Transcript FMLA Absence Management Program

Family Medical Leave Act
(FMLA)
How Do You Manage It
Disability Management Solutions
Introduction
The CareWorks Family of Companies
More than 900 Ohio-based associates delivering customerfocused cost control services 180,000 business customers
with a 98 percent annual customer retention rate.
History of FMLA
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
Changes in 2008 and 2009
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
Eligibility
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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.
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:
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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
FMLA as a Benefit?
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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.
Who is responsible?
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The employer is responsible for designating time off
work as FMLA and informing all employees of their rights
under FMLA.
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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
FMLA: The Cost of Absences
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
 $760,000 every year in payroll costs due to unscheduled
absences.***
 Overall direct costs of FMLA nationally was $21 billion.*
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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.*
*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.
Break
How do you manage it?
Address three primary
challenges employers face.
 Administrative Issues
 Compliance Issues
 Employee Issues
Decrease costs associated
with absences.
Administrative Challenges
 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.
Compliance Challenges
 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.
Employee Challenges
 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.
Integrated Disability Management
Seamless Coordination
 Family Medical Leave Act
 State Specific Leave Laws
 Workers’ Compensation
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Short Term Disability
Long Term Disability
Medical Leave
Personal Leave
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PTO/Sick Leave
Employee Assistance Programs
Wellness Programs
Group Health and Disease Management
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
Best Practices
Four key program
components
 Centralized intake
 Clinical Management/Claim Administration
(Leave Coordinator)
 Return to work programs
 Data/reporting
Best Practices Program Model
Centralized Intake
 Single Point of Intake
 24/7 availability
 Toll Free Reporting
 Efficient for employees
 Efficient for Human Resources
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.
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
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?
Thank You
Holly Moyer, M.Ed., CRC
Senior Disability Management Consultant
[email protected]
(440) 937-9507 office
(440) 413-0729 mobile
&
Ron Lucki
Director of Business Development
[email protected]
(614) 760-3510 office
(614) 989-8681 mobile
Disability Management Solutions