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.