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Family Medical Leave Act (FMLA) How Do You Manage It. Disability Management Solutions. Introduction. The CareWorks Family of Companies.

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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.

history of fmla
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
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.

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

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.

FMLA as a Benefit?
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

Who is responsible?

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
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.*
    • 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 OVERTIMEWORK.**
  • 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.


How do you manage it?

Address three primary

challenges employers face.

  • Administrative Issues
  • Compliance Issues
  • Employee Issues

Decrease costs associated

with absences.

administrative challenges
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
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
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
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
role of the agent broker consultant
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
Best Practices

Four key program


  • Centralized intake
  • Clinical Management/Claim Administration

(Leave Coordinator)

  • Return to work programs
  • Data/reporting
best practices program model
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 model1
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 model2
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 model3
Best Practices Program Model


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

Thank You

Disability Management Solutions

Holly Moyer, M.Ed., CRCSenior Disability Management 937-9507 office(440) 413-0729 mobile&Ron LuckiDirector of Business 760-3510 office(614) 989-8681 mobile