Note: the limitation does not apply to certain excepted benefits, such as a health FSA. © 2021 East Coast Risk Management. Under COBRA, employees and their families that suffer certain defined qualifying events may be able to continue coverage under the employer’s group health plan except when an employee is terminated for “gross misconduct.” https://www.mondaq.com/unitedstates/employee-benefits-compensation/77940 Fighting, physical assault, abuse, or threatening behavior, Blatant disregard for the safety of others or serious breaches of health and safety rules, Any attempts to financially defraud the company or theft, Dishonesty, falsification of documents, or other forms of misrepresentation, Offensive or unlawful behavior (such as discrimination, harassment, or bullying), Working under the influence of illegal drugs or alcohol. Replies, comments, or information gathered on COBRAinsurance.com website may not be accurate, but are intended to be helpful. The COBRA statute does not specifically define the term gross misconduct, so the courts have taken the lead on deciding whether to apply it on a case by case basis. COBRA - Gross Misconduct. None of these individuals are offered COBRA continuation coverage. The Case The trial court in this case initially ruled in favor of the employer, finding that theft and dishonesty can constitute gross misconduct under COBRA, regardless of the amount involved. Your premium assistance can last from April 1, 2021 through September 30, 2021. Did the conduct have a connection or series of connections or physical presence linking the gross misconduct or performance directly to the employer, a co-worker or a current or former client or customer? Employers have been sued for not offering COBRA continuation on the basis of gross misconduct, so it’s important to be careful here. Often, gross misconduct will prompt an employer to terminate an employee are those done in deliberate violation of the employer’s known standards. Employee gross misconduct must be intentional, wanton, willful, deliberate or reckless. The Department of Health and Human Services handles questions relating to state and local government workers. Disclaimer: The information provided on this web site is for informational purposes only and not for the purpose of providing legal advice. To minimize their risk, many employers have decided not to apply the gross misconduct exception at all, but, instead, to extend COBRA to all terminated employees regardless of the reason for the termination. Employers have been sued for not offering COBRA continuation on the basis of gross misconduct, so it’s important to be careful here. Can You Discipline an Employee for Violating a Safety Rule? * If the termination from employment is due to "gross misconduct", your department is not required to offer COBRA coverage. Fired for Gross Misconduct How to Appeal a Denial of COBRA Benefits. One exception would be when the employee is terminated for gross misconduct. The reason for the involuntary termination, does not need to be related to the pandemic. Shannon Kennedy, Licensed Agent. Further, the employee is not eligible for coverage if the termination was due to gross misconduct. There is no definition of or guidance on what constitutes “gross misconduct” either in the COBRA statute itself or in the applicable regulations. Individuals who voluntarily leave employment, or who are terminated for gross misconduct are not assistance-eligible individuals. 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