FMLA / Workmans Comp

mrsbowden

I have a situtation and would like some opinions. The situation is very confusing, but here goes.

On Aug.4th HR was notified that an EE had been off work since July 29th. On Aug. 21st he/she was sent a Certified letter notifying that he/her had meet the minimum requirements for FMLA and had 15 days to submitt a 380 form and respond to the letter or FMLA would be delayed or possible not count toward FMLA. (I realize the time between the notification of her/him being off and the FMLA notice is TOOO long but there is nothing I can do about that my superiors decide when things are ready to be sent!)

So on the 15th day a medical certification was submitted by a family member, and that person also informed us that the EE was applying for workmans comp. ????
Which obviously was a shock to us, since we don't have an incident report to verify a work related incident???

There is a letter in legal review at this time stating that we are granting FMLA b/c the medical certification deemed it necessary back dating his FMLA alottment to July 29th (the EE first day off)

Here is the catcher...this EE is 2 benefit payments behind, due to not recieving a paycheck, that benefits are taken from. In the next few days this EE will be 3 benefits payments behind (more than likely before he receives the letter) So, we are basically giving them a timeline to make the back payments and giving him the option to use his/her sick/vac time (for pay and to go toward those benefit payments) or they will be cancelled.

Also in the letter there is verbage stating should he/she received workmans comp. he/she would need to repay the company back for any sick/vac time paid to them should wk. comp go back and pay him for it. And should he return to work his Sick/Vac. time will be reinstated to him.

I was hoping to get some thoughts on this. x:-/

LindaS

As far as insurance premiums, my understanding of FMLA is that you CANNOT terminate an EE from the plan as long as they are on approved FMLA leave. The employee has three options regarding payment of premiums...1) payment of premiums before they go on leave (when leave is planned, obviously), 2) payment of premiums as they are due while they are on leave, or 3) repay their premiums after they return from leave. This is the EMPLOYEE'S option, not yours. I don't agree with it but it's what we have to do.

The statement regarding repaying time off can be tricky - I have had to go through this and it's not fun but it can be done.

Also notify your W/C carrier that you have questions regarding the validity of the claim and have them do a complete investigation.

Good luck.

cthr

You can't just cancel an employees benefits while they are on FMLA. You have to set up a schedule with them if their premium normally comes out of their check. Below is the verbiage from the FMLA certification.

5. (a). If you normally pay a portion of the premiums for your health insurance, these payments will continue during the period of FMLA leave. Arrangements for payment have been discussed with you and it is agreed that you will make premium payments as follows: (Set forth dates, e.g., the 15th & 30th of each month, upon the employee’s return to work, etc. that specifically cover the agreement with the employee.)


(b) You will have a minimum 30-day grace period in which to make premium payments. If payment is not made timely, your group health insurance may be cancelled, provided we notify you in writing at least 15 days before the date that your health coverage will lapse, or, at our option, we may pay your share of the premiums during FMLA leave, and recover these payments from you upon your return to work. We 0will 0will not pay your share of health insurance premiums while you are on leave.
(c)
(d) We 1will 0will not do the same with other benefits (e.g., life insurance, disability insurance, etc.)
while you are on FMLA leave. If we do pay your premiums for other benefits, when you return from
leave you 0will 0will not be expected to reimburse us for the payments made on your behalf.

jampc

So then, if you as the employer pay 100% of the health insurance costs for your employees, then you are required to do so during FMLA leave?

juju

Yes. You are required to maintain your contribution, regardless of the percentage.