My boyfriend is being hit for insurance fraud for his ex-wife?
My b/f has had his ex-wife on his health insurance for 5 years. He gave his employer 5 years ago the court order to pay child support but his employer never took his ex-wife off the insurance. Now since he's going to marry me, he's taken her off and will put me on once we marry. Now his employer is telling him he's guilty of insurance fraud and if her bills are over 5K they will fire him and convict him of a felony. Can they do this?
- Suzanne: YPALv 71 decade agoFavorite Answer
If your b/f's employer has been paying a portion of his ex-wife's insurance premiums, as most employers do, it's fraud, but NOT insurance fraud. State insurance laws define insurance fraud as theft that is perpetrated by or against a person or entity regulated by that State's insurance commissioner. Since your b/f's employer isn't subject to the regulatory authority of an insurance commissioner, this isn't insurance fraud. Again, if his employer paid any portion of his ex-wife's premiums, it has every right to sue him privately.
HOWEVER -- there may have been fraud committed against the insurance company that covered her; this IS considered insurance fraud, since the theft was committed against an entity regulated by a State insurance commissioner. Most insurers will settle for the amount paid out in benefits, minus the premiums paid, plus interest and attorney's fees; some will insist that a criminal case be brought. So your b/f should get an attorney as soon as possible.
One thought about the child support Order: if the Order simply pertained to the payment of child support, it means nothing; but if your b/f provided a copy of the divorce decree reflecting the FINAL child support Order, then his employer was put on notice that a divorce had occurred. In such a case, his employer cannot take any action against him, nor can the insurer take action against him or his ex, since the employer is legally obligated to inform the insurer of any changes in status, such as divorce.
I hope this helps.Source(s): 16+ years insurance industry experience; 9+ years insurance law experience
- upside downLv 41 decade ago
This is strange, my husband divorced wife #1 in 03 but stayed on her health insurance, NOT cobra, ever since. He married me in 04. He STILL stayed on her insurance from her employer.
we moved to his dad's house and he got ANOTHER new insurance card from the ex-wife in 06. How can this be?
I took this ins. card to the police but I was told "anyone can insure anybody they want".
Some of you say it's fraud and others do not agree. Now I am totally confused.
*try this website and see if you can get a legal answer - www.lawguru.com. I hope you find this out for all of us. **
- korniyenkoLv 44 years ago
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- Anonymous1 decade ago
Yep. They can. The employer is just trying to avoid getting in trouble with the insurer by passing blame on to your bf.
But he had a responsibility to notify them when his divorce finalized. The ex could have gone on COBRA for 18 months. After that, she was on her own.
It could get worse, too. If the insurer goes back to the medical providers, they can get their money back. Then, your bf will have to pay the non-discounted charges for every single thing paid in the last 5 years.
Sadly, I foresee lawsuits, possible jail, and bankruptcy in his future. I hope you really love this guy. If there's any doubts, now's the time to get out. Please do postpone the wedding until this has been settled, as you do NOT want to have any risk of liability for his debts or actions.
Why did he keep paying it for her? Was that court-ordered too? Was she reimbursing him? Was it part of his alimony? Was it meant to cover the kids too?
He needs to get himself a lawyer, ASAFP.
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- AnonymousLv 71 decade ago
Did he ever inform the employer that he was divorced?
Please note, a child support order is irrelevant - all it means is that he's not living with the kids. But he should have notified the employer that he was divorced.
Now, as to whether or not it's insurance fraud - if, at the annual renewal time, he declared her to be his spouse, and she wasn't - that's fraud. If they never asked him, it's not.
- JenLv 51 decade ago
Your boyfriend should have open enrollment every year for insurance and only have himself on the plan (unless he was required per the divorce to maintain insurance for her) via his employer. If he was required to have a plan for her, he needed to obtain one OUTSIDE his employer. If however he changed (a form is required) to having single coverage, and his employer just never sent the documents to the insurance company, then he cannot be fired. He needs to talk to HR and the benefits person and have them pull his paperwork.