FMLA Claims Specialist Interview Questions
Q: Do I need to treat someone on FMLA the same as someone on workers compensation related to recovering health insurance premiums?
A: If an employee fails to provide a medical certification, the employer can delay or deny the FMLA leave. In other words, treat the employee per your normal policy when someone doesn’t show up to work.
A: If the employee does not return to work, an employer may not recover health insurance premiums from an employee taking FMLA and workers compensation concurrently. Also, an employer may not recover any non-health benefit premiums paid during a FMLA-designated temporary disability leave or workers compensation absence.
Q: What happens if the FMLA administrator misses a timeline or fails to provide a form?
A: The FMLA works on a no-harm no-foul principal. So if the employee doesn’t suffer any negative consequence from the employers delay or mistake, it’s probably going to be ok. That said, there may be risk associated with the non-compliance if the employee can show that it was harmed by the lack of notice or the skipped step in process. The adage “early is best, but better late than never” applies here.
Of all the issues HR deals with, FMLA leave probably causes the most headaches. Here’s some help with five common — and confusing — medical leave scenarios. 1. An employee needs follow-up treatments after surgery and asks to take intermittent FMLA — every other Friday afternoon. Do we need to let her leave early? For the most part, the answer’s yes, says Linda Hollinshead, an attorney with the law firm Wolf, Block, Schorr and Solis-Cohen. But you do have some options. After you get her medical certification, you can ask for a second opinion to make sure she really needs leave. Then, ask if there’s any reason she needs to get treated on Fridays — and have her give you verification from her doctor. If there’s no medical reason to take leave at those times, you’re allowed to ask her to schedule the treatments after work or on other days.2. We have an employee on intermittent FMLA. At first, his absences were sporadic, but now he takes off frequently, always on Monday or Friday. What can we do? Get recertification. Employers are allowed to ask employees on intermittent FMLA to get certified every 30 days — or at any time, if circumstances change, or the company has reason to think something fishy is going on. According to a Department of Labor Opinion Letter (available here), a pattern of Monday/Friday absences is enough to warrant recertification.3. To curb abuse, we have managers or HR reps call employees on leave to make sure they aren’t trying to use FMLA as a substitute for vacation time. Is that legal? Yes, says Hollinshead. That can be an effective way to prevent abuse, and courts have found policies like that to be reasonable. In fact, some companies have even gone as far as hiring a private investigator to watch an employee suspected of FMLA abuse and were able to win in court.4. One of our employees has a serious medical condition. We’ve offered him leave, but he refuses to take it. What do we do now? That depends on the nature of his condition. If he qualifies for FMLA, and the condition prevents him from doing his job safely — or he presents a risk to himself or co-workers — you can make him take leave. Otherwise, forcing leave could cause problems. In one recent case, a company lost in court after putting an employee on leave against his will. The court ruled his condition wasn’t serious enough to qualify for FMLA and the employee was still able to perform his job safely (Cite: Wysong v. Dow Chemical Co.). If you’re in a situation where you don’t need to put the employee on FMLA, make sure you document the fact that leave was offered and denied — that’ll come in handy if the employee later claims he was denied FMLA.5. What happens when an employee comes back from leave and can’t perform his job? There are a few questions you need to answer in that situation:
But as the law states, if he’s not protected by the ADA and can’t perform an essential job function, you have no obligation to reinstate him.
Bottom Line? The FMLA landscape is continually shifting and not always cut and dry. Carefully check as many resources as possible before granting FMLA leave and make sure your FMLA policies are up to date to reflect the most recent FMLA regulations. If a difficult situation arises without a clear answer, don’t hesitate to contact an attorney specializing in employment law.
According to the Employers Resource Association (ERA), FMLA, or the Family Medical Leave Act of 1993, ranked as its number one topic inquired by HR professionals to its HR Hotline last year. What makes FMLA so misunderstood? Here are answers to the 3 most commonly asked FMLA questions:1. Who is covered?
Prior to joining PrimePay, Jeff Price worked for an employee benefits brokerage firm. Every Friday for the next two months, he will be presenting a blog series on Human Resources, Benefits, and Health Care Reform.
Members may download one copy of our sample forms and templates for your personal use within your organization. Please note that all such forms and policies should be reviewed by your legal counsel for compliance with applicable law, and should be modified to suit your organization’s culture, industry, and practices. Neither members nor non-members may reproduce such samples in any other way (e.g., to republish in a book or use for a commercial purpose) without SHRM’s permission. To request permission for specific items, click on the “reuse permissions” button on the page where you find the item.
Adapted from The SHRM Essential Guide to Employment Law (SHRM, 2018), by Charles H. Fleischer, Esq.
Members may download one copy of our sample forms and templates for your personal use within your organization. Please note that all such forms and policies should be reviewed by your legal counsel for compliance with applicable law, and should be modified to suit your organization’s culture, industry, and practices. Neither members nor non-members may reproduce such samples in any other way (e.g., to republish in a book or use for a commercial purpose) without SHRM’s permission. To request permission for specific items, click on the “reuse permissions” button on the page where you find the item. Page Content
FAQ
Can an employee interview while on FMLA?
Is anxiety covered under FMLA?
Should I tell my boss about FMLA?
What leaders should know about FMLA?
