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Lost Job for Not Disclosing Condition

By:
David Lack

Question :

I was recently terminated for failure to disclose a medical condition. Legal? Who knows? To avoid having to pay unemployment insurance, the employer labeled the reason for termination "misconduct." COBRA conditions for this employer disqualify people terminated for "misconduct" from eligibility to request COBRA coverage. So: If the employer has found a neat-o way to terminate you for a medical disability and then denies COBRA, what do you do?

X.O.

Answer :

An attorney who deals with employment issues may have to answer the first part of your question. If regulations pertaining to the employment situation are similar to insurance regulations, however, the employer's actions may well be justified. The insurance issue here is misrepresentation, and it is a serious matter. One industry in America that often suffers from fraud is insurance, and far too many people believe it is justifiable to defraud an insurance company. See more about that below.
You acknowledge that you failed to disclose a medical condition, most likely related to an application for employment or insurance. As I understand from your description, when the employer or insurance plan discovered the condition and the underlying misrepresentation, you were terminated. The problem here is not that the employer was looking for an excuse to pay unemployment benefits, but that this action was indeed misrepresentation, a form of misconduct. Blaming the employer is a misapplication of responsibility.

Let's set a couple things straight about unemployment insurance. An employer cannot escape paying for unemployment insurance. The law requires it. Like other types of insurance, however, the rate is determined by the amount of benefits paid out by the insurance. Therefore, employers must be careful who they hire and how they treat employees. Some terminations lead to unemployment benefits, and this will increase the rate for unemployment insurance that the employer will pay. Under certain circumstances, usually involving a "cause" for termination, the employee is not eligible for benefits. In this case, the reason for termination was misconduct, making it a "for-cause" termination. But it was due to the act of the employee -- the misrepresentation -- and the employer should not be penalized with higher unemployment insurance rates.


There are further consequences as well. The misrepresentation also apparently disqualified you from eligibility for continuation insurance benefits under COBRA. This fact severely limits your insurance options now and in the future.

Again, whether the employer is justified in terminating you is a matter for a legal expert, but from what I can tell, it does not clearly appear to be the employer's way of terminating a person for having a medical condition. Rather, the misrepresentation is at the heart of the issue. If the condition is truly a disability, and you had disclosed it, you would probably be protected under the Americans with Disabilities Act (ADA).


Here is how a misrepresentation works in insurance. Insurance applicants too often provide incomplete or inaccurate information, and often leave out crucial facts that the underwriting process may discover. A smoker claiming to be a nonsmoker will be discovered through a urine test. Blood tests and physician records will reveal a host of medical conditions that a person may omit. If these are of sufficient severity, the insurer will decline the person's application and will reimburse any premiums paid.

If certain misrepresentations escape the underwriting process, a policyholder's initial claims may reveal other existing medical issues. If the insurer discovers that a claim is due to a misrepresentation on the application, the insurer may rescind (void) the policy and return all premiums paid.


Though it may sound axiomatic, the best policy is honesty. In issues of insurance and employment, dishonesty and misrepresentation can cause a host of problems. But you still need insurance. You may want to check with an agent or broker to find out whether you qualify for any insurance product or guaranteed-issue program in your state. Many states have "high-risk" pools for those who may be uninsurable on medical grounds. You may qualify for other public programs, such as Medicaid. Call your county health department for information.

 

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