april 26, 2011 © 2011 morningstar health, inc. all rights reserved. occupational services...

April 26, 2011April 26, 2011

© 2011 MorningStar Health, Inc. All rights reserved.

OCCUPATIONAL SERVICESOCCUPATIONAL SERVICES

““Employer Advisory Council”Employer Advisory Council”

BEST PRACTICES IN FMLA BEST PRACTICES IN FMLA ADMINISTRATIONADMINISTRATION

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Presented by:Presented by:

Gail Scott, Gail Scott, PartnerPartner

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BEST PRACTICES

1. Not foreseeable: incapacity must occur first

2. Foreseeable: Employee must give 30 days notice, or as soon as practicable (defined as within 2 business days of the employee learning of the need for leave)

3. Mark due dates on FMLA Medical Certification form (Do not allow employees to download Med. Cert. forms from the D.O.L.’s website or from your intranet.)

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4. Do not allow late filing of claims UNLESS extenuating circumstances exist

5. § 825.115 Continuing Treatment:

Incapacity & Treatment – A period of incapacity of more than 3 consecutive full calendar days (1st visit to HCP must occur within 7 days of 1st incapacity. Requires another visit within 30 days of 1st incapacity, unless regimen of treatment under supervision of HCP.

BEST PRACTICESBEST PRACTICES

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Chronic Conditions

- “Periodic visits” - At least 2 visits to HCP a year.

Care of New Child – one continuous block of time only (not intermittent or partial day)

6. § 825.305(c) Complete & Sufficient Certification – If information is missing on Med. Cert. – Employees needs to “cure”. Provide in writing with due date (7 calendar days), be specific.

BEST PRACTICESBEST PRACTICES

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7. Elective or preventive health procedures usually NOT covered (unless an overnight hospital stay or medical complications that then met another definition of the Act for a serious health condition): Dental exams Annual physicals Lasik surgery

BEST PRACTICESBEST PRACTICES

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8. Physician to Physician clarification preferred: Med. Cert. is vague or ambiguous

Medical release must be signed. If employee refuses – can deny claim.

Contacting of the healthcare provider is permissible by another health care provider, a human resources professional, a leave administrator, or a management official. Can NOT be employee’s supervisor.

BEST PRACTICESBEST PRACTICES

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BEST PRACTICESBEST PRACTICES

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8. (cont’d): Serious health condition as defined by DOL?

Duration (when to when)?

Frequency (times per week/month)?

Length of Incapacity (partial day, full day)

§825.307(a) - If questioning authenticity…employer can contact healthcare provider’s office WITHOUT a medical release (e.g., verifying signature, information on form has not been altered, etc.)

Contacting of the healthcare provider is permissible by another health care provider, a human resources professional, a leave administrator, or a management official. Can NOT be employee’s supervisor.

May conduct a Second or Third Opinion if validity of leave is questioned.

9. Authenticity Questioned9. Authenticity Questioned

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10. Recertification if (occur during a previous approved FMLA leave): Pattern of absences (exceed anticipated duration,

frequency or length of incapacity) Monday, Friday or before/after Holiday absence

pattern Provide employee new Med. Cert form with due

date, mark “recertification”. Advise employee that all future absences for his/her

health condition are now “provisional” until re-certification process is completed & determination is made.

BEST PRACTICESBEST PRACTICES

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11. New Certification (annual) – Starts with date of first incapacity AFTER last certification expired.

12. Tracking FMLA Recommend “roll-back” method Run concurrent with Short-term Disability

AND Workers’ Compensation Multiple FMLA Certifications:

- Require employee to designate which certification s/he is taking time off work for

- Track time off by individual certification

BEST PRACTICESBEST PRACTICES

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13. Require employees to schedule doctor’s appointment, physical therapy, etc. outside of normal work hours if possible If employee can not schedule time away from work

outside of his/her normal workday, then you may transfer him/her to a job of equal pay & benefits (provided does not violate labor agreement)

14. Enforce absence reporting rules

15. BEFORE termination of employment Review employee’s record & time applied to

FMLA

BEST PRACTICESBEST PRACTICES

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Medical Certifications Submitted: 68% Approved (some individual claims

appear in both categories below) 26% were modified changing the D.O.L.

category 58% were limited by reducing the length

of the leave or specifying the number of occurrences

23% Denied No qualifying absence Not a qualifying serious health condition Withdrawn by employee Lack of employee response

9 % Pending

YEAR 1 - OutcomesYEAR 1 - Outcomes

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% Non-concurrent Hours to % Non-concurrent Hours to Total Work HoursTotal Work Hours

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YEAR 1 - OutcomesYEAR 1 - Outcomes

45% reduction in lost work hours (~17,000 reduced to 9,298)

2.1% of total work hours to 0.8%$256,230 labor cost savingsROI: $6.11 : $1:00

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YEAR 1 - OutcomesYEAR 1 - Outcomes

How does $256,230 in expense savings equate to sales (revenue)? Illustration purposes only:

If a company had a 10% profit margin, the amount of sales that would need to be generated to achieve the above savings would equate to:

$2,562,300.

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CASE STUDIESCASE STUDIES

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Case Study #1

BOB BUMMER

You transfer an employee to a job he does not like. He asks you why you can not have someone else do the job. You explain why. Fifteen minutes later he tells you he is leaving because he has a “migraine”. He has done this before. He does have an approved intermittent claim for migraines.

Q: What action should you take?

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Case Study #1 - Solution

The FMLA states that the employer shall inquire further of the employee in an effort to determine whether an FMLA absence is potentially qualifying. When an employee reports to you that they are leaving early and using their FMLA, you should ask (be sympathetic): Is he going home or going to see his doctor Document suspected misuse & contact HR Remind employee to [follow your normal leave

early procedures] & call the call-in line to report leaving early.

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Ted Toolate Ted has had an attendance problem for some time. In February, he receives verbal and written warnings for his absenteeism. On March 4, he receives a final warning for absenteeism. On March 6 Ted is absent and applies for FMLA. He is approved for Category 6 - Multiple Treatments for his gout (e.g., doctor appointments) for the next 12 months. In April and May Ted reports to work late nine times for his “gout”. What options does the company have?

What if Ted’s absences for non-FMLA approved reasons resulted in him being subject to discharge. What should you do or not do before you terminate his employment?

Case Study #2

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Case Study #2 - Solution

1. Supervisor & HR meet with employee

2. Advise employee you are going to require a “Recertification” & that all absences from this point forward are classified “provisional”.

3. If FMLA recertification results in absences not qualifying, and employee is subject to discipline….make sure entire record is reviewed before termination.

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Pam Painer Pam has missed 4 separate days in the past 3 weeks and has called in “not feeling well”. She has used the Call-in line and just selected “illness”. She did not request FMLA. This morning you overheard her telling another employee that she’s been missing work because her back has been killing her. What should you do? Is “pain” covered under the FMLA?

Case Study #3

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What should you do?- Meet with employee in a private area. Address what you

overheard in a caring way and indicate it is not your intent to pry.

- Advise her that this could be an FMLA qualifying condition.- Follow your internal process for employee FMLA requests- Document your conversation.

Is “pain” covered under the FMLA?- No, if it is just “pain”. Yes, IF employee has seen a Qualified

Healthcare provider, there is a regimen of treatment AND there is incapacity that meets the definition of a serious health condition

Case Study #3 - Solution

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QUESTIONS

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Gail ScottGail ScottMorningStar Health, Inc. MorningStar Health, Inc.

(616) 308-5567 or (616) 942-9050(616) 308-5567 or (616) 942-9050gail.scott@morningstarhealth.biz

THANK YOU!THANK YOU!

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