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  1. #1
    Join Date
    Sep 2009
    Posts
    5

    Default Continuation of Health Insurance While Out of Work

    My workers compensation claim was made in the State of: DC.

    I want to clarify something I read elsewhere on this forum. My situation:
    I am not working at all due to a WC covered injury.
    I am entitled to FMLA benefits.

    Is it true that if I file for FMLA I will have to pay the same amount towards my health insurance that I pay when I am working and my employer will have to continue to pay their share?

    And
    If I am out longer than FMLA covers (I don't expect this to be the case), that I will be entitled to COBRA?

    Finally, and I don't know if this is the right place to ask this:
    If for some reason my insurance lapses while I am out on WC will I be entitled to pick it up immediately when I return or will I have to go through a waiting period?

    Thanks in advance!

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Continuation of Health Insurance While Out of Work

    http://www.dol.gov/esa/whd/fmla/
    I think it means you get cobra option when fmla starts and lose your job and all benefits when fmla ends.

  3. #3
    Join Date
    Apr 2009
    Location
    Massachusetts
    Posts
    13

    Default Re: Continuation of Health Insurance While Out of Work

    Check your benefits package including details. In my case I filed Short Term Disability at the same time as WC. This in addition to FMLA. I am nearing the full 26 weeks of my STD, and we have Long term disability too aka LTD. LTD entitles me to continue my medical insurance at a much cheaper rate than Cobra. Does your company offer STD or LTD? If they do, apply for STD with your FMLA. If they don't then you need to find out what your policy is with your benefits package. In my case, it states my employer will automatically let me go at the end of the 26 weeks STD. Right now they have started the application process for LTD. I may not get any money out of LTD just like I got nothing out of STD because of the TD I get from WC. But it protects my benefits until I am no longer considered disabled.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Continuation of Health Insurance While Out of Work

    You can find info on FMLA/ADA/EEOC/WC and the overlaps here http://www.ppspublishers.com/articles/fmla.htm. While this site provides information for ER's, it's good for IW's to be aware of the requirements.

    FMLA and WC are completely seperate benefits. While the ER is permitted to run the FMLA concurrently with the comp leave, after the EE/IW is notified in writing of the intent, FMLA only protects your job and ER provided benefits up to 12 weeks/annum. \
    While a comp claim doesn't provide job protection as FMLA does... you are still an ""EE"" of the employer until you are released to return to work once you are declared MMI. There are other laws, ADA/EEOC that offer additional mandates upon the ER for that time you are released to RTW.

    There are specific federal rules for your RTW, you can find that info here http://www.eeoc.gov/policy/docs/workcomp.html
    13. May an employer require that an employee with a
    disability-related occupational injury be able to return to "full
    duty" before allowing him/her to return to work?

    No. The term "full duty" may include marginal as well
    as essential job functions or may mean performing job functions
    without any accommodation. An employer may not require that an
    employee with a disability-related occupational injury who can
    perform essential functions be able to return to "full duty" if,
    because of the disability, s/he is unable to perform marginal
    functions of the position19 or requires a reasonable
    accommodation that would not impose an undue hardship.
    You shold not, or the law does not require that you lose your job once FMLA ends. You do have to continue to pay your share of any ER provided benefits, and yes, once FMLA ends, you must be offered COBRA to continue to ER GHP plan.
    When/IF your RTW with this ER, there should be no reason to have to apply the waiting period for GHP to resume. You are STILL a employEE of this company. Nothing has changed but possibly your physical condition.

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