Good morning, My firm asked me to relocate in San Francisco from New York. However, the health plan from my firm only covers NYC. As a result I had to subscribe to the most premium plan to access to out of network doctors. Besides the premium, ...
This is a very complicated question … mostly because the Affordable Care Act (ACA), itself, is remarkably complicated.
The simple answer to your question is that, unless otherwise provided for in your employment agreement or employer’s policies and procedures, your employer generally DOES NOT have to pay your health care expenses – whether incurred in or out of state.
Of course, your question is anything but simple.
You add an extra level of complexity to the question here because it sounds like your employer DOES offer insurance, but that there MAY be an issue with the ADEQUACY (i.e., the scope of coverage) and/or AFFORDABILITY of the health insurance offered by your employer. On top of that, you add yet an additional level of complexity because it sounds like your particular insurance needs – at least while on assignment in California – are different from that of the company’s other employees.
The general rule is that an employer is not REQUIRED to provide health insurance to employees. That said, if your employer has a certain number of employees (determined in accordance with the ACA) then the employer must elect to a) OFFER insurance that satisfies the requirements of the ACA, OR 2) pay a substantial fee (an Employer Shared Responsibility Payment) for each full-time employee in excess of 30, INSTEAD of offering insurance. In the typical situation, for insurance to be deemed “ADEQUATE,” it must pay at least 60% of the health care expenses for a TYPICAL population (as defied by the IRS). For the insurance to be deemed “AFFORDABLE,” it should cost less than 9.5% of the family’s income to purchase it.
If your employer is large enough (usually over 50 full-time employees) and the coverage offered is either unaffordable or inadequate, then the employer may be required to pay an Employer Shared Responsibility Payment if at least one of the employer’s full-time employees receives a tax credit for purchasing individual insurance in the Health Insurance Marketplace.
With respect to your situation, you need to know whether the insurance offered by your employer, under these specific facts, meets the requirements of the ACA (i.e., is it adequate and affordable). More specifically, you need to discuss with you lawyer whether the fact that you (i.e., one employee) worked out-of-state for a period of time is sufficient to make your employer’s offered insurance either inadequate or unaffordable. Generally speaking, if your employee meets the minimum size requirements and elects to offer health insurance (rather than paying the Employer Shared Responsibility Payment), then your employer must offer health insurance that is adequate and affordable. However, this does not mean that the employer is required to offer insurance that provides for out-of-state coverage (beyond emergency care).
While it may be too late with respect to your health care expenses, you also need to understand whether you (or your wife) are eligible to receive cost assistance for purchasing insurance that will provide you(r family) with out-of-state coverage. In this regard, the general rule is that, if you have a coverage option through your employer, then you typically cannot get cost assistance if you obtain other coverage.
As you can see, the general rules put you in a sort of “no man’s land.”
Given the many issues relating to your specific question, I would encourage you to speak with an employee benefits lawyer or health law lawyer that is familiar both with the ACA and your state’s specific health insurance laws. This really is the only way for you to get to the bottom of this question.
Good luck!See question
She is 19, a full time student and has no income. I pay for her college tuition and expenses.
The answer to your question is a bit tricky for several reasons ... most important of which is that family law (i.e., divorce) matters like this are very state specific, so this answer may be different from one state to another. In addition, the lawyer you speak to (and, for this question, you should speak with a family law attorney familiar with the laws of the state in which you and your husband were divorced) will need additional information about the agreements and Court orders came out of your divorce proceedings.
That being said - and not to be used as a substitute for speaking with a qualified family law attorney as noted above - the general rule is that this issue should be addressed in a custody agreement with your ex-husband or in a Court Order governing how unreimbursed medical expenses are to be handled as between you and your ex-husband.
Again, if this is an important issue for you and your daughter, you should seek a qualified attorney to discuss this matter with you based on your specific facts.
Good luck!See question
from the same employer.
In Maryland, you typically can collect benefits for up to 26 times your weekly benefit amount ... or about 6 months. This is governed by state law.
Here is a FAQ (with answer) from the Maryland Department of Labor, Licensing and Regulation's website (http://www.dllr.state.md.us/employment/claimfaq.shtml#bye)
WHAT IS A BENEFIT YEAR AND HOW LONG DOES IT LAST?
Once you qualify for benefits, you establish a "benefit year." Your benefit year is the one-year (52 weeks) period beginning with the Sunday of the first week in which you file your new claim. For example, if you filed your new claim on Friday, September 13, 2013, your benefit year would start with the preceding Sunday, September 8, 2013; this would be your "effective date." Your benefit year would last until September 7, 2014. During a benefit year you may receive up to 26 times your weekly benefit amount. Under normal circumstances, you may not start another benefit year until the first one is completed. However, if you have also worked in another state during your base period and have received all your Maryland benefits in your benefit year, you may file against the other state in which you worked and you may be eligible for benefits from that state. Call the Claimant Information Service for further information on establishing a new benefit year.
