Protective Orders Not a Qualifying Event Under COBRA

July 18, 2005 ( - A protective order against a health plan participant's estranged husband was not the same as a legal separation agreement and therefore was not a qualifying event for continued coverage under COBRA, an appeals court has ruled.

District Judge Bobby Baldock of the US Court of Appeals for the Tenth Circuit upheld a lower court ruling for Zeda Simpson that a protective order against her estranged husband was not the same as a legal separation agreement and therefore did not trigger the plan administrator’s obligation to notify the covered beneficiary of the right to continued coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Simpson was covered under her husband’s health plan with employer T.D. Williamson Inc (TDW), according to a BNA report.   In July of 2000, she filed for divorce and a court issued protective orders for Simpson’s husband to stay away from her and the marital residence.   Simpson sent a letter to TDW asking them to not disclose medical information about her to her husband.   TDW considered this letter notice of a qualifying event as a result of legal separation and notified Simpson of her right to continued health insurance coverage under COBRA.   Simpson elected coverage, but neither the company nor Simpson paid the premiums for the coverage.  

In June 2002, the employer notified Simpson that her health coverage was being cancelled due to non-payment of premiums.   In July of that year, Simpson notified T.D. Williamson that a final divorce decree had been issued and she wished to elect COBRA coverage.   The employer told her she could not be reinstated because her rights had expired.   Simpson filed a case with the US District Court for the Northern District of Oklahoma.   The court ruled in favor of Simpson and ordered TDW to provide her health coverage and reimbursement for uninsured medical expenses and attorney’s fees.

TDW appealed the ruling.   Since COBRA does not define “legal separation” and there were no appeals court precedents, Baldock relied on an immigration case in which the legal separation was defined as a judicial alteration of the marriage. In his opinion, cited by BNA, Baldock, said that “a decree of legal separation directs the parties to live apart and defines the parties legal rights and obligations in regard to custody, support, property division and/or maintenance” without dissolving the marriage bond.   He found that no legal separation occurred and agreed with the District Court in favor of Simpson.

The full text of the opinion can be found  here .