Employer overstepping boundary

[Guest Greta]

We had an ee return from disability leave. The claim ended up denied by our TPA as the ee's provider did not turn in documentation. I spoke to the ee several times during their LOA and ee stated that the provider was too busy to sign the paperwork.

Upon returning to work, the ee spoke to his manager about this and asked us (the employer) to get involved. We told the manager no, it was the ee's responsiblity to resolve this with his provider. At the ee's request, the manager still called the provider regarding the documentation, explicitly after he was told not to get involved.

Do his action put us in any jeopardy? Or was this simply bad judgement but not hurtful to our company? Any insight is appreciated.

Thanks, Greta

[jsb]

I agree that it is ultimately the sole responsibility of the employee to provide the information needed to support his claim. It sounds like he is trying can't get cooperation from the provider.

There should not be much jeopardy. Oh, I suppose a good attorney on a subsequent claim could construct a theory about your NOT helping out his employee-client when they couldn't get info from a provider to support a claim, but that would be a stretch, and you could mitigate it by helping all of your employees (precious few, I would imagine) who find themselves with the same problem.

Was the manager directly insubordinate in ignoring a valid order from an authorized superior in your company when he called the provider? If so, you have a personnel issue with the manager that you need to address. Even if so, this manager sounds like a pretty decent human being who actually cares about his employees. Your company should try to find more like him. He's improving morale and your employee relations.

I empathize with the employee who can't get cooperation out of his provider. What is wrong with trying to help by having a manager rattle a cage or two? Is the provider affiliated with your health plan in a way that your benefits manager can lean on the health plan service manager to get compliance out of the provider? Help the employee out if you can.

If it is indeed the provider who won't cooperate, why do you want to punish your own employees for the provider's failure? I don't get it...

[Guest Greta]

Thanks for your feedback.

We do appreciate compassionate staff, but this manager doesn't understand all of the processes we've set in place and goes overboard in trying to "correct" our wrongs (as he perceives them.)

With HIPPA privacy, we do not want the company involved with the physicians at all (granted, the provider would liable if they gave any confidential information.) We hired a TPA, in part, for this reason. And if there was a compelling reason to contact the physician, it would come from Benefits - not the manager. There's more to this situation and there was not a valid reason for the company to get involved. It really fell back on the employee.