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Question about Benefits While on WC Indiana

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  • Question about Benefits While on WC Indiana

    Facts:
    • Employee found a pedestrian collapsed in the street and attempted to pick them up on company time. In doing so, injured themself.
    • The Employee has been restricted from all work for three (3) months.
    • The WC adjuster has no tentative return to work status/schedule/date.


    With the above given information, what is the maximum amount of time an employer may leave said employee on payroll and maintain empolyee's benefits?

    Thank you in advance

  • #2
    Does FMLA apply?
    I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

    Comment


    • #3
      Has the employee worked for employer at least 12 months (do not have to be
      consecutive);
      Has the employee worked for employer for at least 1,250 hours in the 12 months
      immediately preceding the leave;
      Does the employee work at a location with 50 or more employees within a 75-
      mile radius?

      Thanks.
      Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

      Live in peace with animals. Animals bring love to our hearts and warmth to our souls.

      Comment


      • #4
        The MAXIMUM amount of time is whatever the employer (and the plan documents for the various benefits) decide.

        The law determines MINIMUM times, but not MAXIMUM times.
        The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

        Comment


        • #5
          Agree. If FMLA applies, the employer must allow the employee to take up to 12 weeks of unpd. job protected leave per 12 month period. However, an employer can always allow additional time off.
          Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

          Live in peace with animals. Animals bring love to our hearts and warmth to our souls.

          Comment


          • #6
            Follow Up

            Everyone is on the same page with my understanding, I just needed to verify the notion.

            Also, a policy question: If an employer pays 100% of health insurance - if one remains full time - and is out on a leave; who would pay the premiums? I was recently asked this question and I really do not know, because the employee hasn't worked for 3 months, however, the employer is still paying 100%.

            Finally CBG, what is the minimum time mandated?

            Comment


            • #7
              There is no minimum time either, unless either (1) FMLA applies or (2) your state has some specific requirement for w/c situations.

              The policy question depends on whether FMLA applies as well. For the duration of FMLA, the employer pays the premiums (since they pay 100% of premiums when the employee is working - if the employee paid a portion when they are working, they would continue to pay that same portion while on FMLA). If FMLA does not apply, or if FMLA has expired, then it depends on company policy and/or the definition of an eligible employee in the plan document.
              The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

              Comment


              • #8
                Is there any laws regarding the retro of FMLA (i.e. they were out 3 months ago); therefore, would have exhausted 12 weeks.

                Or

                If we start FMLA it needs to start now?

                Comment


                • #9
                  Okay, let's establish whether FMLA even applies first. Betty asked you several questions a few posts ago; you need to answer those.
                  The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

                  Comment


                  • #10
                    There is a site here http://www.ppspublishers.com/articles/fmla.htm that will help answer many of your questions about the WC/FMLA/EEOC overlaps
                    1. How are leaves covered under the FMLA and workers’ compensation statutes and how much time off is required?
                    2. When is a WC injury covered under the FMLA?
                    3. Should WC leaves be treated separately from other types of leaves?
                    4. Should the employer give the employee any special notification under the FMLA?
                    5. Does an employer have to pay for health insurance for an employee on WC leave?
                    6. Can an employee on WC leave be required to use vacation or sicK leave?
                    7. If the employee is released to light duty, can he be required to return to work?
                    8. Does the employer have to reinstate an employee returning from a WC leave?
                    Prevent Legal Headaches: Count WC Leave as FMLA
                    You two specific questions are answered as
                    4. Should the employer give the employee any special notification under the FMLA?In order to deduct the time spent on WC leave from an employee’s annual FMLA leave entitlement, the employer must notify the employee in writing that the WC leave is designated as FMLA leave and will count against, and run concurrently with, the employee’s 12-week entitlement. The notice to the employee must detail the specific obligations of the employee while on FMLA leave and explain the consequences of a failure to meet these obligations. Most employers use the Department of Labor’s Form WH-381 to comply with these notice requirements. If the employer does not provide the notice, it cannot count the WC leave towards the 12-week FMLA entitlement. Therefore, the employee may be entitled to an additional 12 weeks of FMLA leave at a later date.

                    If the employee has been on WC leave without being placed specifically on FMLA leave, the employer should send notice to the employee immediately so that the FMLA clock starts running. However, the employer may then only designate the leave from the date written notice to the employee is provided. It cannot retroactively designate the time spent on WC leave against the FMLA entitlement.

                    5. Does an employer have to pay for health insurance for an employee on WC leave?
                    If the employee qualifies for FMLA leave and the employer normally pays for health insurance, the answer is yes. Although most state WC laws do not require employers to pay for health insurance during a WC leave, the FMLA requires the continuation of health insurance benefits during an FMLA leave. Typically, the state WC laws cover the employee’s medical costs related to the work injury but do not mandate continued coverage under, or payment for, a health insurance plan. However, under the FMLA, employers must provide the same health benefits during an eligible employee’s FMLA leave that it would have provided if the employee worked throughout the leave. Thus, if the employer normally pays 80% of an employee’s health benefits premium, it must continue to do so during the employee’s FMLA/WC leave.
                    (underline emphysis added.)

                    Is there any laws regarding the retro of FMLA (i.e. they were out 3 months ago); therefore, would have exhausted 12 weeks.

                    Or

                    If we start FMLA it needs to start now?
                    No 'retro' FMLA... begins on notice to the EE/IW.

                    Comment


                    • #11
                      Ummm - before making that statement too strongly, go back and read Ragsdale v. Wolverine, a SCOTUS case from 2002. Ragsdale states quite clearly that as long as the employee received all the time entitled to them and was not harmed by the lack of notice, the lack of notice does NOT entitle the employee to an additional 12 weeks.
                      The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

                      Comment


                      • #12
                        As far as medical insurance is concerned, you need to check with your summary plan description to see how long an employee can be covered while out of work. Ours allows us to keep an employee on for 12 weeks max if they arent working. So, if we extend time past the end of FMLA, we cant keep them on our plan and they have to go to COBRA.

                        I know some have suggested bringing the employee back to work for one day to reset the clock and allow 12 more weeks coverage but that is not something I want to consider.
                        I find that the harder I work, the more luck I seem to have.
                        Thomas Jefferson

                        Comment


                        • #13
                          Originally posted by cbg View Post
                          Ummm - before making that statement too strongly, go back and read Ragsdale v. Wolverine, a SCOTUS case from 2002. Ragsdale states quite clearly that as long as the employee received all the time entitled to them and was not harmed by the lack of notice, the lack of notice does NOT entitle the employee to an additional 12 weeks.
                          Agree with cbg. If the time qualified as FMLA time & the employee was not harmed
                          by lack of notice, there is no add'l. time the employee is entitled to if they used all
                          their FMLA time.

                          However, in this case, OP never came back & answered my questions to know if FMLA applies here or not.
                          Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

                          Live in peace with animals. Animals bring love to our hearts and warmth to our souls.

                          Comment


                          • #14
                            Originally posted by Betty3 View Post
                            Agree with cbg. If the time qualified as FMLA time & the employee was not harmed
                            by lack of notice, there is no add'l. time the employee is entitled to if they used all
                            their FMLA time.

                            However, in this case, OP never came back & answered my questions to know if FMLA applies here or not.
                            I apologize Betty3; yes, the employee is eligable to receive FMLA and should have been on FMLA 3 months ago.

                            Comment


                            • #15
                              Then I strongly recommend that you review the SCOTUS case referenced above.
                              The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

                              Comment

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