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FMLA exhausted/Short Term Leave Pending

Discussion in 'Employment, Labor, Work Issues' started by Harr2503, Jan 20, 2010.

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  1. Harr2503

    Harr2503 Law Topic Starter New Member

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    I live in PA. I’ve been employed with my company for over 10 years. Six weeks ago, I took ill with a recurrent illness. The first day I was out from work, I advised my employer I would be using FMLA time. I also notified my employer every couple of days I was still using FMLA time. My condition is chronic and was previously approved for FMLA several months before this event. I am l not able to return to work as of today. 4 weeks ago, I called my employer’s occupational health department to advise I still needed to use FMLA time and it was noted. A few days ago, I received a call from my employer’s occupational health office stating I need to “request” short-term disability leave by submitting completed short-term disability forms from my physician. I was told to return the forms asap (forms were emailed to me that day). I received a letter in the mail today from my employer stating if the completed short-term disability forms are not received in 2 days, the short-term medical leave will be denied, and my "paid benefits" will stop. I have not received compensation for past 4 weeks because my paid days off were already used - and I did not expect to receive any income/ pay. The letter also stated my medical leave request was pending beginning the period dated 6 weeks ago (my first day out of the office). I thought I was using FMLA the entire time, NOT waiting for short term leave/income replacement since I never requested that type of leave. Please note, my fmla should be exhausted in a few days since I used time intermittently earlier last year for my condition. I am unable to get out to see my doctor this week (before the deadline) to get the forms completed since I'm still ill and can’t get an appointment for the next ten days.
    My questions: My health insurance benefits were still being paid by the employer to this date even though I wasn't receiving paid income. I’ve had medical visits while I was out from work and used prescription benefits for my meds as well. Can the employer make me pay premiums retro to the date 6 weeks previous? Also, since the short-term leave “request” will be denied in 2 days can my employer fire me? If I'm not fired right away and the paid benefits stop (according to the letter), can my employer cancel my health insurance right away? What are my rights under COBRA if I'm still officially employed and insurance benefits are canceled? I have medical tests and a minor procedure scheduled in the next week and need health insurance coverage.
     
  2. Harr2503

    Harr2503 Law Topic Starter New Member

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    I know the post above was very long and detailed. My apologies. In a nutshell, I'm just concerned about keeping my health insurance for upcoming medical tests/procedure in the next couple of weeks. Can my employer stop my health insurance while I'm still employed since I'm still away from work?
     
  3. Patricia_Young

    Patricia_Young New Member

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    How much FMLA time have you used?
     
  4. Harr2503

    Harr2503 Law Topic Starter New Member

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    I've used 12 weeks as of today. (since 2009)
     
  5. Patricia_Young

    Patricia_Young New Member

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    Then legally, your employment can be terminated. Because you were taking intermittent leave, I'm assuming you had kept up with the employee share of the medical, and now you're talking about the employer share?

    http://www.dol.gov/whd/regs/compliance/1421.htm

    Doesn't mean they necessarily will, but does mean, generally speaking, they can.

    Whether or not your coverage will end as of the day you are terminated is up to the policy itself. Some policies provide for immediate termination; some for coverage through the end of the month you're terminated. Only your HR person or the Plan Summary Description could tell you that.
     
  6. cbg

    cbg Super Moderator

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    If the employee is UNABLE to return to work at the exhaustion of FMLA, the employer may not charge him back for health care premiums. If he CHOOSES not to return to work, the employer may do so, but not all or even most exercise the option.

    When your insurance ends is determined by the wording of your policy. In my experience (30 years worth), about 50% of the time it ends on the last day of employment; the other 50% of the time it ends on the last day of the month in which your employment ended. Both are legal; both are common.

    ANY time your employment ends for any reason whatsoever with the sole exception of gross misconduct, you are eligible for COBRA. The employer/administrator have a combined total of 44 days after the last day of insurance coverage to send you the notice of your COBRA rights; you have 60 days from your receipt of the notice to make your election; you have 45 days from the day you make your election to make your first payment. The employer MAY cancel your insurance until he has received both your election notice and your first payment; however, the reinstatement will always always always without exception and by statute be retroactive to the cancellation date so that there is no gap in coverage. Any claims incurred during that time will have to be resubmitted, but there should be no trouble with processing them. Any insurance carrier will be familiar with the process.
     
    Last edited: Jan 23, 2010
  7. Patricia_Young

    Patricia_Young New Member

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    I sit corrected on the circumstances under which the company can charge back the employer share of medical premiums incurred during FMLA leave. I'll remember next time. ;)
     
  8. theretoo

    theretoo New Member

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    Hold on folks....EEOC....DISABILITY....to the OP, check your state disability laws and your company's LOA (Leave of Absence) policy for disability. Your employer must allow LOA (leave of absence) for a disability. Check your company policies on disability LOA. If they do not allow for LOA for disability (an EEOC protected class) then call your local EEOC office and or an employment law atty
     
  9. cbg

    cbg Super Moderator

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    No, you hold on and get off your hobbyhorse. Not all or even most illnesses for which FMLA would apply, qualify as disabilities under the ADA. Nor does the ADA require an unlimited leave of absence. A SHORT extension of FMLA CAN in SOME cases be considered a reasonable accomodation IF the ADA even applies, which is by no means certain. But there is no general requirement that ALL employers must grant an extended leave of absence for ALL disabilities under the ADA or any other law.
     
  10. Harr2503

    Harr2503 Law Topic Starter New Member

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  11. Harr2503

    Harr2503 Law Topic Starter New Member

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    Then legally, your employment can be terminated. Because you were taking intermittent leave, I'm assuming you had kept up with the employee share of the medical, and now you're talking about the employer share?


    My share of premiums were taken from my pay when I was working. However, I haven't received a pay for a while. But because I was able to have medical visits and fill prescriptions since I've been out from work I knew my coverage was still in force.

    Thanks for your response.
     

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