Group Insurance While on Workers Comp

Tapatio · May 2003

We have an employee who has been on disability leave due to a job-related injury for about a year now. Would we incur the risk of a retaliation claim if we were to terminate his group medical insurance, which we have been carrying all along up until now? We had another employee who was on FMLA and subsequent ADA-protected disability leave, not work related, whose group medical insurance we terminated after one year. Can we, or should we do the same thing with this other employee who is out on workers comp? Anybody with a similar experience?

Don D · May 2003

If you have a union contract, you must follow that. If not, you must follow your written policy addressing insurance benefits continuation and payment of premiums. In the absence of a policy, you should follow the precedent you have set earlier in similar instances. You must also follow the FMLA continuation laws assuming the person is concurrently on both comp and FMLA. Also check with your state specific comp laws as there is nothing Federal addressing that.

Balloonman · May 2003

I sit down employees that I know will be out for a long time and give them a payment schedule for their share of the premiums. I have been burned, and now let them know that the insurance company will terminate coverage for non-payment and they will be offered cobra if they do not make their portion of the payment.
My $0.02 worth.
DJ The Balloonman

Cap · May 2003

We are nonunion. When an ee has a reduction of hrs and does not qualify for FMLA or has used up the 12 weeks under FMLA, than I COBRA them for reduction of hours. It works well and is another incentive for the ee to get back to work.

lorrie · May 2003

Our employees pay a share of the health insurance premiums, and anytime they will miss a paycheck (FMLA, work comp, or any other leave) they must pay the company their share of the premium that would normally have been withheld from their check. I have a memo I give them ahead of time if they know they will be missing, so they are aware of how much and when they have to pay. The memo also reminds them that if they miss their payment by 30 days, their insurance can be cancelled.

If it will be a short absence (a couple of weeks) I will let them sign an authorization to withhold it from their next paycheck, if they don't want to pay it up front. This way it will still be pre-tax money. (Or in the case of 6 or more week maternity leave when they know far in advance, they can start having the premiums withheld from their paycheck early, so that it is taken care of before their leave and they don't have to worry about remembering to mail a check or coming up with the money.)

Eliant · May 2003

I will agree, if you're an unionized employer foloow the agreement. Otherwise, look at your policy and be sonsistent for everyone regardless of why they are out.

However, it has been my experience that the best thing to do in these cases is run work comp consurrent with FMLA, advise them in writing that they are responsible for their share of their premium. Thirty days before their FMLA runs out I remind them in writing that once their FMLA runs out they will be eligible for COBRA. This is an incentive for the employee to return to work.

If you follow the FMLA rule consistently you will avoid potential risk.

Do you belong to the California Chamber of Commerce, or Employers Group? Good source in CA for these types of issues.

Eliant

Group Insurance While on Workers Comp

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