Employer Added Wife to Insurance, Now They Retroactively Voided Her Coverage My employer "accidentally" included my wife in my health insurance plan. (They are now saying that they don't cover spouses). They retroactively voided the plan without informing us. We thought she had coverage, but due to their mistake, we are stuck with medical bills. Can my employer do this? Does PPACA apply since it was their mistake for enrolling her?
This practice is known as "rescission". It is legal under 45 CFR §147.128 in some circumstances. The regulation says (a) A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must not rescind coverage under the plan, or under the policy, certificate, or contract of insurance, with respect to an individual (including a group to which the individual belongs or family coverage in which the individual is included) once the individual is covered under the plan or coverage, unless the individual (or a person seeking coverage on behalf of the individual) performs an act, practice, or omission that constitutes fraud, or makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage. The law also prohibits surprises: A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must provide at least 30 days advance written notice to each participant (in the individual market, primary subscriber) who would be affected before coverage may be rescinded under this paragraph (a)(1), regardless of, in the case of group coverage, whether the coverage is insured or self-insured, or whether the rescission applies to an entire group or only to an individual within the group. (The rules of this paragraph (a)(1) apply regardless of any contestability period that may otherwise apply.) Note that the regulation pertains to insurance plans, and not employers. The employer may in good faith believe that you are stuck with the medical bills, but their opinion does not matter as far as this regulation goes. However, the employer also does not have the right to "declare" on behalf of the insurance company that your wife was covered. If you assume that she had coverage because the employer (mistakenly) said you did, but there was actually no coverage, then that is between you and the employer, or possibly you and the doctor. A prior question is whether she was actually covered in that past period. The contract between the insurance company and the employer might hypothetically state that only employees are covered, and may have accidentally submitted enrollment information with mistaken information ("X is an employee"). Since there was no intentional misrepresentation (we assume), coverage cannot be rescinded. Also note that rescission is retroactive cancelling, not prospective cancelling ("henceforth, you are not covered").
Your problem is not just that you don't have a working stopcock, but that you now know that you don't have one. Of course it's not illegal by itself, the problem is what is going to happen if you have an insurance case. Your home insurance most likely has to pay for accidental damage. But any damage that would be caused by not being able to close the stopcock, when you knew it wasn't working, they could claim that this is due to gross negligence. Whether they would succeed with that claim or not, I don't know, but fixing the stopcock seems to be a much, much cheaper solution. PS. Seems I made a wrong assumption here - that it was your home, owned by you. The same reasons that would have made it a good idea for you to fix the stopcock obviously make it a good idea for the landlord as well. So I would make sure that you tell the landlord as soon as possible. If something goes wrong, and the insurance doesn't pay, your landlord would be responsible for the damage. Whether it's legal to not fix the stopcock - that's a different matter. I thought you were the owner. You would have endangered yourself and your property. Nothing illegal with that. But with the landlord it's different; he wouldn't be endangering himself but someone else's property.
Off the top of my head, unless there's a provision that says otherwise, no, they cannot do that. Obviously, I can't tell you if there's a provision that says otherwise. Consult a lawyer for more specific advice.
You cannot contract outside the law Any "contract" that purports to break the law isn't a contract - it's an unenforceable agreement. For example, across all jurisdictions, a contract that is unconscionable is void. So is a contract that requires one of the parties to break the law - a "contract" for murder for example. In addition, you cannot call an employment relationship a "business" relationship - if the relationship meets the requirements of an employer-employee relationship then that's what it is and woe betide you if you haven't complied with all relevant entitlement, tax, insurance and safety laws. In addition, all of the relationships you listed are contracts.
