Doctor with conflicting information

Dfox · November 2003

We have an ee that applied for our short-term disability which also requires FMLA papers to be completed. The short-term benefit was denied by our carrier; however, according to the FMLA papers the employee should be on leave. We have requested a second opinion, and the ee scheduled it in three weeks. Of course, the manager is demanding more information, which will can not give her. What are our alternatives?

LindaS · November 2003

Have you asked the carrier WHY the benefits were denied? Before I would have the EE go for a 2nd opinion I would take a look at both sets of paperwork to determine why the carrier denied the benefits. Sometimes benefits are denied basic clerical errors. You also have the option of forwarding the FMLA paperwork to the STD carrier as supporting documentation.

Don D · November 2003

And, the fact that 'the manager' is 'demanding' more information is irrelevant. FMLA is handled solely in the HR arena, not by departmental managers. Tell her to cool her jets until you unravel the scenario.

awuta1 · November 2003

Normally, if an employee qualifies for STD, that employee also qualifies for FML; however the reverse is not necessarily true. If the employee's medical provider certifies the employee for FML, and your carrier has denied the employee STD benefits, you should grant the employee's FML and not pay the employee STD benefits. In other words, the employee would be on a non-pay FML. The carrier should have some type of appeal procedure. If so, the employee may then appeal the denial.

Doctor with conflicting information

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