Diamond State Telephone Commercial Union - CWA Local 13100

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Click here to download FMLA Certification Form

NEW CHANGES TO FMLA ANNOUNCED AT VERIZON
 
Beginning Nov. 5, 2006, there will be some changes to the administration of
Verizon’s Family and Medical Leave Act (FMLA) process.  Currently, Verizon manages the frequency of episodes used against an employee’s approved certification and requires the employee to recertify any episode that exceeds the approved amount.  A similar process will now be followed in managing the duration of each approved FMLA leave.  In addition to managing duration, other aspects of the FMLA process will be modified and all employees can expect the following changes:

      Each FMLA approved certification will be assigned a case number.
      This case number will be provided on all correspondence from the FMLA team after Nov. 5.

      Employees will need to reference the case number of the appropriate
      approved certification (or refer to absence date if certification
      approval is pending) when reporting a related or intermittent absence
      to their department.

      All currently approved certifications on file will also be assigned a
      case number.  Your department can see these case numbers in the
      Absence Management Tracking System (AMTS) and can relate your
      intermittent claim start date with the new case number and share with
      you for future use.

      Employees who exceed their FMLA approved frequency or duration will
      be notified of this fact by letter and be required to have a
      Recertification Form completed by their treating health care provider
      for the hour(s)/date(s) exceeded.  Failure to submit the completed
      form within the time frame specified in the letter may result in a
      denial of FMLA leave for the hour(s)/date(s) exceeded. Therefore,
      those absences may be subject to the provisions of the established
      attendance plan and practices in your area.

      Reduced Work Schedule (e.g., employee working 6 hours of their normal 8 hour tour) – If employee is actively at work and needs to reduce
      their schedule, the employee must apply for FMLA in order for job
      protection for the time reduced.

      Any absences that occur on or after Nov. 5 will be administered as
      set forth in the preceding bullets.

      If an absence episode commenced prior to Nov. 5 and has not yet been
      processed by the FMLA team for that occurrence prior to Nov. 5, this
      claim will also be administered within the new process.


Please note that our FMLA systems and AMTS will be unavailable from Friday,
Nov. 3, 12 p.m. ET through Sunday, Nov. 5, 12 p.m. ET, in order to process
the new changes.  This means that 1-877-Ask-VzHR may not be able to access
the appropriate system to fully answer questions specific to your FMLA
claim during this outage period.


If you would like more information about FMLA, call 1-877-Ask-VzHR
(1-877-275-8947).  Once connected, enter your Social Security number when
prompted, then say "Absence Administration" from the main menu and follow
the instructions to speak to a customer service representative.
Representatives will be available Monday through Friday from 8 a.m. to 6
p.m. ET. You may also e-mail FMLA questions to AskVzHR@verizon.hewitt.com.
E-mails may be sent at any time, but they will be responded to during the
normal business hours stated above.

CWA & Verizon reach agreement on adminstration of FMLA and the 1250 hour requirement eligability (click here to read more).

A Lotus Notes message sent to all associates on 3/22/05
 

Important information about FMLA forms.

Effective immediately, Family Medical Leave Act (FMLA) medical certification forms will be available on the eWeb at http://vids.verizon.com/telecom/it/eforms/forms/e/20-1923.doc for East
employees.  This will give East employees access to medical certification forms prior to absences.  The purpose is to enable employees to bring a certification form to their appointments with health care providers or to scheduled surgical procedures.

Please note that the Absence Reporting Center (ARC) will continue to mail FMLA medical certification forms to administratively eligible employees when absences have been reported, regardless of whether or not employees previously obtained forms from the Web site.  Employees must be made aware that they are not to forward completed medical certification forms to the ARC prior to their first day of a reported absence.

Employees will not be pre-certified for an absence, i.e. administrative eligibility will not be determined until the absence has been reported on the first day of absence. Administrative eligibility will be determined within two business days of the absence being reported. Employees will receive notification by mail of their eligibility status.

Certification forms received at the ARC prior to an employee's first day of a reported absence will be returned to the employee without being processed or reviewed for accuracy and completeness.  Certification forms received from employees who have been deemed administratively ineligible will likewise be returned to the employees unprocessed.

