Workers Comp and Cobra

Cat · April 2005

I have an employee on WC, FML, after the 12 weeks of FML is up, can I offer Cobra? Thanks in advance. If Cobra is an option, can you point me to some information?

HRinFL · April 2005

Why would you offer COBRA? Is the ee being separated? Has the ee continued to pay the insurance premium while oout on FMLA? I would think the only reason to offer COBRA is that the ee is not longer employed and therefore not elgible for coverage under your group plan.

Maybe some more information would help clarify your situation. Hard to give a helpful answer when the details are "fuzzy."

Cat · April 2005

Employee has been out 15 weeks with sprained ankle. I have called and left messages for him to get with me to work out plan to pay his portion of health and dental premiums. He does not call me back. Today I am sending letter asking him to please pay. Has been fiasco since beginning. He called me last Tues and said he was going to Dr the next day and was going to tell him he was fine (self diagnosis) and he would be coming to work this past Monday. He did not show up and hasn't returned my calls. I went online to La Dept of Labor and got a number for WC division and called. They said that I could offer cobra after the 12 weeks, but didn't know where to direct me to find info. So I am still looking.
There is just too much to write, I just wanted to know if anyone knew of anything in writing that said you can/cannot offer cobra after 12 weeks FML is exhausted if employee was out due to WC.
Thanks for your help!

POPEYE · April 2005

Unless there are extenuating circumstances (covered in our policies), when an EE exhausts all of their FMLA entitlement and any other leave that we offer, they are terminated and eligible for Cobra.

Your insurance broker or carrier Rep should be able to help you with the obligations of notification and offerings.

HRinFL · April 2005

I agree with Popeye. Since the ees had not kept up with the premium, has not provided any documentation to show he is either eligible to return to work or has reached MMI, I would terminate, and THEN send the COBRA letter.

pork1 · April 2005

WHOA NELLY; If I am reading the original post right this is a W/C--FMLA running concurrent, I believe until the W/C situation is resolved, that the employer would be required to keep all benefits constance. Given the shoe was on the other foot the W/C has been resolved and it is the FMLA condition that keeps the person out of the work force. When the dead end date for return has happened, then, we may, in accordance with our written instructions to the individual which placed the person of FMLA in the first place, decide to exercise our right of termination. Upon termination then we can offer COBRA.

You should have long ago been communicating with this and all other employees with "serious medical issues" by US Mail and return receipt required.

PORK

Cat · April 2005

I have been calling and leaving messages to please call to make arrangements to pay his portion of Ins. premiums. Then he called to say he would be at work Monday. No show of course. Now I have sent Certified letter to please make arrangements to pay insurance premiums that are in arrears or we will Cobra effective the end of this month due to non payment of his portion of premiums. The company that handles all our Cobra notices has informed me this is OK to do.

Whatever · April 2005

Do you have any rules about no show/not calling? If so, enforce them.

pork1 · April 2005

[font size="1" color="#FF0000"]LAST EDITED ON 04-19-05 AT 09:25AM (CST)[/font][br][br]CAT: Since this is a FMLA-Cobra running concurrent there should not be any premiums in the arrears. The payments are being paid by the employer and once the employee is returned to full duty capacity then the company can adjust his/her premium payments, accordingly, to collect the accumed portion plus the normal payment.

Last day of work and termination should be spelled out in your letter approving the FMLA and the termination date is the start date for COBRA and not the last day of the month. The reason being is that an employer does not want to keep a terminated person on the rolls for any benefit beyond the date required by law. If the x-ee does not pay the COBRA cost retroactively back to the termination date then the company is not liable for medical claims after the termination date. The last disability payment,paid by the company vs your medical insurance payment, if you have one, can be collected towards the pre-paid medical insurance payments that are in arrears.

These are the sort of issues that makes it favorable for the company to have FMLA/W/C running, concurrently. Our company due to a corporate decision does not run, concurrently, and that is a shame. I feel for your frustrations.

PORK

KP68 · April 2005

We ran into a situation not unlike this last year, and we were, at the time, running FMLA concurrent with any other leave that the employee would be eligible for - we still do.

We did, however, adopt a policy stating that as long as an employee was on an approved medical leave (whether short term disability or work comp), we would contine benefits for up to 6 months, at which time the employee would be offered COBRA - this all under the assumption that the employee was holding up his/her end of the bargain and submitting monthly premium payments to us.

We were advised by legal counsel to do it this way because we would not be treating employees on one medical leave different from another medical leave. All employees on medical leaves get their benefits for a max of 6 months.

National Guard · April 2005

I think COBRA rules allow for reduction in work hours as an qualifying event for COBRA. There are also provisions for non payment of premiums from your carrier, right? What has your carrier told you?

irenesmsaclaims · April 2005

No, actually, reduction in hours during a FMLA leave is NOT a qualifying event under COBRA. There are other threads about this subject. During other types of leave, possibly, but not FMLA. It's special. The COBRA QE occurs when the employee does not return to work after a FMLA leave or notifies the employer of his or her intent not to return.

You can also terminate coverage during FMLA leave if the employee does not make his or her premium contribution (as any other employee). Again, not a QE, unless there is termination of employment.

Workers Comp and Cobra

Comments