Full Disability benefits but 2nd job?

Hello all!

I am unsure of where to post this scenario so I am going to post here and in the benefits forum.

The situation is this:

An employee has been out of work on a leave due to radiation and chemotherapy treatment. The physician has indicated that she is completely incapacitated. She exhausted FMLA in 2003 as we are on a rolling calendar year, but we have extended her a "personal leave" for the time she is out. She has been out since January 2, 2004 and not expected to return until March. She is a salaried employee that receives "salary continuation" for the time she is considered ill/disabled. This pays full pay and benefits for up to 90 days.

It came to our attention by a co-worker that she is "moonlighting" at another clinic doing work on Mondays. Her supervisor followed up by calling the clinic and finding out that indeed she is. We do not have a non-compete policy and doing work like this is okay in our organization. I contacted the employee and she admitted that yes she is working 2-4 hours for this other clinic while she is out on disability. We talked about her coming back to her position working part time and she indicated that her physician would not allow her to do that at this time. Her regular position is too stressful and he thought she was doing better overall with just working at the smaller clinic and stood by his March return to our organization.

I am at a loss, I don't know where to go with this one? I am considering a second opinion, but because we are a healthcare organization it is frowned upon to second guess our own physicians.

She is being paid by this other clinic while at the same time being paid full time disability here? Can or should I require her to pay back the difference?

Any help or anyone that has dealt with a situation where a person has a second job please help! I have never had this happen, but I know I will run into it again!

Thank you - Kris

Comments

  • 6 Comments sorted by Votes Date Added
  • Do you have a full time 3rd party administrator for your disability? If so inform them and they can determine how much to reduce the payments by. Personally, if someone proves they are able to work, then I don't believe they should be collecting disability.
    I would probably be considered evil, but would not allow things to continue the way they are.
    My $0.02 worth.
    DJ The Balloonman
  • This gets even worse -

    We fund the salary continuation ourselves thru our own payroll department
  • I was kind of afraid of that. Well you need to read up on your policy and what constitutes qualifying for this benefit. My self I would reduce her benefit by 20% to start with. Then you have to wrestle with the decision do you want to send her for a second opinion.
    My $0.02 worth.
    DJ The Balloonman
  • We do not have a policy for salary continuation. Which I am sure that I will now be asked to write, but salary continuation is for a very small group of our total employees. Only our physicians, directors, VPs and Mid-level Providers are qualified. Everyone else is covered by a short term disability benefit that we as employees elect and pay for.
  • I think it has a lot to do with the way your policy is written, but I have a hard time believing that any policy would pay full benefits while allowing the employee to work at another job for whatever reason.

    I know there have beens some FMLA cases where it was found that an employee could work another job while maybe not being able to do the job that he was on leave from. It appears though that this person you are referring to is doing the same type job...just less days a week. She could certainly come back to you in this same capacity.

    I would check with the carrier about this. It seems she is making money off you!


  • I'm a little confused about your reference to placing her on a "personal leave". Is that leave the same as short term disability? If so, look to your plan document for that. We self insure our short term disability plan (up to 26 weeks over coverage) and we have included a statement that employee would jeopardize STD benefits if he/she was working another job while on STD. We have the same statement in FMLA policy, which courts have ruled is acceptable provided you restrict it for other types of leave (this doesn't pertain to your question but thought I'd throw it in!).

    If you don't have anything that specifically addresses this in your policy/plan document, you may not be able to prohibit it. I would go the route of sending the essential job duties and requirements to the physician for an updated status - are there requirements in your job that are different/heavier than those at the clinic she's working at? It's an odd situation to be sure.
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