The Maryland Department of Labor, Licensing and Regulation has a lot of good information about unemployment insurance on its website. That is a good place to check.
I hope this helps!See question
Need an attorney in the Howard County, MD area with knowledge and experience in the field of music law to especially include copyright, licensing, digital media rights and related artist business structure and operating considerations.
You probably are looking for a lawyer with experience in "intellectual property" (or "IP") law and technology law and who has worked on matters involving "musical works" and technology or possibly "artistic works."
You can search Avvo or Google. Talk to a couple of people before you make a decision and make sure that you include in your initial discussion that you have questions that are specific to musical works as intellectual property.
Good luck!See question
I only worked there for 4 month but i quit afterwards.
While your question could bring up a number of issues … and problems … the real issues for you probably are whether your employer is 1) complying with applicable wage and overtime laws, 2) complying with applicable unemployment and worker’s compensation laws, and 3) properly withholding state and federal taxes for you and your fellow employees. Of course, there are a number of other issues that are involved, such as whether your employer is paying you at the right time, etc., but those issues may go beyond your question.
The thing to understand is that your employer is not required to use fancy payroll processing software or a third-party payroll service. In fact, while highly unusual, your employer could handwrite your paycheck, as long as the employer is doing things correctly and keeping complete and proper records of what they employer pays you, withholds on your behalf, etc. The bottom line is that the employer is required to pay you properly, timely and, generally speaking, to withhold state and federal income and employment taxes on your behalf.
The first issue noted above deals with the Fair Labor Standards Act, which establishes minimum wage rules, overtime pay rules, record keeping rules and other rules about how employers are supposed to pay employees. The general rule is that (most) employees 1) are eligible to receive minimum wage (which now varies by state and, in some instances, by county), and 2) may only work 40 hours per workweek at the employee’s usual pay. For anything over 40 hours in a given workweek, (most) employees are entitled to overtime pay, which generally is 150% of the employee’s regular hourly pay. This is a very complicated, huge problem area for employers, so this is something to consider. The burden of doing this correctly – and keeping correct and complete records – falls upon the employer, however. At a minimum, your employer should have a poster on display at the workplace that outlines the basic requirements of the Fair Labor Standards Act.
The second issue deals with whether your employer is complying with laws designed to protect/provide for employees in the event of injury or termination. Both the federal government and most states have requirements for typical employers (some non-profit organizations can elect other alternatives) to provide worker’s compensation insurance and to pay into the government’s unemployment program. The worker’s compensation insurance is an insurance policy designed to provide some basic levels of insurance to employees in the event the employee is injured while working for the employer. If this insurance is not in place, the employee may have to fight with his/her employer to get paid for the workplace injury. Not a good scenario for either the employer or the employee. The unemployment program participation, on the other hand, is intended to make certain public assistance available to certain of an employer’s employees, depending on a number of factors (such as how long the employee worked for the employer and the amount of wages earned prior to the termination, the reason for the termination, etc.). Maryland’s Department of Labor Licensing and Regulation has some excellent on-line resources about Unemployment Insurance in Maryland.
The third issue more of a tax issue. Both federal and state laws require employees to withhold, deposit and report employment taxes on behalf of their employees. Note, this does not apply to properly designated independent contractors. Typically the federal taxes withheld and/or paid are income tax, Social Security and Medicare taxes, and Federal Unemployment tax. Again, complying with these federal and state withholding rules is the responsibility of the employer. This is another area where it is easy for employers to make a mistake.
I hope this helps to provide you with some guidance.See question
My college roommate's children are investigating rehab facilities. Their mother is a stage 4 cancer victim. Her parents would like to know if they have a say in this selection.
You ask a difficult question. Not only because of how difficult this is for your roommate’s children and their mom, but also because the answer to a question like this is very fact specific.
To point you in the right direction, however, your question probably has less to do with health care and health care facilities (at least for the time being), as is more related to your roommate’s children’s mother’s ability to take care of herself and to be her own best advocate. This sounds like a question of “guardianship.”
Generally speaking, adults are responsible for their own actions and making their own health care decisions; and the government generally frowns upon people trying to limit those rights. When it is not possible for an adult to act on his or her own behalf, however, perhaps because the person is incapacitated or suffering from a physical or medical condition that makes him or her unable to take care of himself or herself, most states have statutes (written laws) and rules that explain how an “interested person” may be “appointed” to act on behalf of the incapacitated person. While all state statutes are different, in Maryland an “interested person” is “the minor or the disabled person; the guardian and heirs of that person; a governmental agency paying benefits to that person or a person or agency eligible to serve as guardian of the person under [Maryland law].”
