followed every rule from starting FMLA last year to asking for ADA accommodations (I was told nonexempt employees are not entitled to ADA accommodations), and filing my STD paperwork timely. Colitis is highly stress driven so remission hasn’t even been an option while off, and all sorts of other medical issues have arisen from treatment. If this becomes an LTD claim through MetLife chances are good my family will be burying me.

Answer

Answered on February 21st 2015 by Attorney Rachel Alters

Julie, Your company is responsible for providing you with a copy of your policies. I would recommend you send a written request advising them that the policies are being requested pursuant to Section 1332 of ERISA and that failure to provide same could result in civil penalties.