Opinion ID: 2552656
Heading Depth: 3
Heading Rank: 3

Heading: Justin and Sara Jones

Text: In 1997 Janssen offered a job to Justin Jones. At the time, Justin was working for a company that provided health insurance to him and his wife Sara. Justin's employment with Janssen was to be as a project engineer, a nonunion position. Janssen promised to provide him with a health care plan through the Trust. In April 1997 Justin accepted the position with Janssen. There was a gap between the time when Justin's former employer would no longer provide the Joneses with health insurance and when the Trust health insurance would become effective. Freitas told Justin that Janssen would not be able to provide health insurance to the Joneses for Justin's first ninety days of employment. To fill this gap, Justin purchased COBRA insurance. Justin was particularly concerned about insurance coverage because Sara was pregnant. Justin began to work for Janssen in May 1997. Within weeks of beginning employment, Justin asked Freitas when coverage would begin and was assured by Freitas that this would occur on September 1, 1997. Between this initial inquiry and late August 1997, Freitas confirmed for Justin on a number of occasions that coverage would begin on September 1. To verify that this was so Freitas called the Trust and would speak to either Patton or Renz, who assured Freitas that the Joneses' coverage would indeed begin on September 1. In late August 1997, however, the Joneses learned that Janssen's promised coverage would not begin until October 1, 1997. Around this time, Justin had again asked Freitas to confirm the September 1 start date. Freitas called the Trust and, according to Justin's testimony, spoke to Patton, who told Freitas that the insurance would begin October 1, 1997. In mid-September 1997 Janssen began its attempts to make contributions to the Trust on the Joneses' behalf. Freitas called O'Dell to find out how to make such contributions for Justin. Following O'Dell's instructions, Freitas prepared and submitted a monthly remittance report that reported Justin had worked 100 hours for each of the last three months. The Trust received and processed this report. In accordance with the normal practice for monthly remittance reports, Renz entered Justin's reported hours into the Trust's computer records. Renz testified that while she found it a bit unusual for Janssen to report hours for three separate months in one monthly remittance report, it was not so extraordinary that she thought much of it. In contrast, Patton took notice. Evidently 100 hours per month is the minimum time required for coverage. The report of the exact minimums for three months running raised a red flare for her, and she suspected that something was amiss. Patton ordered an audit of Janssen's books and records. Pending the audit a freeze was ordered on any claims for medical insurance that the Joneses might submit. Neither Patton nor anyone else from the Trust communicated these problems to the Joneses. Meanwhile, Sara, concerned, but unaware of the freeze on the Joneses' insurance, inquired whether the insurance would cover her pregnancy. Sara first called Freitas, who confirmed that the insurance would begin on October 1, but did not know whether the insurance would cover Sara's pregnancy. Sara then called Patton. Although Patton knew that the Trust had frozen the Joneses' insurance, she did not mention this, Instead, she confirmed to Sara that the insurance would begin on October 1. However, Patton too did not know whether the insurance would cover Sara's pregnancy, so Patton referred Sara to Pellitteri of Administrative Services. Pellitteri confirmed that the Joneses' insurance would begin on October 1 and that the insurance would covert Sara's pregnancy. In early October 1997, after receiving confirmations from Janssen, the Trust, and Administrative Services that their health insurance would begin on October 1, the Joneses canceled their COBRA coverage.