FMLA Leave Administration
Staff Training
Training Session Outline
• Why Third Party Administrator
• FMLA Refresher
• Integrated Intake Overview
• FMLA Leave Management Process
• Roles & Responsibilities
• Unum Contact Information
The Value of a Third Party
Administrating FMLA Leave
• Streamlines the FMLA process by consolidating all leave administration to
one source
• Maintains confidentiality and impartiality of decisions
- Calling Unum to request leave does not guarantee approval
- Employees must satisfy FMLA eligibility and certification requirements
- OU has final discretion regarding leave decisions
• Reduces lost time and lessens the impact on productivity
FMLA Refresher
FMLA provides employees with up to 12 weeks of unpaid* leave for the
following reasons:
• Employees Own Serious Health Condition/Disability
• Care of a Family Member (Spouse, Parent, Child) with a Serious Health
Condition
• Care of a Child due to Birth, Adoption, or Foster Care Placement
To qualify for FMLA leave, an employee must:
• Work for the employer for 12 months
• Work 1,250 hours in a 12-month period
*Employees must use accrued Sick Leave/ Personal and may be required to use accrued
vacation during any otherwise unpaid FMLA. Any paid time off used during leave will
be counted against the available leave under the FMLA.
FMLA Refresher
OU’s FMLA Calculation Method:
• The 12-month period is measured backward from the date an employee takes
any FMLA leave.
–
Example: Employee requests FMLA leave on April 1, 2008. The employee must have at least
1250 hours worked since April 1, 2007 to be eligible.
Job Protection Under the FMLA:
• Employees who return to work on or before the expiration of FMLA leave
should be reinstated to their same or equivalent job with the same pay,
benefits, and terms and conditions of employment.
•
Employees on FMLA have no greater right to reinstatement or other benefits
and conditions of employment than if they had not taken leave.
Leave Schedule
•
Full/Continuous Leave
– Leave that is full-time/continuous (e.g., 12 consecutive weeks)
•
Reduced Schedule Leave
– Schedule of leave that reduces the number of hours an employee works
daily or weekly (e.g., full-time to part-time)
•
Intermittent Leave
– Leave taken periodically and may be taken from less than an hour to
weeks at a time
Leave Reasons & Certification
Types
•
Employee’s or family member’s serious health condition
– Medical Certification Form
•
Newborn (Paternity)
– Copy of application for birth certificate
•
Adoption or Foster Care
– Court document with date of placement
Certification: Serious Health
Condition
Six Serious Health Condition categories under the FMLA:
•
Hospital Care
•
Absence Plus Treatment
•
Pregnancy
•
Chronic Conditions Requiring Treatments
•
Permanent/Long-term Conditions
•
Multiple Treatments
Integrated Intake Overview
Customer Disability and Leave
Management Line at Unum
Employee calls Unum
at
1-866-779-1054
Integrated Intake
Report a new
disability claim,
family / medical leave
Leave
Management
Center
Processes all
claims / leaves
for FMLA / State
qualification
Benefits Center
Processes all
disability
claims
Ongoing Leave/Claim
Processing &
Communication
NOTE: Intake line at Unum will
reference disability claim.
Employees should follow this
process to report all leave types,
including FMLA, Extended Sick
Leave, and STD.
Leave/Claim Intake Process
•
When employee calls Unum, the following information will be requested:
– Name and social security number or employee id number
– Date of birth
– Complete address and phone number
– Company
– Marital status and number of dependents
– Occupation (job title)
– Physician’s name, address and phone number
– Brief description of medical condition
– Cause of medical condition (illness or injury) or need for leave
– Your last day worked and first day absent from work due to condition
– Date and description of illness or injury (disability claims only)
– Date of your first visit, your most recent visit and your next scheduled
visit with your physician for this condition (disability claims only)
– Date you expect to return to work (if known) or the actual date if already
returned to work
Leave/Claim Intake Process
•
During telephonic intake for leave claims, the caller is also instructed to
provide the Attending Physician with a signed authorization to release
information to Unum so that the medical information needed to process the
claim can be obtained.
