An employee was on a medical leave and considered able to return to active employment.
She had been receiving benefits under her employer’s medical plan rather than Medicare.
In this instance, she did not receive benefits from the plan, which stated that Medicare was to be the primary carrier, contraindicated by previous claims payment. The court, however, held that while someone in “current employment status” would normally have the plan be the primary payor, they also said that such status does not extend beyond six months, and therefore the plan was correct in denying the claim.