Refuses To Comply

rhammett

Recently, an employee had blocked artery heart surgery. FMLA paperwork was initiated and sent to this employee over 45 days ago. As of yet, I have not received the Certification of Health Care Provider. It plainly states that the certification does need to be returned within 15 days. I did call ee to remind him of the paperwork; his wife told me that he had been released by his doctor that had initially filled out the paperwork and that is why it had not been returned. But, he had not been released from his cardio doc. I sent the ee new Health Care Provider paperwork to be filled out and returned, but have not received anything yet.

Since his leave is not validated at this point, can we now assign COBRA? As a company that has self-insured health benefits, can we pend any insurance claims until it has been determined what the intentions of this employee is, whether this individual is coming back or whatever?

Down_the_Middle

I be cautious about messing with his current medical bills, cuz he'll likely either keep his current coverage or convert to COBRA. Suspending the payment process may tangle things tremendously. Pending his claims will create friction from the providers who rendered the service and will probably come back to haunt you if the employee later claims that his employer froze health payments, which led to him being billed by the providers, which may not be according to your plan design, which may result in a collection agency........... I appreciate your desire to leverage him by doing this, but I'd go about it diferently.

The issue appears to be...FMLA or no FMLA. Your current policy should dictate how you proceed with failure to return the paperwork. Personally, I'd place him on non-FMLA and inform him his job is not protected, he may be in violation of other policies you have and handle it that way. Messing with his medical bills seems too extreme for me to consider.

Margaret Morford

I agree with the answer above, but I do believe you can leverage this somewhat. Send the employee a registered letter with a new packet of paperwork and advise him that his job is not protected (as was suggested above). While I wouldn't assign him to COBRA, you might also tell him that if you don't get the paperwork back within 7 days, you will have to notify the insurance carrier/third party administrator that he may need to be assigned COBRA status, that you are very concerned about this as COBRA status could result in delaying or nonpayment of his bills. This should get the paperwork done and that's all you really want to have happen. Good luck!

Margaret Morford
theHRedge