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Breach of Duty of Care of the Employer and Denial of Benefits to the Employee

In administering the insurance policy the employer is to do more than merely make the arrangements for the coverage. The employer acts as the agent of the insurer in advising their employees of their entitlements and collecting the premiums by remitting them from their salaries to the insurer. As such, the employer owes a duty of care to the employee when it comes to representations made about the benefits available and the eligibility requirements, if any. The fact of the matter is that the employee is blind to the employer’s actions in regards to purchasing and setting up an insurance policy and thus they are unable to properly defend their own interests without such knowledge. Normally  employees rely on the information provided to them by their employer.

Both the insurer and the employer may be liable for misrepresentations made by the employer to the employees in regards to the insurance policy. The employer owes a duty of care to advise and assist the employees with their claims. This duty includes the timely disclosure of the details of the benefits available under the coverage, the relevant timelines and deadlines, and any penalties that may arise. However, in certain instances, the employee must also make attempts at obtaining the requisite information or otherwise risk loss of coverage and contributory negligence arguments.

Zeilikman Law can assist you in navigating the often-times confusing world of employer/employee relations in the context of group insurance and disability insurance. Our in-depth knowledge and focus on employment disability law will help you in getting what is rightfully owed to you.