Worker's Compensation and continuing benefits - not FMLA eligible

I have an employee who recently went out on worker's compensation repetitive strain injury and her provider (our carrier's MPN) has had her off work for almost a month.  The employee had previously returned from an extended maternity leave, allowed to surpass the FMLA time frame, and returned to work in early April. The employee has no accrued time to cover her time off; the carrier is delaying claim for 90 days and only allowing medical costs as they are investigating, so she is on unpaid leave.  For unpaid leave, our employees are not covered by our benefits.  I assume she will be applying for SDI (state disabilty insurance) through our state, California.

 If she was eligible for FMLA, we would place her under that protection while on workers comp. leave, but she is not since she exhausted her leave in early spring.

Are we required to provide medical benefits due to the worker's compensation claim or can we move her to COBRA at this point since she is not under protected leave?

 Thanks for any advice...


  • 2 Comments sorted by Votes Date Added
  • Hi Bucky,

    You would not be required to provide benefits since the employee is no longer protected under the FMLA. However, by no longer paying for an employee's benefits this may be taken into account with your States' W/C program in determing the benefit amount which may in turn affect your experience rating. I would contact the California W/C department to determine the effect of removing the employee from your benefit plan. You can always be more generous than necessary to employees if you desire by paying for benefits (and if the insurance company will allow an employee to stay on the plan while he/she is on a LOA) I think an important piece would be that you would handle all cases such as this in a consistent fashion - offering every employee in this situation the same benefits. Hope this helps...

  • Be very cautious about saying that you are not required to keep the individual covered under your group health plan just because their FMLA has exhausted.  W/C laws are equally as protective of employees.  You want to be very careful, especially in California, that you are not doing anything which may come across as retaliation or you just may end up in  long and grueling litigation.  I suggest asking your legal counsel how to appropriately handle this situation.
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