If you would like more information about FMLA, call 1-877-Ask-VzHR (1-877-275-8947).  Once you have connected to AskVzHR, enter your social security number when prompted, then select "Absence Administration" from the main menu and follow the instructions to speak to a customer service representative. Representatives will be available Monday through Friday from 8 a.m. to 6 p.m. ET.

You may also e-mail FMLA questions to AskVzHR@verizon.hewitt.com.  E-mails may be sent at any time, but they will be responded to during the normal business hours stated above.

NEW  changes to FMLA policy favorable to Verizon, but the  DOL ruling is against our membership/employees.  Verizon can ask for addition medical information when they feel there is a "suspicious pattern" in FMLA certified absence.

By: Victoria Kintzer, FMLA Health Care Coordinator

August 1, 2005

      If the company, meaning the direct supervisor feels there is a SUSPICIOUS pattern of absences, the DOL has given them the blessing to ask for Additional Medical information via ARC.   The supervisor is supposed to notify ARC of the Suspicious pattern and ARC will send out a letter to the employee telling that employee that a "suspicious pattern" has erupted with their chronic condition on file and that due to that fact, they are being told have the doctor "recertify that absence" and a new certification form is being sent out to them.

      All well and good, for we don't agree with the DOL decision nor do we agree with the new practice, BUT the letter that they are sending to our folks is INCORRECT for it states CONFLICTING information as to how they are to cover the absence(s).     

      The letter tells the person to "recertify" in one sentence because there's a suspicious attern.   The next sentence the letter states they are being asked to "recertify" because they "exceeded their frequency".   We asked well what is it?    Since they can't design a correct letter in the system, they are taking the "original recertification letter" and generically putting a new first sentence to it.     That letter also states that the employee has the ability of "SPECIFICALLY COVERING THE ABSENCE WITH A NOTE FROM THE DOCTOR ON THE DOCTOR'S STATIONARY", which should include the medical condition as referenced with the condition on file and that the doctor understands the absence dated _______ was incurred by the employee and is covering the absence for the employee for FMLA.  The company is stating they WILL NOT except a note from the provider.  We stated then GET IT OUT OF THE LETTER.  They can't do that because the
Information Technology people haven't fixed their ability to "construct" a correct letter to the issue at hand.

THEREFORE, I WENT ON RECORD THAT IF THE LETTER STATES I CAN SEND A NOTE COVERING THE SPECIFIC ABSENCE IN QUESTION WITH THE MEDICAL JUSTIFICATION OF THE CONDITION I'M CERTIFIED FOR AND THE DOCTOR STATES SUCH IN HIS/HER LETTERHEAD, THAT IS SUFFICIENT TO MEET THE REQUIREMENTS AND THAT ABSENCE(S) BETTER GET APPROVED.

 

For questions call Vicki Kintzer at 1-866-248-4449

 

If you receive a request for re-certification because of a suspicious pattern, please see a Union Representative immediately or call us at 302-999-1100

FMLA 1250 HOURS WORKED SETTLEMENT

 

THERE HAS BEEN SOME CONFUSION EXPRESSED OVER THE 1250 HOURS SETTLEMENT.  BELOW ARE SOME CLARIFYING POINTS.  CALL ME WITH ANY QUESTION VS. GUESSING THE ANSWER.  IF I DON’T KNOW, WE’LL FIND OUT.

 

The settlement provides that the satisfaction of the 1250 hour eligibility requirement will be determined on the first day of the first absence caused by or due to a chronic serious health condition.  The initial satisfaction of the 1250-hour eligibility determination shall apply to all subsequent intermittent absences due to that same Chronic Condition during the following 12-month period.  Once the Chronic Condition is on file with ARC, you’ve then met the 1250 hours worked requirement for a year from that initial certification period.  Example: I have an absence May 5, 2004 and ARC certifies me until May 5, 2005 for that Chronic Condition.  No matter what hours I’ve worked during that time, I still qualify for that condition to use part of my 12-week allotment.  BUT----After May 5, 2005, you must re-qualify under the eligibility rules all over again by 1) having some of the 12 weeks to use, and 2) ensuring you’ve worked 1250 hours in the year prior to the absence that’s occurring after May 5, 2005.  If you don’t have those 1250 hours, YOU CAN NOT get re-certified for that condition until you do.  Once you’ve re-established that qualification, you’re good for another year. 

