Should benefits continue while on WC?

MelvilleNY · April 2004

We have an employee who has been out on WC for over 45 days. Can I offer him COBRA (reduction in hours) or must I continue to keep him on our plan (employer pays 75%)? Also, He has requested that we pay him all vacation time not taken. We do not pay out vacation till an employee terminates employment. Should I pay him out and/or can he collect vacation pay while on WC?
Thanks for your help.

jennifer jo · April 2004

There are some other questions Melville. We have a similar situation. I left the ee on the health insurance and told him that he needed to send in his share of the premium. Have you been in touch with WC? Do they have any idea how long he may be out? To me, the duration and severity of the injury would help me determine whether or not to put the ee on COBRA. I would not pay out vacation time not taken at this point. Since you don't pay out until termination, he should not receive his vacation pay. I'm pretty conservative when it comes to WC. Are you running his FMLA concurrent with his WC leave? Hope you get lots of posts...looking forward to opinions on this one!

System · April 2004

First of all, let me say I'm no WC expert. My only experience is a work-related volleyball injury (no kidding).

Maybe I'm missing something, but what's the downside to letting him use vacation time? You're going to pay him for it sooner or later, and I bet he can really use the money right now.

I'm also unsure about COBRA. When I settled my WC claim, the insurance company paid me for all the expenses I incurred. If I had to pay for health insurance while I was out of work, I would've asked them to reimburse me for that.

Then again, I'm no expert.

James Sokolowski
HRhero.com

Balloonman · April 2004

James, they would not have paid "your" portion of the premium. It would normally come out of your pay, but you get a check from your WC carrier instead of work so it is very reasonable to expect them to pay it.
My $0.02 worth!
DJ The Balloonman

njjel · April 2004

If you are required to offer FMLA and he is eligible, he should be on FMLA leave running concurrent with WC. Therefore, you would be required to continue his insurance for the 12 weeks as required (and he would be required to pay his portion of the insurance if that is your policy). COBRA should be offered at the completion of his 12 weeks of FMLA. If he's eligible, I would place him on FMLA today (you can't go back to his first day out). As far as collecting vacation pay goes, I would pay him.

Giants Junkie · April 2004

As suggested by Njjel, WC and FMLA run concurrently. If your company has at least 50 employees within a 75 mile radius, you are a covered employer under the FMLA. If this particular employee has been employed for at least one year AND has worked at least 1,250 hours during the year prior to the date of his injury, he/she is an eligible employee. Therefore, you must continue benefits coverage. Additionally, if you hadn't already designated his/her leave as FMLA, and because you cannot retroactively designate leave as FMLA, not only should he/she have had continued health benefits coverage since the inception of his/her leave, he/she will get another 12 weeks beginning the first day you designate it. And remember, that designation must be made in writing to the employee.

Re. the vacation payout, I would be sure to follow whatever practices or policies your company has followed in the past.

Good luck!

KP68 · April 2004

We recently had this same thing come up, and what we did is designate the time as FMLA, continued benefits for the duration of FMLA (obviously), and once that was over, we invoiced for the missed paycheck premiums. We gave the employee 30 days to pay in full, and will cancel benefits as of the end of the 12 week period if not paid.

If payment is submitted, we continue for up to 6 months from the first day out, as that is how we handle benefits for someone on short term disability. We try and keep it consistent.

SusanW · April 2004

Whenever an ee is eligible for FMLA and out on W/C we run the leaves concurrently. What does your plan document say about termination of coverage? That is what you must follow. We amended ours to term coverage after 15 wks of leave (disability and comp treated the same). They would then be eligible for coverage under COBRA. As far as vacation, according to FMLA, an ee may request (and employer may require) to substitute paid time for unpaid time. We require them to use vacation when on disability (1 day for every 2 days absence because disability pays 50% so 50% is unpaid) but can't require use of vacation while on comp because it is not unpaid. If they request vacation time we allow it but you should follow your policy.

Should benefits continue while on WC?

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