Typically … and again, remember that the statutes are state specific … the process requires an interested person to make a formal, written request to a court to appoint a guardian for the (alleged) incapacitated person. The court typically must be a court that has the ability to make decisions about the disabled or incapacitated person, so this likely would need to be done in the state where your roommate’s children’s mother lives or otherwise is located.
Getting back to your specific question: In light of the above information, if your roommate’s children are old enough to be interested persons (typically over the age of 18), then it is possible that either the children or the parents could be proper guardians. The court will need to decide that issue.
Good luck to you and your roommate’s family.
Please understand, legal questions, like yours, are very fact specific and are difficult to answer based on the limited space available on Avvo. As such, the above response is for information purposes only. In addition, my response above is not intended to offer any legal advice or any legal information with respect to any specific state or jurisdiction (unless noted). This response does not create an attorney/client relationship between you and me or you and my law firm, Paley, Rothman, Goldstein, Rosenberg, Eig & Cooper, Chartered ("Paley Rothman"). If you are not an existing client of Paley Rothman, (1) nothing in this e-mail establishes an attorney/client relationship between you and Paley Rothman, (2) nothing in this e-mail shall be deemed, nor should you interpret anything in this e-mail to be legal advice or opinion, and (3) do not disclose anything to Paley Rothman that you expect Paley Rothman to hold in confidence.See question
My friend is a ward of the state of Maryland and has been institutionalized +/- 20 years. She is 55 years old.. She recently had a severe heart attack. She did not receive medical treatment for three days. When she was taken to the hospital, all m...
This sounds like a very difficult situation for you and your friend and, while, complicated, help is available.
Unless there is family to represent your friend, which sounds unlikely if she is a ward of the State, you may need to "petition" the Court to appoint a guardian for your friend. If, like you, your friend is in Montgomery County, you can go to the Montgomery County Circuit Court, in Rockville, and speak with the Clerk at the Family Law Department (the phone number is 240-777-9426). The people in the Clerk's office are wonderful and they will be able to give you basic help with the process to have a guardian appointed and some guidance about whether you are "an interested person" who can petition the Court on your friend's behalf. The Clerk also may be able to help you determine whether the hospital can help as well (with having a guardian appointed).
This all being said, based on the limited facts provided and without knowing more, the best thing for you to do, if you can, may be for you to speak with a qualified elder law attorney with experience in guardianship matters in Montgomery County. There are several excellent, qualified attorneys in Montgomery County. If you have a hard time finding a lawyer to help you, you also can contact The Bar Association of Montgomery County, Maryland's Lawyer Referral Service at http://www.montbar.org/displaycommon.cfm?an=1&subarticlenbr=24, or by calling 301-279-9100. This is a great group of people and they are available to help you.
Overall, there are processes in place to help your friend, but the process can be tricky to figure out and can be confusing. As such, speaking with a qualified lawyer who does guardianship matters in Montgomery County probably is the best first step.
Good luck to you and your friend!
Please understand, legal questions, like yours, are very fact specific and are difficult to answer based on the limited space available on Avvo. As such, this response is for information purposes only. This response does not create an attorney/client relationship between you and me or you and my law firm, Paley, Rothman, Goldstein, Rosenberg, Eig & Cooper, Chartered ("Paley Rothman"). If you are not an existing client of Paley Rothman, (1) nothing in this e-mail establishes an attorney/client relationship between you and Paley Rothman, (2) nothing in this e-mail shall be deemed, nor should you interpret anything in this e-mail to be legal advice or opinion, and (3) do not disclose anything to Paley Rothman that you expect Paley Rothman to hold in confidence.See question
The DOL has determined that they are only going to pay me a portion of my original pay that I was making before I accepted this lower grade position. When I was given the new position I was making $1.75 more than the position they accomodated me w...
As with most legal questions, the answer to your question is “it depends.” The world of employment law, perhaps more than any other area of the law, is very, very fact dependent. For your question, the things we would want to know include: 1) Was your injury of the type that you should have been provided with up to 12 weeks of medical leave to recover and return to your prior job or a job of similar substance and pay? 2) If you did take medical leave, are you now able to perform the essential functions of your prior position, either with or without some reasonable accommodation by the Government? 3) Was your injury of the type that – with or without 12 weeks of medical leave to recover – you no longer are able to perform the essential functions of your prior job?
The real issues for you are 1) have you been provided with a reasonable opportunity to recover from your injury, and 2) are you still able to perform the essential functions of your previous position, even if it requires some reasonable accommodation (for example, a modified work station, a modified schedule, etc.)?