 

When you call the supervisor to report your absence, you must tell the supervisor the absence is “RELATED” to a condition on file.  If you don’t, you could be deemed ineligible.  You would then need to appeal that denial.

 

Remember: While the 1250 hours are calculated on a rolling 12-month cycle, your 60 days or 12 weeks of FMLA protection is counted on a calendar year basis.

 

Secondary issue: Say you have a short-term disability, and your doctor covers it under FMLA, but the doctor doesn’t list the condition as chronic at the time to cover absences beyond the original disability.  You return to work and find you need physical therapy, radiation, have relapses to the condition, etc.  You may INITIALLY be deemed ineligible for hours worked.  DURING YOUR APPEAL, YOUR DOCTOR NEEDS TO WRITE A NOTE TO ARC EXPLAINING THAT THE CONDITION IS RELATED TO THE PREVIOUS DISABILITY AND IS CONSIDERED CHRONIC.  ARC should then allow you to send an Amended Certification to cover future absences for the same condition to avoid any confusion on the hours worked.

 

PRIOR DISCIPLINE UNDER RAP, THE COMPANY MUST REVIEW PAST ADVANCEMENTS

Don’t forget – You only get 60 days of FMLA protection each calendar year.

The only cases that the attorneys are handling are suspensions and terminations. 

According to our settlement, prior to any advancement to a higher Step on RAP, the supervisor should review the employee’s complete absence file to determine if the absences used in prior Steps should now be reversed.  NO additional discipline can apply until all prior absences have been considered under the terms of our Settlement Agreement, and the employee should be given an opportunity to have the past certification amended.  It’s best for the Union reps to get involved with the supervisor to ensure that prior absences are being handled properly.  It’s a possibility that Steps need to be removed.

 

ANY doubts, questions, please call Vickie Kintzer at 866-248-4449.  I will return your call if I’m not available at the time.

 

posted 2-23-05

 

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FMLA Settlement

 

CWA Local 13100 is extremely pleased to advise you that CWA has negotiated a settlement with Verizon regarding the way the Company determines FMLA eligibility for employees with chronic serious health conditions.  In the past, Verizon made new eligibility determination each time an employee with a chronic serious health condition was absent.  If an employee dropped below the 1250 hours worked in the proceeding 12 month period, Verizon deemed him or her ineligible for FMLA and the employee was stepped on the Absence Control Plan.  Some employees were suspended; some were fired.

 

CWA told the Company that we believed their practice violated the law and that we would consider a lawsuit if they did not change the way they administer FMLA leave in these situations.  Happily, CWA was able to convince the company to change their practice and we have negotiated an excellent agreement that we believe represents an important step in our efforts to achieve full compliance with the rights guaranteed by the FMLA.  Shortly, CWA will send out a detailed memo describing the Agreement and procedures that van be given to local officers and others involved in responding to member questions and pursuing grievances.

 

(posted 01-23-05)

Summary of FMLA Agreement

 

Effective November 1, 2004, the Company will change its administration of the FMLA 1250 hour eligibility requirement regarding employees with chronic serious health conditions.  The Company will not make the eligibility determination only once for a twelve-month period – at the time of the employee first absent due to such a condition.  This change is prospective in nature, affecting all employees who are absent with a chronic serious health condition beginning on November 1, 2004.  However, the Agreement also provides for relief for those employees who have already been harmed in some manner by Verizon’s old 1250 hour interpretation and who have filed grievances and/or DOL complaints about their situation at any time between May 19, 2001 and November 1, 2004, or who cases have not been referred to CWA Specialist, Linda Kelly

 

The agreement also ensures that anyone who received a step on the absence control policy resulting from the Company’s 1250 hour eligibility determinations during the period between May 19, 2001 and November 1, 2004 would have that step corrected in the future at any point that it causes them to suffer any harm covered by the contract (e.g., discipline, promotion, or transfer limitations).

