Ineligible benefit claim not fraud, just a mistake: Arbitrator

Employee was unaware his wife couldn't claim coverage for safety glasses

An Ontario company did not have just cause to discipline a worker it suspended for using benefits coverage for his spouse, an arbitrator has ruled.

The worker was a dye-setter for Tenneco Canada, a manufacturer of exhaust systems for the automotive emissions control industry based in Cambridge, Ont. As part of the collective agreement between Tenneco and the union, employees and their families were entitled to a vision care plan that covered prescription glasses and laser surgery. Employees were also entitled to coverage for prescription safety glasses, but this benefit was employees-only and not for their families.

In late 2013, the worker was on medical leave recovering from surgery when his wife asked if she could make a claim on his vision care plan for prescription safety glasses. The worker called the human resources department to verify if this was allowed, but he was unable to reach anyone. He contacted the union and asked about getting the form for prescription safety glasses, but he failed to mention they were for his wife.

The worker’s wife picked up the form at the union office and noticed it had the worker’s name typed into the appropriate field. She crossed it out, entered her own name and proceeded to purchase the safety glasses.

Soon after, Tenneco received an invoice for $77.50 for the prescription safety glasses with the worker’s wife’s name on it. The human resources department noticed the invoice wasn’t for an employee and contacted the optometrist who processed the order. The optometrist confirmed the glasses were not for an employee but were for the worker’s wife.

Tenneco met with the worker, who denied making any changes to the claim form and hadn’t actually seen it. He acknowledged his wife had submitted the claim and offered to reimburse the company for the expense. However, Tenneco suspended the worker for three days without pay for “attempting to defraud the company of a safety glass benefit that is for employees only.”

The union grieved the suspension and the worker claimed he didn’t know his wife altered the claim form or that she wasn’t covered for prescription safety glasses. He admitted he didn’t fully understand the benefit entitlement but testified he would never jeopardize his job or his record for a small amount such as the value of the safety glasses.

Tenneco said it was the worker’s responsibility to know his benefit plan and should have inquired about his wife’s eligibility before letting her make the claim. The company argued it should have been obvious it wouldn’t pay for safety glasses that would be used at another workplace.

The arbitrator believed the worker’s claim that he didn’t actually see the form and wasn’t aware his wife had changed the name Though he was aware his wife was making a claim for glasses for herself, his apology and offer to reimburse the company mitigated any misconduct, said the arbitrator.

“If the (worker) took steps to cover up his actions or subvert the watchful eye of the employer, my view of (his) behaviour might be different,” said the arbitrator. “There was no attempt to hide who the prescription safety glasses were for.”

The arbitrator found the worker's explanation that he thought his wife was eligible for the benefit and he didn’t think to inquire about it was acceptable and the lack of coverage for family members for safety glasses wasn’t as obvious to him as it was for the company. Once he learned of his mistake, the worker in good faith offered to pay back Tenneco the cost of the safety glasses. The incident may have been the result of poor judgment, but not cause for discipline, said the arbitrator.

Tenneco was ordered to rescind the suspension and compensate the worker for lost time. See Tenneco Canada and USW, Local 2894 (Teska), Re, 2014 CarswellOnt 15539 (Ont. Arb.).

Latest stories