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This is not a legal or contractual document between the unions and the company. This is an informational packet created by
a Health Care Benefits Coordinator to assist you with FAQ regarding absence administration procedures, forms, and vendors.
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FMLA AND DISABILITY FREQUENT QUESTIONS:
VICKIE KINTZER 866-248-4449
PLEASE DO NOT SHARE “MEDICAL”
WITH YOUR SUPERVISOR
MEDICAL IS SHARED BETWEEN YOUR DOCTOR AND THE VENDOR
INVOLVED WITH THE ABSENCE
If you are asked what’s wrong with you, politely
state that medical is confidential and is shared between the vendor and your doctor.
1. Who does the employee call if the absence is going to be less than
7 calendar days?
employee is responsible for notifying his/her supervisor or absence person. The
employee is NOT to provide any medical information to the supervisor when reporting off.
The employee advises the supervisor that the absence is either a “new condition” or for a “related
FMLA condition on file”. The Supervisor is responsible to call the ARC
center to report the absence.
2. After the absence is reported to the supervisor, what happens?
The ARC center,
within 48 hours, should send you either a Full certification form for the doctor to cover the absence or they should send
you a letter stating why you are not qualified for FMLA. If, you DO NOT receive
anything from ARC within 5 days of the absence date, please call ARC at 877-275-8947 to tell them you’ve not received
any papers for the absence.
after calling ARC, you find that your absence was NOT reported, you will need to notify your supervisor. Once your Supervisor reports the absence, you will be deemed eligible for FMLA, unless you have exhausted
your 12-week allotment for the year and you will be given 25 days from the date it was reported to submit the appropriate
paperwork to cover the absence.
3. Calling 877-275-8947 (877-Ask-VzHR), what must I do?
If you’ve never called the center for any benefit issues, be prepared to Enter your Social Security number, state
you’re calling for Absence Administration, using the voice portal as an Employee and provide your VZID number. You’ll need to follow the prompts for the registration of a Voice Portal
4. Once I am certified for a chronic health condition with
intermittent absences, what will I need to do?
When you have an absence that is “related” to your condition on file, you will need to advise the supervisor
to which “ORIGINAL absence DATE” you’re referring to. If
your absence is for a dependant, you will need to tell the supervisor what dependant and what Original absence date so the
absences can be applied to that certification.
5. What if I receive a full introductory packet and I have
a certification on file?
Either the absence was reported as NEW to ARC, which needs to be corrected by the supervisor OR you could have EXCEEDED
the parameters of the certification regarding frequency of absences or duration of the absence.
What if I have submitted a certification for my chronic condition, I’m not certified as yet, and I have subsequent
absences? How do I cover them?
I suggest you contact ARC to let them know the absence should be noted as “related” and that you’ve
submitted a certification for absence beginning on ___X date__. Since it’s
still pending ARC’s review, you will be sending a note to cover that absence under the original certification submitted
and provide them with another copy of that certification previously submitted. Remember,
if the “trigger absence” certification form gets denied for whatever reason, you must fix the certification for
that absence and subsequent reference to additional absences must be noted accordingly.
6. What if I do exceed my frequency and/or duration of my
can cover the specific absence dates with a note from the doctor. The note needs
to state the dates of the absence, the condition it’s related to and any treatment you received. IF you want to change/modify the terms of the frequency or duration on file, you can have the doctor
fill out another certification form and return it.
7. What happens if my absence is denied for FMLA?
the absence is denied for FMLA, a letter stating why the absence didn’t qualify will be sent to you. Your supervisor will receive a copy of this letter and should give you a heads up that you’ve
been denied. This is the time to call me to discuss the appeal process
for you only have 14 calendar days from the time of denial to fix the denial.
supervisor(s) should be sharing any notices from ARC that they receive to give you a “heads up” on any denials. Be careful when calling ARC to see why you were denied. Ask them to fax you a copy of the denial letter so you can see what was wrong. Don’t take their word for what you need to correct.
8. How do I request an administrative review?
14 days from the date of the denial of the FMLA, you must correct the certification form sections in error and you must send
a LETTER of Request for Review along with any other Supporting documentation.
9. What is supporting documentation?
If you’ve been denied for non receipt of a certification form during the original submission time of 25 days
after the date the absence was reported, and the provider was the cause, you must provide a letter from the Health Care Provider
of any delay on the part of the provider explaining why he/she caused the delay in processing.
IE the HCP was on vacation, etc.
If you have a fax transmittal proving a prior faxing of the form for which ARC claims no receipt of, you must include
with your written request for review a copy of that fax transmittal and a copy of the original certification form sent. If the provider was the person who faxed the form, you will need something from the
provider indicating the date and time the provider faxed the form.
If you missed the original submission of 25 days and the absence was a “disability” case covered/approved
by MetLife, during your appeal, you need to explain in your written request for review the absence was certified for disability
and if possible provide a copy of the approval letter from MetLife.
employee must call the disability vendor, MetLife at 800-638-4228, no later than the 7th calendar day of absence
to report the disability case. If you know of an upcoming disability, you
can call MetLife a week prior to the absence date to initiate a claim.
