Denied STD in MVA w/ FMLA implications. Need Insight!

hhaynal

Have an employee who was involved in MVA six weeks ago. We are self-funded in STD plan with a 3rd-party administrator. Pending medical paperwork, employees are generally paid first two weeks pending approval of STD claim by 3rd-party admin. STD claim denied due to MVA resulting from DUI. Since 3rd-party admin has medical records, we have no way to verify employee's absence for last 6 weeks is an "approved absence." Approved "claims" are automatically "approved absences". However, in this situation, since the STD claim was denied, absent any medical records, the company has no choice but to put absence on the books as unapproved. We are seeking to contact employee to get a release for purposes of getting records from medical provider, or in the very least, asking employee to submit doctor's note covering absence. The third-party admin will not release records without employee release, and since we are getting release, we might as well go directly to medical provider.

Anyway, has anyone come across a situation like this before? And if so, any easier way to address? Also, if you saw my post on the FMLA link, this is the situation in which it was brought to my attention that this particular employee was not provided the FMLA letter package since the time off was related to the employee and not for family member. I would think that if the FMLA package was sent, we would be in a better position now to request medical qualification and expected return date.

Don, you are pretty savvy in this arena, care to offer your thoughts?

SMace

I would not request the employees medical records from his doctor. That will do more harm than good.

I would send him FMLA paperwork. You could ask for a doctor's note in the meantime if you like, but I don't think it's necessary. If he does not return the FMLA paperwork, follow your attendance policy.

You need to get a handle on how you administer FMLA. Start it off right with this guy.

bsa

The easiest way to address absences involving ee long/short term illness would be to give them a medical certification form for FMLA at the start of the absence. As this issue stands right now the ee has been off work for 6 weeks and still has 12 weeks FMLA available. If the ee is off work due to a serious medical condition (certified by his doctor), then he has the right to the job protection of the FMLA. Approved or unapproved STD, DUI or not, has no bearing whatsoever on FMLA rights.

Brad Forrister

I agree with bsa. The STD approval doesn't enter into it, the DUI doesn't enter into it. It's purely a question of whether it's a FMLA-qualifying absence. And you can't apply it retroactively.

If it is truly DUI, and if he ends up serving jail time for it, you could take action under your attendance policy. But not for FMLA-qualifying absences.

Brad Forrister
VP/Content
M. Lee Smith Publishers

hhaynal

Again, thanks for the input. Brad, I thought I read a case that came out about a year ago that in essence said (I'm paraphrasing here) an employer can start the FMLA clock ticking when it becomes known to it of an FMLA event. Such an event could be the filing of a STD claim since usually disabilities qualifying under STD are generally events qualifying as an FMLA event. In further support of starting FMLA clock was employer's policy indicating FMLA runs concurrently with any STD leave.

But, I agree, our monitoring FMLA leave is sloppy and I need to get a firmer handle on it.

Thanks again, all!