Continuation of health insurance for employees on medical leave – Monterey Herald

Question: I have an employee who was off work for six months with a workers compensation injury. What is my obligation to continue to place this employee in the company’s health insurance plan?

Answer: An employee on medical leave due to a work-related injury may or may not be entitled to continued health insurance under the same terms as if the employee 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 designate the first 12 weeks of the employee’s leave based on a work-related injury as FMLA and/or CFRA. Employees on FMLA or CFRA leave are entitled to health insurance benefits for 12 weeks under the same terms and conditions as employees continuing to work. After FMLA and/or CFRA expires, the employer must engage in an interactive process with the employee to determine whether additional leave is a reasonable accommodation. Under California’s Fair Employment and Housing Act, medical disability leave is a reasonable accommodation as long as the additional leave enables the employee to return to work, and the leave does not cause an undue hardship to the employer. Also, if your injured employee is pregnant, the employee will likely be eligible for up to 4 months of pregnancy disability leave and an additional three months of CFRA leave for child custody. In that case, the employee’s company may continue the health insurance benefits for up to seven months.

After the expiration of 12 weeks of FMLA/CFRA leave, or up to seven months of combined pregnancy disability leave and CFRA child bonding leave, the health insurance plan document will determine how long the employee’s company-provided coverage will last. You can contact your insurance broker or review plan documents to determine when an employee is ineligible for coverage. Many policies state that after three or four months of medical leave, the employee becomes ineligible to participate in the plan as an active employee. At that time, unless the employee is on protected pregnancy disability leave or CFRA child bonding leave, the employee’s company health insurance coverage will cease, and the employee will be offered health insurance continuation at the employee’s expense through the Consolidated Omnibus Budget Reconciliation Act. A reduction in employee hours is a qualifying event under COBRA, and your health insurance broker or plan administrator can help you terminate coverage for the employee and offer continued coverage under COBRA.

Employers sometimes believe that employees on workers’ compensation leave are entitled to health benefits indefinitely, but they are not. Employers sometimes forget that medical disability leave due to a work-related injury or illness is handled like other disability leave and will run at the same time as leave granted as a reasonable accommodation under the FMLA, CFRA, and FEHA.

For more information about family and medical leave, and pregnancy disability leave, visit https://calcivilrights.ca.gov/family-medical-pregnancy-leave/

Sarah Boynes 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 questions to [email protected].