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Family Medical Leave Act (FMLA) How Do You Manage It Disability Management Solutions.

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Presentation on theme: "Family Medical Leave Act (FMLA) How Do You Manage It Disability Management Solutions."— Presentation transcript:

1 Family Medical Leave Act (FMLA) How Do You Manage It Disability Management Solutions

2 Introduction The CareWorks Family of Companies More than 900 Ohio-based associates delivering customer- focused cost control services 180,000 business customers with a 98 percent annual customer retention rate.

3 Family Medical Leave Act (FMLA) Enacted in 1993 Congress “it will be a simple program to administer” Provide job protection for time off work due to your own illness or to care for a family member The act confers certain rights to employees Job protection- Unpaid leave Health insurance premiums paid-Employer pays their portion Guaranteed reinstatement Protection from retaliation claims History of FMLA

4 Military Family Leave-Signed into law 1/28/2008 Qualifying Reason for Leave Eligible employees are entitled up to 12 weeks of leave because of an exigency arising out of the fact that spouse, son, daughter, or parent of the employee is on active duty or has been notified of an impending call to active duty status in support of contingency operation Up to 26 weeks of leave in a single 12 month period to care for a service member. An eligible employee who is the spouse, son, daughter, parent, or next of kin of a covered service member who is recovering from a serious illness or injury sustained in the line of duty Changes in 2008 and 2009

5 Eligibility Employer must have 50 or more employees within 75 miles Employed for at least 12 months by a covered employer Worked at least 1250 hours of service during the 12 month period immediately before the leave started.

6 Eligibility The Family Medical Leave Act of 1993, known as FMLA, is a federal law allowing eligible employees of a covered employer to take job-protected leave, for up to a total of 12 work weeks in any 12 months for: Birth of a child. Adoption & foster care. Care of a spouse, child, or parent with a serious health condition. Your own serious health condition. Care of a spouse, child, parent or next of kin with a serious injury or illness incurred or exacerbated within 5 years of active duty in the Armed Forces (up to 26 weeks). Qualifying exigency arising out of the fact that a spouse, child or parent is on active duty in the Armed Forces or is deployed to a foreign country

7 FMLA as a Benefit? FMLA Statute and regulations make clear that FMLA is not intended to be an additional 12 week leave entitlement stacked on top of an employer’s existing leave policies. Neither the employee or the employer can “waive” or “trade off” their rights under FMLA.

8 Who is responsible? The employer is responsible for designating time off work as FMLA and informing all employees of their rights under FMLA. General notices-Posters Employee handbook Notice of rights and responsibilities given when leave is requested Designation notice- When leave is designated as FMLA The employee is responsible for providing medical certification by a health care provider, supporting the need for leave due to a serious health condition

9 FMLA Non-Compliance Costs According to the Society for Human Resource Management, the average cost to defend a FMLA lawsuit is $78,000, regardless of the outcome. Employees who successfully sued for wrongful termination based on FMLA Absence received on average between $87,500 - $450,000 in damages. (Source: EEOC) According to the U.S. Department of Labor, managers and supervisors can be sued directly and held personally liable for paying damages (Shultz v. Advocate Health & Hospitals Corp.). FMLA: The Cost of Absences

10 $760,000 every year in payroll costs due to unscheduled absences. *** Overall direct costs of FMLA nationally was $21 billion.*  Lost productivity due to FMLA cost employers $4.8 billion in profit.  Employers paid $10.3 billion to replace workers who took FMLA and paid $5.9 billion in healthcare coverage for employees on FMLA. Costs of unscheduled absence plans (sick leave, Short and Long Term Disability, salary continuation, workers’ compensation) can add up to 4.4% of payroll. ** The most common method of covering unplanned absences is OVERTIME WORK. ** Workflow disruption was also cited as a concern by employers. * FMLA: The Cost of Absences *Statistics by Employment Policy Foundation Analysis on 04/19/05. **Fourth Annual Marsh/Mercer Survey of Employers’ Time-off and Disability Management Programs. ***Commerce Clearing House (CCH) Unscheduled Absence Survey.

11 Break

12 Address three primary challenges employers face. Administrative Issues Compliance Issues Employee Issues How do you manage it? Decrease costs associated with absences.

13 Coordination of policies – avoid “stacking.” Better tracking of who is off work. Accurately capturing lost work days. Decentralized information. Definitive Roles – who handles what? Staffing concerns – leave taken with little or no notice. Return to work coordination. HR personnel with multiple responsibilities. Administrative Challenges

14 Consistent claims handling. Meeting timeframes for notice, designation and denial. Reduced exposure to litigation. Appropriate coordination of benefits. Appropriate application of benefits. Reduce privacy concerns. Compliance Challenges

15 Low morale – co-workers having to pick up additional work to cover for those who are absent. Reduced productivity. Misuse of benefits – FML. Increase in absences. Dislike of having to share sensitive information with supervisors. Employee Challenges

16 Integrated Disability Management Seamless Coordination Family Medical Leave Act State Specific Leave Laws Workers’ Compensation Short Term Disability Long Term Disability Medical Leave Personal Leave PTO/Sick Leave Employee Assistance Programs Wellness Programs Group Health and Disease Management

17 Role of the Agent/Broker/Consultant Employers need assistance in evaluating their occupational and non-occupational absences Identify best practices Provide guidance for program management Outsourcing In-house program Hybrid of outsourcing and in-house management Tracking and reporting

18 Best Practices Four key program components Centralized intake Clinical Management/Claim Administration (Leave Coordinator) Return to work programs Data/reporting

19 Best Practices Program Model Centralized Intake Single Point of Intake 24/7 availability Toll Free Reporting Efficient for employees Efficient for Human Resources

20 Best Practices Program Model Clinical Management/Claim Administration Nurse Case Manager and Leave Coordinator Leave Coordinator  Knowledge of multiple benefits  Understand policy language  Work closely with Nurse Case Manager Nurse Case Management  Occupational & Non-Occupational  Use of Nationally accepted Disability Guidelines  Early Identification of Long Term Disability and Benefit Coordination  Work Closely with Claim Administrator Housed in same physical location.

21 Best Practices Program Model Return to Work Fitness for Duty Coordination of Return to Work Job Analyses – Essential job functions Transitional Work (occupational & non-occupational) Written Policy Onsite and Off-Site

22 Best Practices Program Model Reporting/Data Types of Reporting: Raw Data & Trending  Number, Type and Location of Claims  Approval/Denial Rates  Benefit hours utilized, left and recovered  What does my overall program look like?  Who is taking off and why? Return on Investment Impact  What are my savings?  Hard $$ savings: Lost work days = $$  Soft Savings – administrative time, employee morale etc.  Where have we improved?  Where can we still improve?

23 Thank You Disability Management Solutions Holly Moyer, M.Ed., CRC Senior Disability Management Consultant (440) office (440) mobile & Ron Lucki Director of Business Development (614) office (614) mobile


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