If you have not been following this blog, you may want to check out some of my earlier posts for some background information.
Hopefully, you took a look at my claim denial letter from CLEA. A few things are significant in that letter and they tried to manipulate the truth later, but in this post I want to focus on the question of being ineligible due to administrative leave status.
When you search Administrative Leave on the Internet only a handful of professions are mention in connect with the term. Almost all information on admin leave references its use by law enforcement organizations. Since it is fairly unique to the profession, is it fair to disqualify someone from insurance coverage for being placed on admin leave? Especially when your insurance plan is supposed to be custom built to ensure the financial security of police officers.
Lets take a look at the definition of "Active Service":
"Active Service" means an Employee's normal full-time employment of at least thirty (30) hours per week with a qualifying municipal or public corporation or district at the Employer's usual place of business or other assigned work location. An Employee will not be considered in "Active Service" during
(i) any extended leave, administrative leave, or other absence of the Employee without pay that continues for a period of more than three (3) work days (other than due to Total Disability),
or
(ii) any extended leave or other absence of the Employee of greater than thirty (30) consecutive days with pay (other than due to a Total Disability).
That is the language that they used to exclude me. I did not change any wording or punctuation. I did add the bold and italics and I separated section (i) and section (ii) for to make it easier for everyone to read.
So lets look at the language like a cop would read the Penal Code. We do not take elements of a crime and add plug them into the different subsections to create a crime. So we should read insurance policies the same way.
Under section (i) the policy writers were clearing defining the conditions that a person was not considered active service if they were off without pay. The term administrative leave is clearly mentioned as a reason that would cause you to lose eligibility. But only if you are on unpaid administrative leave.
Section (ii) is a completely separate section. They added distinct headings (i) and (ii) that explained two completely different situations. Section (ii) defines an absence from work with pay. Despite putting the term administrative leave in section (i) it was deliberately omitted from section (ii). But CLEA has combined the two separate sections into one to deny my coverage. When I pointed out the fact administrative leave was deliberately omitted from the with pay section, they stopped saying it was because of my administrative leave status and began using the term other absence.
Interestingly when I first spoke to Laura, the supervisor she said I was denied coverage because of the language that stated usual place of business. She said since I worked from home while on admin leave it was not usual place of business and therefore made me ineligible. I asked if I went to an extended training class or worked undercover in the field for an extended period of time would make me ineligible. I also pointed out the part that said "or other assigned work location" and they stopped pushing the issue about work location.
So that is the main issue I have, but I have more that shows a pattern of conduct on the part of CLEA to deny coverage. But I think it is very clear, the policy does not exclude someone from coverage for being on admin leave. Even if it did, why would a police officer want a policy that could lapse in coverage at any time just because of an allegation? Even a flat out false one.
Further, take a look at the language. Any leave of absence for more than three days without pay results in a loss of benefits. So if you get 4 days on the hook for you third traffic accident or some other issue that could realistically happen to anyone, you are now without coverage.
Even if you never get in trouble, never even do anything to even be placed on admin leave, take a look at why they can strip your coverage. Any leave of absence with pay for more than thirty (30) days results in loosing coverage. Anyone in your department ever take an extended European vacation? Extended leave for the birth of a child? The policy states the only exception is for Total Disability. Even if you are injured, but not disabled taking that light duty position may cause you to lose your coverage the way they try to manipulate the intent of the policy.
I can not say for certain CLEA would deny coverage under any of these circumstances. But the language is clearly written that they could deny coverage. In my case even without the language they still denied coverage.
In my next post I will cover CLEA trying to manipulate the truth about what was told to them and why. Also how they documented irrelevant information that was not even factual in my case file in an attempt to make me look like a person of poor moral character.
After that I will post an article about why these companies deny claims and how difficult it is to pursue a lawsuit against them.
Hopefully, you will take the time to read threw all of these posts and inform your union leadership of these issues. CLEA claims to represent 10,000 first responders, if they do this to even 1% of the people putting their lives on the line day in and day out it is flat out wrong and unethical.
I paid a lot of money for years for a plan that never paid me a dime. I counted on this to be there for me and my family. It nearly destroyed my life, do not let it happen to you.
Do Not Buy Insurance from California Law Enforcement Association