11. What will I receive from MetLife for the disability claim?
MetLife will send you a Medical Release Form. This medical release form
is optional for you to sign, BUT make sure your Health Care Provider(s) are aware that MetLife is the Verizon Disability Vendor
and they will be contacted for Medical justification of the disability. You
will also receive an Attending Providers Statement, which you can take to the doctor and have the doctor fill in out and fax
it back to MetLife. MetLife’s fax #800-230-9531
What does my doctor need to do for Certifying my Disability claim?
When your absence is beyond the 7 calendar days, the doctor can call MetLife or fax the Attending Provider Statement
to justify the disability claim. Please stress to your doctor that he/she
doesn’t have to wait for MetLife to contact them to justify the claim. As
soon as possible, to avoid pay roll problems, the doctor should be in contact with MetLife regarding your medical condition.
12. Do I still need to send in FMLA certification form if I have a Disability case?
YES. ARC needs certification to approve the absence to avoid any RAP disciplinary
action. MetLife needs certification to approve your pay for the absence. Your pay is based on the Net Credited Service date at the time of the disability. ARC should be notified by MetLife via CTLR records, but that doesn’t happen
in most cases.
13. What if I have an On the Job Injury? What
do I do and is FMLA involved?
Any On the Job injury MUST be reported to the supervisor IMMEDIATELY. You
must also notify MetLife of the On the Job Injury for any missed work time for they will also be involved with the illness. If the supervisor reports the absence to ARC, then FMLA is involved with the illness
related to an On the Job Injury. You will need to cover the absences or the company
will apply the RAP plan.
Your supervisor is required to file an on the job injury report. Sedgwick,
WC vendor, will call you within 48 hours to discuss the details of the injury. If
you do not receive a call from Sedgwick within 48 hours, verify with the supervisor that a report was filed.
FYI---the company is going to implement a Prescription Plan associated with WC benefits vs paying up front for them. More to come in the mail.
14. Who is the Vendor dealing with Worker’s Comp? (in most states)
Sedgwick is the vendor involved with Worker’s Comp claims. I’ve
included the mailing address for claim submission either by you or the Health Care Provider.
Once the accident is reported to Safety, Sedgwick is notified and a claim is investigated.
Address for claim: Sedgwick
1801 Market St, Suite 500
Phila PA 19103
15. If I am receiving Worker’s Comp, why do I need to involve MetLife?
on your Net Credited Service date and the nature of the accident, MetLife will make up the portion of your wages that Worker’s
Comp doesn’t under the law. Example, if your are entitled to full pay for
13 weeks and under WC law, WC only pays 2/3 of the wages, MetLife will pay the balance of your wages either under the Sickness
Plan or the Accident Plan for those 13 weeks. Once you reach a ½ pay status under
either Sickness or Accident Plan, you will only receive your WC wages for they are usually greater than the ½ pay you would
receive under disability. Even if you are NOT receiving any additional
wages from MetLife, you should still be providing medical information to them so an open claim is kept on file.
16. What if I run out of my FMLA time and I know I have an Upcoming disability?
If you have exhausted your 12 weeks of FMLA time or you know you don’t qualify for FMLA based on hours worked
(ie 1,250) and you have a KNOWN disability coming up, you can cover the absence from discipline by using ANTICIPATED DISABILITY
LEAVE. Anticipated Disability Leave is an unpaid leave of absence
which can be ONE day prior to a KNOWN disability need. A known disability applies
to Birth of a child and Surgery. If this leave is taken, the ENTIRE absence is
NOT subject to the RAP plan for the absence is NON chargeable.
17. What’s necessary on the FMLA Certification form from my doctor?
If the absence is for SELF and the condition is NOT chronic/ongoing in nature, then Section B : the Health Care Provider
(HCP) needs to provide the following information.
B: List the patient’s name, relationship is self and Date of
Q1. Describe the medical facts to support the need for illness as stated
in the definition of the question. List all the symptoms etc from the illness
for the medical facts do not need to include a diagnosis for there are times when one has not yet been determined.
Q2. First day
of incapacity covered __/__/__. List the first date of illness onset,
doesn’t matter if work day or not a work day. Example: cut your hand after work and you went to the emergency room on 12/7/04.
That’s the date to list for that’s when your illness began regardless if you already worked that day.
Q3. Probable last day
of incapacity __/__/__. List the date
of your expected recovery from the illness.
Q4. Patient under care
since __/__/__. Doctor treating you since when (date)
Q5. Yes, it’s
to be noted as a serious health condition with the appropriate sub-category. Hospital
stay to qualify MUST be overnight. Out patient procedures do not use the Hospital
stay area. b) Absence Plus Treatment will cover most of these type illnesses. The incapacity period must have exceeded 3 consecutive calendar days and you MUST
have the doctor (in the blank line area) list the treatment you’re receiving such as prescriptions, physical therapy,
etc. List any follow up appts. If
you see the doctor on more than one occasion during your illness, that information needs to be listed within the blank lines
in that section as well. Multiple visits to a health care provider constitutes
treatment in itself.