Ask yourself... What are you trying to achieve? My understanding is an employer is not obliged to provide you a positive job reference. I believe at most, they are only to obliged to confirm that you worked there. Anything above that is optional. The fact that you have left British Columbia only makes it more difficult for the company to chase you - It does not alter your legal obligations. As part of the settlement, both the employer and employee singed an mutual non-disparagement agreement. Why did you sign a mutual non-disparagement agreement if you still disagree? It leads me to believe there could be trust issues between you and others. Why do you think your old employer must abide by the agreement, but you have an exemption? Let's say you make noise - let's say your old employer in BC tracks you down. Ask yourself how an independent third party like your new employer would react when they read that you signed an agreement, then decided to ignore it. Both you and your previous employer have begun new separate journeys. You two crashed once - I suggest you not alter your path or you could crash again. Life is too short. Concentrate on making your new home in your new city and a new job a new start. It will bring you a greater benefit than breaking a signed, sealed non-disparagement agreement.
Under U.S. law, when you hire someone and they are injured while doing work for which you hired them, the ordinary tort law regime does not apply. Instead, you are in the worker's compensation regime, under which the employer is strictly liable for the injury. Whether the employee or the employer was at fault in any way (negligent, grossly negligent, reckless, or intentional) is largely irrelevant (except that worker's compensation insurance does not cover the employer's intentional harm to workers which is the employer's responsibility to pay on an uninsured basis). This applies to all injuries on the job, whether or not they are related to the work, and whether or not anyone involved with the employer actually did anything wrong. For example, an employer has strict liability for the injuries of a convenience store clerk sustained by the clerk in an armed robbery of the convenience store where the clerk is working undertaken by felon who escaped from prison hours before due to the carelessness of the prison guards. Usually, that injury is fully insured if the employer has the legally required worker's compensation insurance in place, but the penalty for not having it in place is most commonly that the employer has liability to the full extent, if not greater, than the employer's worker's compensation insurance would have if it was in place. Worker's compensation recoveries are limited to actual economic damages like lost wages and medical expenses, without regard to non-economic harms like pain and suffering and worker's compensation plans also have a very limited death benefit when the worker has no dependents. But these limitations on damages don't always apply when the employer fails to have worker's compensation insurance in place. Worker's compensation liability varies from place to place, but in most states it applies to independent contractors who have not put in place worker's compensation insurance for themselves as well. In your example, Fred has full liability for Barney's injuries. Uriah does not have liability for Barney's injuries due to his good faith belief that he was acting in self-defense or defense of others. But note that Fred's strict liability for Barney's injuries does not preclude a third-party from having liability as well, both to Barney (for damages for which there is not employer liability under the worker's compensation regime such as pain and suffering, and/or in the case of an intentional tort like the armed robbery of the convenience store, punitive damages), and to the employer/worker's compensation insurer for a subrogation claim to recover the amounts paid to Barney as a result of the third-party's negligence or intentional acts.
In the United States, the main statute governing the use of health care information is HIPAA, the Health Insurance Portability and Accountability Act. HIPAA and its related statutes and regulations detail what you can and can't do with medical information. You can't always collect it; if you do, you can't always share it, and you can't always delete it. This is a complex field of law and it's easy to screw up in a way that would cause big, serious, company-destroying, job-ending problems for everyone involved. To put this another way: this is absolutely, positively, not something you want to get advice on from strangers on the internet. You don't just need a lawyer; you need a HIPAA specialist--or the equivalent in whatever other countries you plan to operate in--before you push anything out to real-life patients, especially children.
You have been told that the other person's insurance may not be valid. Why it may not doesn't really matter, perhaps the other person didn't pay premiums or lied on an application. So the situation is much the same as if the other person is uninsured or under insured. Your p[olicy must cover things. And your policy has a deductible. So you have to pay the deductable amount. That is what a deductible is, the amount that you must pay before your policy coverage kicks in. The lower it is, the higher your premium is. You don't have any choice about that. Depending on your jurisdiction, you may be able to sue the other person involved in the accident, and get that person to pay. Your insurance company might do this for you, but if they won't you would have to hire a lawyer yourself to do that. Such a lawyer could get all the details of your case, and advise you of your options.