Fired for Gross Misconduct

How to Appeal a Denial of COBRA Benefits

The "qualifying events" that trigger potential eligibility (election notices) for COBRA benefits include generally getting fired, but exclude specifically getting fired for gross misconduct. However, in the eyes of a court, an employee's alleged act of gross misconduct must have been truly "gross" (e.g., inexcusably bad, but not necessarily criminally bad) for an employer to have justifiably denied COBRA benefits to the employee.

Subsequently, if your employer fired you for gross misconduct and denied you COBRA benefits as a result, then you may appeal the denial of COBRA benefits and file a lawsuit if your appeal fails.

Within 90 days after your employer denied you COBRA benefits, your plan administrator must provide you with a notice explaining that your employer denied you and why.

To protect your employer legally, your COBRA denial notice is not likely to explain exactly what you allegedly did to get fired for gross misconduct. However, the notice must at least tell you how to appeal a denial of COBRA benefits, as the process varies based on the rules for different plans.

Regardless of the procedural rules for your particular plan, your plan administrator must give you at least 60 days to appeal a denial of COBRA benefits after notifying you about same. Be sure to follow appeal instructions to the letter and meet or beat deadlines, as your first chance might be your only chance. Consult an attorney if you're not comfortable gathering evidence or otherwise appealing on your own.

If you followed all appeal instructions and met all deadlines, but your appeal failed anyway, then you'll likely have to take a denial of COBRA benefits to court for resolution. Consult an attorney about that. If the court allows your case to proceed and you win, then your employer will probably have to at least retroactively grant you COBRA benefits and pay your legal expenses.

If the court decides in your favor and your employer never bothered to provide you with a COBRA election notice by way of your plan administrator, then the court might further monetarily punish your employer for not giving you the notice that would have been required by law, had your employer not wrongfully denied you COBRA benefits in the first place.

If you don't want to go through the trouble of appealing a denial of COBRA benefits or if your appeal fails, then you might be able to find what turns out to be a better deal on short-term health insurance anyway, to get you between jobs. Be sure to investigate pre-existing condition limitations and other coverage differences from your COBRA plan, and your HIPAA portability rights as well.

Your former employer may not retaliate against you for appealing a denial of COBRA benefits or for participating in related proceedings. The employer also may not retaliate against witnesses, such as former coworkers, who testify on your behalf. If the employer retaliates anyway, then you or your witnesses likely may sue the employer in court.

Fired for Gross Misconduct
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