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FMLA AND DISABILITY FREQUENT QUESTIONS_

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FMLA AND DISABILITY FREQUENT QUESTIONS_ Powered By Docstoc
					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.


     FMLA AND DISABILITY FREQUENT QUESTIONS:

                      Gates McDonald 866-453-2837
                            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.




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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.




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   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




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   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




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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 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?

   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)




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    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.



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    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.



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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.




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