When an employee has health insurance paid by the employer, the employee is still a "subscriber" to the policy of insurance and is also considered a third-party beneficiary (employer buys the policy for the benefit of the employee). When a carrier acts in such a way as to not follow the policy of insurance and harms the employee, the employee has legal rights to recover for the wrong. The employee usually has the right under the policy of insurance to appeal within the decision of the carrier...