Tuesday, July 24, 2012

FMLA, Short-Term Disability, Workers Compensation and Unemployment Compensation - How Do They All Fit Together?


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Philadelphia Employee Lawyer Explains How Family and Medical Leave Act Works for Employees Who Are Suffering From an Injury or Illness

Family and Medical Leave is available under a number of circumstances, including when an employee is suffering from a "serious health condition" that makes it impossible for the employee to fulfill his/her job requirements, such as the acute onset of a pre-existing medical condition, distress resulting from a new and recently diagnosed illness or an injury resulting from physical trauma.

FMLA - Job Security - No Money

How Do I Know If I am Qualified for Leave Under the Family and Medical Leave Act (FMLA)?

Any company with more than 50 full-time employees must provide up to 12-weeks of FMLA leave per year to any employee who has been employed with the company for more than a year, and has worked at least 1,250 hours during the 12-weeks immediately preceding the leave request.

So, if you have a serious health condition, and work for a qualifying employer, you are likely eligible for FMLA leave.

NOTE:  An employee is also entitled to take FMLA leave to care for a newborn child, or a family member who is suffering from an illness or injury; however, since the employee is not disabled in such circumstances, disability benefits are not available.

The Key to the Family and Medical Leave Act is the Right to Job Reinstatement

Prior to the enactment of the FMLA, women that took time off to have a baby were often terminated. Similarly, workers forced to miss more than a week or so of work due to their own injury or illness often found themselves unemployed.

Taking time off to care for a sick parent or child, or to spend sometime with your wife and newborn child??  Unthinkable if you wanted to keep your job.

FMLA changed all of that.  This Post focuses on an employee's rights if he/she is forced to miss work due to his/her own illness or injury.

The Family and Medical Leave Act provides that employees suffering from a serious health condition that limits their ability to perform their essential job functions are entitled to up to 12 weeks of UNPAID leave per 12 month period with a right to job reinstatement upon their return from leave.

The Family and Medical Leave Act is designed to make sure that employees who are forced to take time off from work due to a health crisis will not suffer the loss of their employment.  The FMLA is all about JOB SECURITY.

Your Employer Decides if You Are Entitled to FMLA Leave

If you need FMLA Leave, you make an application through your employer's HR Department.  You will be required to have your physician complete medical certification.  The company then reviews that paperwork, and decides whether to approve your request for FMLA Leave.

You May Be Required to Use Up Your Vacation and Personal Days if You Go Out on Family Leave

As noted above, the Family and Medical Leave Act provides a right to unpaid leave with a right to get your job back when you are ready to return. However, your employer is permitted to require that you "take" any vacation days, personal days or sick days at the outset of your leave (doing so does not extend the length of your leave, it just results in you getting paid for the number of vacation, personal and sick days you have accrued).

Click Here for a detailed description of the Family and Medical Leave Act.

Pennsylvania Employment Attorneys Explain How Short-Term Disability Benefits Are Available to Employees Out on FMLA Leave

STD Insurance - Money Not Job Security

The term "Short-Term Disability" refers to an insurance policy purchased by employers to provide income subsidy payments to employees who are out of work due to a serious health condition. A Short-Term Disability insurance policy typically provides benefits equal to 66.66% of an an employee's base salary or weekly earnings for up to 26 weeks.

HERE ARE SOME OTHER LINKS YOU MAY FIND WORTHWHILE:

What is a "Serious Health Condition" Under the Family and Medical Leave Act (FMLA)?  Is the Flu Covered by FMLA?

FMLA, Short-Term Disability, Workers Compensation and Unemployment Compensation - How Do They All Fit Together?

Am I Eligible for Unemployment Benefits if I am Out on Family Leave?

New Jersey State Temporary Disability Insurance  - Contingent Fee Lawyers

The Insurance Company That Issued the Disability Policy to Your Employer Determines if You Are Entitled to Short-Term Disability Benefits

Short-Term Disability insurance policies are issued by insurance companies such as Hartford, State Farm, Cigna, Prudential, etc.  These insurance companies are not employers of the employees who apply for benefits.  It follows, then that your employer does not decide if you are entitled to STD Benefits; rather, the insurance company does.