FMLA Leave Management
Process
FMLA Leave Management Process to Request New Leave
•
Within 2 business days of the telephonic leave request, Unum will mail a
packet to the employee containing:
– Notice of eligibility or ineligibility for FMLA leave
– FMLA Rights & Responsibilities
– If eligible:
• Conditions of leave and employee obligations
• Medical Certification form if applicable
• Permission to Contact form if applicable
Medical Certification
Requirements
•
FMLA leave with a concurrent STD/Extended Sick Leave claim
– No medical certification form is requested for the FMLA leave
– FMLA will be approved concurrently with the STD/Extended Sick Leave
claim
– If the STD/Extended Sick Leave claim is not approved, Unum will send a
subsequent request for medical certification if needed
•
FMLA leave only
– If eligible, a medical certification form or appropriate documentation is
requested
***Certifications are reviewed by leave specialists.
FMLA Certification Timeline for absences
NOT being processed for disability
•
Day 1 - Report of family medical leave
– Certification is due 15 days from the date of request
•
Day 16 - Certification Reminder letter sent to employee if certification has
not been submitted
– Certification due date extended 7 calendar days
•
Day 23 - FMLA leave denial letter sent to employee if certification not
submitted
•
Incomplete certifications received are returned to employees with a
certification due date extension
– Certification due date is extended 7 calendar days from original due date
or 10 calendar days from the date of the incomplete letter, whichever is
later
NOTE: This process includes absences for employees on leave due to
workers’ compensation claims. FMLA will run concurrently if the
employee is eligible and approved per the process above.
FMLA Leave Management –
Denial Reversal Process
•
If an employee submits a complete and qualifying certification:
• Within 15 calendar days of an FMLA leave denial
- Unum will send an email to UHR contact notifying that a
complete/qualifying certification has been received and that the denial will
be reversed in 24 hours.
• Beyond 15 calendar days of an FMLA leave denial:
- Denial never reversed absent extenuating circumstances
If a denial is not reversed, leave may be approved prospectively from the date
complete/qualifying certification was received.
FMLA Leave Management – Certification
Review and Advice to Leave
•
•
•
•
•
•
Certification Screening Checklist
Incomplete Certifications
– Returned to employee (with copy and explanation)
Validity Questioned
– Verify authenticity
– Request Recertification
– Request 2nd Opinion (on original certifications)- Employer pays for this
Clarification Needed for Complete Certifications
– Nurse Case Manager will contact the doctor (with signed permission to
contact)
Complete Certification
– Evaluated for qualification under FMLA regulations leave law
FMLA Approvals from Short-term Disability Approvals, where possible
FMLA Leave Management Ongoing
•
Unum monitors approved/pending FMLA leaves and/or Extended Sick
Leave/Disability claims through Return to Work
– Request medical recertification as needed and allowed by law
• Requests for extensions
• After minimum duration specified by health care provider has passed
• Every 45 days for indefinite or unknown durations
• Change in circumstances
• On-going validity of absences questioned
– Receive and verify intermittent hours reports
FMLA Leave Management –
Return to Work
• Verify Return To Work plans and remind employees to submit Return to Work
Authorization, when appropriate
• Confirm actual return to work date with the manager and HR contact via email
Key Capabilities of Unum’s Program
– Single dedicated toll-free number for integrated intake
– Compliance with federal regulations
• Ongoing advisement and support of internal legal counsel regarding
compliance with federal regulations
• Centralized and automated eligibility determination and leave
tracking
– Consistent administration across workforce
– Advice to Leave Service
• Measure, track, analyze and report all FMLA leaves
– Integrated FMLA/STD/Extended Sick Leave processes, where appropriate
– Nurse Case Manager clinical advisory expertise
– FMLA/STD Integrated reporting
– Intermittent hours tracking and reporting
Roles & Responsibilities
Employer Obligations
FMLA
• Notify the employee of his/her FMLA rights within 2 business days of
becoming aware of the possible need for leave.
• Notify the employee when lost time from work is being counted as FMLA
time.
• Return the employee to the same or equivalent job when they return from
leave.
• Disregard FMLA lost time whenever taking disciplinary action for
excessive absences.
Employee Responsibilities
•
Contact Unum immediately to report Family/Medical leaves or Disability
claims at 1-866-779-1054.
•
Notify supervisor of leave request
•
Supply requested certification to Unum within specified timeframes
•
Provide Unum with signed copy of Authorization to Release Information.
•
Maintain contact with Unum and Supervisor while on leave
•
Notify Unum and Supervisor of any changes in return to work status or date
University Human Resources
Responsibilities
•
Provide employee with leave brochure as requested
•
Ensure that all family/medical leaves are reported to Unum immediately
– If an employee cannot, will not, or has not reported a leave to Unum,
UHR should do so in order to facilitate compliance.
•
Facilitate an ongoing dialogue with Unum regarding status determinations,
problem/suspect leaves and other extenuating circumstances
Contact Information
•
Leave Management Center
– FMLA/Leave
Representatives may be
reached by calling the toll
free number 1-866-779-1054
and choosing the option for
inquiring about an existing
family/medical leave
– Fax number: 800-447-2498
•
Unum’s Benefits Center (Shortterm Disability) Unit
– Call toll free number 1-866779-1054 and choose the
option to inquire about an
existing disability claim
Any Questions?