How to Win a COBRA Appeal

COBRA benefits are a continuation of your health-care plan after you have lost health coverage due to a qualifying event. Qualifying events include losing your job, a reduction in hours that makes you ineligible for your employee health plan, death of a covered employee, divorce from a covered employee, becoming eligible for Medicare and, in the case of dependents, aging out of health-plan eligibility. COBRA benefits can be the only way some people can retain coverage, and a denial of benefits can be a serious situation.

Things You'll Need

• Paperwork from your termination of employment
• Stationery supplies

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Instructions

• 1

  Review your employment documents. You only can be denied coverage under COBRA if you were terminated for "gross misconduct." Even if you were terminated for misconduct, for your coverage to be denied, your misconduct must have been inexcusably bad in the eyes of the court. Find the reason for your termination and compare it with your employee handbook and any other documentation you have from when you were employed. If what caused your termination was anything but truly "gross misconduct," you have grounds for an appeal.

• 2

  File an appeal using the guidelines laid out in your termination of coverage notice from your employer. Your employer is required to give you notice of denial of COBRA coverage and the reason why the employer is denying you coverage within 90 days of your termination. You then have 60 days to appeal this decision. The exact appeal procedure varies from plan to plan, so make sure you follow the exact guidelines in the termination letter.

• 3

  Consult an attorney if you fail to win the appeal. The next step is to take the COBRA denial to court. If you win, the court will grant you COBRA benefits, backdated from the date of your denial of benefits. You also may be able to be granted reimbursement for your legal costs, including the cost of your attorney.