This area basically
will cover short term disability illnesses as well by following the above guide to medical information necessary.
If the doctor is covering
you for a short term disability case and you’ll need treatment IE chemo, Physical therapy, etc upon your return to work,
the doctor can list all that on the form at one time.
questions on these forms, please call me so we could discuss the circumstances.
18. What if I have a chronic/ongoing treated condition?
Again, Section B to be filled out by the doctor. If you have multiple
doctors treating you, any one coordinating your care can fill out the form.
Describe the medical facts of all the symptoms/conditions that you are getting treated for.
Example: you have allergies and asthma with recurring sinus infections
First day of incapacity covered by this certification: __/__/__ (list the first date you became ill with the condition)
Probable last day of incapacity covered : ___/__/__ (can be covered for up to
one year from the first date of incapacity)
Patient has been under my care……__/__/___(doctor to state approximate date you began seeking treatment for the
condition. If that goes back years, that’s the date that should go in there.
Q5. Yes a serious health condition. With the Chronic Condition area getting
filled out by the doctor. Make sure the doctor is listing ALL your treatment,
such as needs XYZ medication and is getting chemo treatments or physical therapy or blood work monthly, or monthly visits
to the doctor etc all should be explained on the blank lines of the section c).
The doctor can cover this current absence OR the doctor can cover both the current absence and future absences in this
section. IF the doctor is covering future absences, the doctor MUST provide
a BENCHMARK of the probable time you might need off to deal with your condition.
If you have a chronic illness there’s typically times when you might need recovery time.
The doctor needs to state that he/she is covering
absences for you weekly, monthly or yearly and how many of those. Along
with that frequency of absences, the doctor needs to provide a benchmark for the duration of your absences. Is your recovery period one day, two days etc and provide that.
IF you also are getting treatments along with
your illness condition the doctor can authorize a schedule under sub-section d) for those times as well.
We do NOT get paid for attending Doctor visits,
treatment appts, Xrays, MRI’s blood work etc Unless it’s Pre-admission testing for a surgical procedure.
If the FMLA time is for a dependant’s care, the dependant’s doctor will need to follow the above guide
to provide medical justification under FMLA to allow you the time off for care giving.
The PATIENT’S medical information MUST qualify under FMLA or you are not able to take FMLA time against the dependant’s
condition. SECT C MUST be filled out by the patient’s provider for
you to take time off. Make sure the doctor is covering a period of time
(see question 7) and stating whether you’ll need full and/or intermittent leave.
The same benchmark of anticipated time is necessary in this section as well.
Remember, this Benchmark is an estimate of time necessary. If you
exceed the original request for time off, you can ALWAYS cover the additional time with a note from the patient’s provider
or your provider WITHOUT requesting a new certification be filled out.
If your doctor is requesting restrictions upon your return to work from a Disability, that restriction request should
be discussed with MetLife prior to your return to work. You should also provide
a note (WITHOUT MEDICAL INFO) to the supervisor upon your return. That
note should indicate what the restriction is and how long the restriction is necessary.
If your doctor is requesting restrictions without an associated disability case, you need to provide a note to the
supervisor (WITHOUT MEDICAL INFO), stating what the restriction is and the length of time the restriction is necessary. Upon a request for a restriction to the supervisor, the supervisor is responsible
to file a “no lost work time” form with MetLife.
Once the supervisor notifies MetLife of the restriction request, you will need to have your provider contact MetLife
to medically justify the restriction requested by the provider. Make sure you’ve
signed a medical release with your provider to ensure release to justify the claim.
After MetLife reviews the medical information, you should be sent a letter of approval listing the dates the restriction
is to be in place and specifically what restriction was approved. A copy of the
approval from MetLife is also sent to the Supervisor indicating the restriction has been approved.
Any extensions to the approval time, your doctor must contact MetLife with additional medical information to justify
continuing the restriction request. You will need to notify both the supervisor
and MetLife of the need for an extension.
If there is a dispute regarding restrictions, a Functional Capacity Evaluation may be appropriate.
Unless you have a chronic/ongoing disease related
to digestive issues or unless your doctor is using a colonscopy as a test to determine a condition, it’s hard to cover
these tests under FMLA.
Because this type of test requires a sedation/anesthesia,
it is considered an ILL day for paying you under the Incidental Absence Contractual payments.
The only thing is it’s hard to cover it under FMLA unless you have a chronic condition where this test is diagnostic
or evaluative in nature and the HCP lists this under the chronic section of the form.
If this test is being conducted because it’s
a Preventative Care Scheduled test, ie you’ve turned 50 and the doc wants a preventative care test, then it’s
hard to cover it under FMLA although it can be coded as a ILL day contractually.