If You Are Deemed Eligible for FMLA Leave by Your Employer, You Will Usually be Granted Disability Benefits by the Disability Insurance Company

If you are qualified for FMLA leave due to your own injury or illness, you will in most cases (most, but not all) be approved for STD Benefits while you are out on family leave.

FMLA Will Protect Your Job
Workers' Comp Will Pay Your Bills

You Will Be Entitled to Family Leave if You Are Hurt at Work; You Will Not be Eligible for Disability Benefits for a Work-Related Injury

If you are hurt at work and cannot do your job, you will be entitled to FMLA Leave.  Further, you can apply for workers' compensation benefits to subsidize your loss of income.  Remember, though, you need to return within 12-weeks or you lose your job reinstatement rights under FMLA!  That said, if you are out for more than 12-weeks, you would continue to get wage subsidization through the workers' comp carrier.

One cannot get short-term disability benefits for work-related injuries.

Can You Get Short-Term Disability Benefits if Your Are Out of Work Due to Stress?

As noted above, if you are granted FMLA Leave by your employer, you will usually be eligible for Short-Term Disability insurance payments. However, that is not because your employer "works together" with its disability insurance carrier. Rather, it simply makes sense that if you have an illness or injury serious enough to justify FMLA Leave in your employer's eyes, then a reasonable insurance company will likely see things the same way.

However, this syllogism is not true if you are out of work due to work-related stress. While your employer will often grant FMLA Leave under such circumstances (in part for the perceived good of all involved) disability carriers are often not so generous.

If the insurance company believes your stress is solely work-related, it may deny your disability claim on the grounds that you claim for loss of income, arising as it does from an injury suffered at work, must be filed with the employer's workers' compensation insurance carrier.

So, while you be entitled to FMLA Leave if the cause of your absence is job-related stress, you will likely be denied STD Benefits in such instances.

In our experience, workers' comp carriers generally frown on paying benefits on stress claims.

Do I Qualify for Short-Term Disability if I Have a History of Depression, Bi-Polar Disorder, Mental Health Problems or Anxiety? Philadelphia Disability Attorney

Generally speaking, one needs to prove a somewhat lengthy history of psychological infirmity that was simply "brought to the surface" by work-issues to have a strong claim for short-term disability benefits when the medical condition is related to mental health issues.

Even then, these claims are among the most challenging. Sad to say, disability carriers have a hard time understanding (or at least often claim to) how an employee who could work last week could not this week.

The insurance carriers' views in this regard may reasonably be seen egregiously ignorant, woefully outdated and outrageous; modern science has proved, and any educated person knows, that mental health issues are unpredictable and can be triggered by any number of things. Nevertheless, that is too often the reality for those seeking disability benefits in mental health matters.  This is why seeking counsel to help analyze the situation and develop a strategic approach is a great idea.

How to Appeal a Denial of Your Claim for Disability Benefits for When Mental Illness, Depression or Anxiety are Basis for Claim

In such cases, a strong appeal from an initial denial of the claim is essential. Certain legal requirements must be satisfied to put maximum heat on the carrier.

NOTE:  If you are making a mental health disability claim, it helps to have your doctor point out the physical manifestations of your condition, i.e. sleeplessness, stomach upset, migraines, etc.

NOTE:  Due to the complexities of stress-related FMLA and disability claims, it is not a bad idea to consult counsel before seeking leave if it is the company's "hostile work environment" that has driven you to consider exercising your FMLA rights.

One Can Get Disability Benefits Even if Fired From Job

You Can Get UC Benefits if Out
 on Sick Leave Without Pay

If an employee cannot return to work within 12 weeks of the start of  FMLA leave, he/she can be fired without recourse.  However, such an employee would still be eligible for up to 14 more weeks of Short-Term Disability payments.  Consequently, an employee who is terminated from his/her job because he/she could not return to work within 12 weeks of the start of FMLA leave could still receive Short-Term Disability payments for an additional 14 weeks.

Can I Get Unemployment Benefits if I am Out on Sick Leave?

In many situations, the answer is: Yes.  Click Here to learn more.

Philadelphia FMLA and Short-Term Disability Lawyers who Work on a Contingent Fee Basis

Philadelphia Are Employment Attorneys Representing Employees

We are employment lawyers who represent employees in Pennsylvania. 

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