FMLA
5560905
37 Posts
I have an employee who notified us on 3/22 that she had to have a cyst removed from her wrist and that she would need a leave of absence. We gave her the general FMLA packet with "Your Rights" and "Your responsibilities" and a Certificate of Health Care Provider. She last contacted us on 4/29/05 having had surgery on her wrist and stating she required surgery on her other wrist as well. She brought in the Certificate which stated she would be out 3 weeks after the second surgery. The diagnosis was bilateral carpal tunel. At no time did she infer that her condition was work related. Both surgeries and her follow up care have been paid for by our company sponsored health insurance plan.
Last week, we received a Notice of Mediation Hearing from State Worker's Comp office. I immediately completed a report and turned the matter over to our Worker's Comp carrier. We have had no control over her care, since she was treated as a "personal illness" case rather than worker's comp.
Her 12 weeks FMLA was up on 6/8/2005 and per our policies we are terminating her for failure to return or contact us requesting an extension of her leave time (our option per our policy). She has been sent COBRA information to continue her health insurance if she chooses.
I rarely have to deal with FMLA and have never had occasion where after the fact the employee claims a work related condition. Am I on solid ground here? Is there anything else I should do?
I tried calling the employee but got no answer.
Last week, we received a Notice of Mediation Hearing from State Worker's Comp office. I immediately completed a report and turned the matter over to our Worker's Comp carrier. We have had no control over her care, since she was treated as a "personal illness" case rather than worker's comp.
Her 12 weeks FMLA was up on 6/8/2005 and per our policies we are terminating her for failure to return or contact us requesting an extension of her leave time (our option per our policy). She has been sent COBRA information to continue her health insurance if she chooses.
I rarely have to deal with FMLA and have never had occasion where after the fact the employee claims a work related condition. Am I on solid ground here? Is there anything else I should do?
I tried calling the employee but got no answer.
Comments
Gene
We are facing a 5 year first report of an injury situation. We have no record of any report of injury and most of the employees directly associated with this terminated employee are gone. Our defense is only one statue of limitations, followed then by no record or ability to disprove his cause of injury from an accident. The passing out and hitting his head which now causes severe pain all across the back, shoulder, and arm is his claim. We do have one witness who remembers one day helping the individual up from the floor after passing out, which he claimed at the time was heat and after a short rest he was up and at it again. That is our manager's knowledge, so we hope the statue of limitations works.
PORK
(She lied if she said she was having a cyst removed.) Anyway, in this state I too would have terminated, because I can. If your state comp law suggests you cannot terminate a person who has a pending or active comp case, you'll have to reverse. Otherwise, let it sort out. Even if the carrier and physicians and comp board in LA collectively establish a work connection with the injury, she's still terminated and you'll only be stuck with the meds and comp payments through whatever period your comp lawyer convinces the board she would have been out of work had she remained employed.
I think you handled it correctly.
>years in private practice
Hey Gene, What type of private practice were you in?? I didn't know you had hung a shingle out!!!
As to 'why you would ever turn this in to your comp carrier', that happens to be the law here. If an individual represented by an attorney represents to the commission, through appropriate paperwork, that medical treatment and a medical condition previously handled as non-comp is in fact work related, the client's attorney prepares another set of paperwork, including interrogatories and subpoenas and sends that to either the company or its comp carrier. The comp carrier turns it over to their attorney who visits me and ties me up for weeks on end preparing to do battle before the commission to give evidence that the case is not comp. As I said, I have three of these ongoing at this time. So, it is not a matter of me 'turning it in to my comp carrier'. The legal process has done that. I'm just along for the ride as required by law.
Almost identically the same process ensues when the carrier denies a claim of work related injury and her attorney suggests to the commission that it is comp related.
You may now edit your post.
If you feel this is NOT work related, make sure you provide your w/c carrier as much information as possible to argue against the claim.
You also did the right thing to terminate according to your policy. I agree that if certain things play out you may have to reverse, but I would not do anything unless and until you have to. (I think the ground was solid when you made the decision, but that doesn't mean it won't shift later!)
PORK
Finally, the determination of whether or not the claim is wc and, therefore, who is responsible for the loss of time and medical expenses should be determined by the carriers and the wc board and not by me. I am merely the messenger.