Again, without knowing all of the facts, it is not possible to answer your questions. The general rule, however (and remember, there almost always are exceptions to the “general rule”), is that, if your employer is required to comply with the Family and Medical Leave Act (“FMLA”), that Act provides that eligible employees (meaning that, prior to your injury, you worked for your employer for 12 months and, during that 12 months, you worked at least 1,250 hours) are able to take up to 12 workweeks to treat a serious health condition that makes the employee unable to perform the essential functions of his/her job. At the end of the leave period, the employer generally is required to restore to employee to the same job or a job of nearly identical responsibility and pay. If this was not done, then you may have a claim for your old pay.
In addition, the Americans with Disabilities Act (“ADA”) protects people with disabilities (like a physical or mental impairment) from certain employment-related discrimination if (and that “if” is important) the person otherwise is qualified and able to perform the essential functions of the job. Under the ADA, if you still are able to perform the essential functions of your old job, even if it requires some reasonable accommodation, then there may be a claim that the Government should not have changed your job and pay. Again, we would need to know more.
In the facts you provide, you note that you need time “to allow me time to get myself to that performance level I was at originally.” This statement suggests that you are not able to perform the essential functions of the job you were doing when you were injured. The facts you provide suggest that someone, either rightly or wrongly, already has made the determination that you are not able to perform the essential functions of your prior position. If you look at the first and second paragraphs above, you will see that this is one of the key issues for you. While I am not familiar with a blanket rule that requires the Government to provide you with 2 years to recover from an injury, it is possible that such a rule exists under a particular agency’s rules or under some type of union or collective bargaining agreement, but, again, those are additional facts we would need to know.
The best suggestion we can make is for you to meet or speak in person with a qualified employment lawyer who has experience handling disability and accommodation matters for employees of the federal Government. Most lawyers who practice in that area of the law will meet or speak with you for free to help you evaluate your specific facts and to help you determine whether you have been treated correctly. Hopefully you now can go to that meeting with a little more knowledge and a lot of information so you can help the lawyer help you.
Good luck!See question
Prior to service/products I was told bill will be about $150. Eight months afterwards I am billed for over $1300. I receive conflicting information from medical company depending who I talk to. Billing supervisor does not return my calls. I do no...
This is a difficult question to answer because we need more information. For example, do you have insurance (private, Medicare or Medicaid)? If you do have insurance, was the service covered by your insurance and did the provider (i.e., doctor) participate with your insurance?
Typically, when someone gets an “estimate” for a medical procedure, there is an assumption that the person is uninsured or that the procedure is “elective” and, as such, not covered by insurance. In such cases, there generally is a contract between the provider and the patient, where the provider promises to provide the agreed to services, and the patient promises to pay the agreed to amount. If either side does not perform as promised, then there may be a breach of contract. Based on the facts provided, it appears that 1) there was a misunderstanding about the cost of the services to be provided, 2) the provider performed services beyond that which was agreed to, or 3) the provider is billing the patient more than the agreed to amount. If any of these is true, then under pure contract law theory, the patient may not be responsible for paying any amount over the agreed to amount.
On the other hand, if insurance is involved, then, generally speaking (and there always are exceptions), the patient only is responsible for 1) his/her co-payment, the amount of which is agreed to in advance between the patient and the insurance company, on the one hand, and between the insurance company and the provider, on the other hand, and 2) his/her annual deductible amount, in the event the patient has a high-deductible insurance plan. With high-deductible insurance plans, the patient typically pays all provider costs directly to his/her providers until the patient has met his/her annual deductible. Outside of the patient’s responsibility for the co-payment and the deductible, the rest of the provider’s fees generally are negotiated between the insurance company and the provider and paid by the insurance company. Under such circumstances, the provider generally is not allowed to bill the patient outside of that agreement. One exception to this general rule applies to services performed by out-of-network providers, in which instance the typical insurance policy will pay up to a maximum of 80% of the provider’s fees and the patient is responsible paying for the rest. The patient usually will know if he/she is going to an out-of-network provider.
The best thing to do is to contact an attorney in your area who can evaluate these issues with you and help you to understand whether you are liable to the provider for any amount above the $150 “estimate.” This should take less than an hour of the attorney's time. If you are liable for an amount above the estimate, the attorney may be able to help you negotiate a reasonable payment plan. If you are not liable to the provider, the attorney may be able to help you resolve the misunderstanding before a careless billing services turns you over to a collections company. The important thing is to be proactive, but also to make sure the attorney understands that the amount in controversy is $1,000! It is not helpful to get the medical bill cleared in exchange for a $1,000 legal bill. So ask questions!
Good luck!!See question