Question: I have an employee who has been off work due to an industrial accident for six months. What is my obligation to continue to keep this employee on the company health insurance plan?
Respond: An employee who is on sick leave due to an accident at work may or may not be entitled to continued health insurance under the same conditions as if they continued to work.
If your employee is eligible for leave under the federal Family and Medical Leave Act or the California Family Rights Act, you will designate the first 12 weeks of the employee’s leave based on the injury related at work as FMLA and/or CFRA. Employees on FMLA or CFRA leave are entitled to health insurance benefits for 12 weeks on the same terms as if they were continuing to work. After FMLA and/or CFRA expires, the employer must initiate the interactive process with the employee to determine if additional leave is a reasonable accommodation. Under California Fair Employment and Housing law, medical disability leave is a reasonable accommodation as long as additional leave is likely to allow the employee to return to work and the leave does not cause undue hardship to the employer. Additionally, if your injured employee is pregnant, she will likely be eligible for up to 4 months of pregnancy disability leave and an additional three months of CFRA leave to bond with the baby. In this case, the employee’s company provided health insurance benefits for up to seven months.
After the 12 weeks of FMLA/CFRA leave expires, or up to seven months combined of pregnancy disability leave and CFRA infant bonding leave, the health insurance plan document will determine the duration of coverage. provided by the employee’s company. You can contact your insurance broker or consult the plan document to determine when an employee becomes ineligible for coverage. Many policies state that after three or four months of sick leave, the employee becomes ineligible to participate in the plan as an active employee. At that time, unless the employee was on protected pregnancy disability leave or CFRA baby bonding leave, the employee’s company health insurance coverage would cease and the employee would be offered the continuation of health insurance at its expense through the Consolidated Fiscal Reconciliation Act. Reducing employee hours of work is a qualifying event under COBRA, and your health insurance broker or plan administrator can help you terminate employee coverage and provide timely continued coverage under COBRA.
Employers sometimes believe that employees who are on workers’ compensation leave are entitled to health benefits indefinitely, but this is not the case. Employers also sometimes forget that medical disability leave due to a work-related injury or illness is handled the same as other disability leaves and will run concurrently with FMLA, CFRA and leave provided as reasonable accommodation under the FEHA.
For more information on family and medical leave and pregnancy-related disability leave, visit https://calcivilrights.ca.gov/family-medical-pregnancy-leave/
Sara Boyns is an attorney at Fenton & Keller in Monterey. This column is intended to answer questions of general interest and should not be construed as legal advice. Email your queries to [email protected].
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