 

CWA – represented employees with chronic serious health conditions who were suspended based on the Company’s determination that they had not worked the required 1250 hours prior to a related absence, and who had been found FMLA eligible for absence for the same chronic serious health condition within the prior twelve-month period, will be made whole.  They will receive back pay they lost and will have their files corrected to remove the disciplinary action and readjust their absence record to reflect a FMLA qualified absence.  They will also be credited with any lost work hours due to the suspension for the purpose of future 1250-hour eligibility determinations.

 

CWA – represented employees with chronic serious health conditions who were terminated based on the Company’s old 1250 eligibility determination will also be eligible for financial relief and/or reinstatement, as appropriate. Such employees will have an opportunity to participate in a binding review process, if their case is not going to be arbitrated by CWA under the contract or has not otherwise been satisfactorily resolved.  A neutral mediator will resolve each case brought to the binding review process using both FMLA case law and just cause principles.

 

(posted 01-23-05)

What you should know about FMLA

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NOTE: 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

FAX 610-921-4358

ARC 877-275-8947

MetLife 800-638-4228

 

PLEASE DO NOT SHARE “MEDICAL” INFORMATION

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?

The 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.

 

If, 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 Pin.  

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 certification?

 

You 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?

 

If 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.

 

Your 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?

Within 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.  

 

10.  Who do I call if the absence is greater than 7 calendar days?

 

The 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

                  Phone:  800-451-7336

 

 

 

 

 

 

 

 

 

15.  If I am receiving Worker’s Comp, why do I need to involve MetLife?

Based 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 pay status under either Sickness or Accident Plan, you will only receive your WC wages for they are usually greater than the 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?

 

Examples:

 

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.

 

Sect B:    List the patient’s name, relationship is self and Date of Birth

 

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.  

 

Any 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.  

 

Q1 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

 

Q2 First day of incapacity covered by this certification: __/__/__ (list the first date you became ill with the condition)

 

Q3 Probable last day of incapacity covered : ___/__/__  (can be covered for up to one year from the first date of incapacity)

 

Q4. 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. 

 

RESTRICTIONS:  

 

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. 

 

 

 

 

 

COLONSCOPIES:

      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. 

 (posted 01-23-2005)

Have you been denied FMLA because you have not worked the required 1250 hours?

 

If you have been certified for FMLA and have a later absence that should be  covered under your FMLA certification, you can not be denied.  When an employee of Verizon is out for FMLA that they have been previously approved for Verizon is “testing” the 1250 hour rule for that date of absence to see if that absence is eligible for FMLA coverage.  According to the U.S. Department of Labor (DOL) they can not do that.  The DOL says that once an employee is certified for FMLA for their FMLA covered condition, all future FMLA certified absences during the period of certification can not be “tested” for the 1250 hours worked the past year.

 

If this is happening to you, you need to do the following. 

 

Once you get your FMLA denial notice from MetLife, file an appeal immediately.  You have 14 days to do this, but do it immediately. 

 

State the reason for your appeal is that you have been certified for FMLA for this condition / illness.

 

State that you are cover by the FMLA law under section CFR 825.110(a)(1), CFR
 825.110(a)(2)
.
  Also state that  you are covered under section 29 CFR 825.114(a)(2)(ii) and 29 CFR 825.112(a)(4) and that you qualify for the duration of your certification period according to the law.

 

It is strongly suggest anyone who receives an ineligibility letter for an absence APPEAL that decision citing the above portions of the law.   You should call Vicki Kintzer our Health Care Coordinator at 1-866-248-4449 for a copy of the opinion letter she had back in Sept. 2000.    

 

This is the law as written.  It can be found on the internet at http://www.dol.gov/dol/allcfr/ESA/Title_29/Part_825/29CFR825.110.htm

Click here for direct link to US Department of Labor regarding FMLA

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