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No. As per what I have already described, and per your own words above, the quarantine is specific and mandated as part of the treatment itinerary.
Is it the medical facility imposing the required quarantines? If it's a medical quarantine required specifically for your treatments monitored by your treating physician, that's different from a quarantine mandated for entry to the country regardless if medical or tourist or other. So you need to be specific as to who is mandating the quarantines and why.
Quote:
Originally Posted by AirDroz
If dates of travel are to be accepted as part of the claim, then why is their approval start date on the date of my surgery? Why aren't they giving me a few more days of buffer?
Buffer? there's no such thing under FMLA. It's the dates of required medical care, nothing more, nothing less. The reason travel is generally accepted (although not actually written in the law) is because of availability. If a medical professional states your care is needed in Arizona, your direct travel to AZ to get care is covered. You don't get the days between travel and care, only the travel days. And the courts have stated that if during the travel you do anything personal as part of that travel, it voids the travel as covered.
Quote:
Originally Posted by AirDroz
It is the asshat claims processing company, Matrix Absence Management, which is making this difficult and not providing an explanation for their decision.
Aahh so there's a compliance management component involved. It's highly likely that what you were initially given and submitted with your request was sent to the providers for compliance verification and what was sent back required the change in approval dates. If the providers never mentioned anything about travel, quarantine, pre treatment testing, etc., those dates are out the window.
Is it the medical facility imposing the required quarantines? If it's a medical quarantine required specifically for your treatments monitored by your treating physician, that's different from a quarantine mandated for entry to the country regardless if medical or tourist or other. So you need to be specific as to who is mandating the quarantines and why.
Buffer? there's no such thing under FMLA. It's the dates of required medical care, nothing more, nothing less. The reason travel is generally accepted (although not actually written in the law) is because of availability. If a medical professional states your care is needed in Arizona, your direct travel to AZ to get care is covered. You don't get the days between travel and care, only the travel days. And the courts have stated that if during the travel you do anything personal as part of that travel, it voids the travel as covered.
Aahh so there's a compliance management component involved. It's highly likely that what you were initially given and submitted with your request was sent to the providers for compliance verification and what was sent back required the change in approval dates. If the providers never mentioned anything about travel, quarantine, pre treatment testing, etc., those dates are out the window.
-The government of the country is requiring quarantine and the hospital has integrated the quarantine requirement into the workup process prior to getting surgery. I'd be very suspicious of someone going into that much detail when deciding whether to approve the claim or not. You are splitting hairs and at that point just actively looking for a reason to make my life harder. It is completely ridiculous.
-Your point about the travel dates is fair. Thank you for clarifying how that works.
-Everything was fine until the asshat claims examiner saw the word "quarantine" on my medical certification form. The surgeon's office explained that there was a quarantine period REQUIRED prior to surgery. As soon as the asshat saw that word and realized that quarantine in and of itself isn't covered by FMLA, he went ahead and denied my entire workup period prior to surgery. He completely neglected the fact that it is a part of the process of getting the surgery. He is wrongfully applying the rule.
Mod cut. It would be no skin off your back to just approve the claim and let me go on with my life and focus on the major medical procedure I am about to go through. None at all, but you HAVE to find a reason to make it difficult for me and stress me out further at a critical time in my life. Mod cut.
Last edited by PJSaturn; 06-04-2022 at 10:41 AM..
Reason: Personal attacks; name calling.
I am actually not aware of that being a thing. But this situation affecting me certainly makes me sympathize with those women.
Or women and men who have to use it all for their own illness (yes, I've known people who've lost jobs because they've had an illness or surgery that had them out of work longer than 12 weeks, or who had to go back to work sooner than they should've after injury or illness because they don't have any leave left and can't afford to not get paid), or to care for a family member. Certainly not exclusive to pregnancy. (Oh, and none of these people got special "family" leave-- it was sick leave, and vacation time, and that was that-- when that ran out, it was either get back to work or don't get paid.)
Quote:
Originally Posted by AirDroz
[Snip.] It would be no skin off your back to just approve the claim and let me go on with my life and focus on the major medical procedure I am about to go through. None at all, but you HAVE to find a reason to make it difficult for me and stress me out further at a critical time in my life. [Snip.]
Well then. That's certainly going to make other people want to help you.
Or women and men who have to use it all for their own illness (yes, I've known people who've lost jobs because they've had an illness or surgery that had them out of work longer than 12 weeks, or who had to go back to work sooner than they should've after injury or illness because they don't have any leave left and can't afford to not get paid), or to care for a family member. Certainly not exclusive to pregnancy. (Oh, and none of these people got special "family" leave-- it was sick leave, and vacation time, and that was that-- when that ran out, it was either get back to work or don't get paid.)
Well then. That's certainly going to make other people want to help you.
I sympathize with those individuals. Goes to show the importance of family. FMLA and governmental protections can only do so much. When all that runs out you need people there for you who are willing to help.
That poster isn't helping. I shouldn't of said that though. I'm sorry.
That poster isn't helping. I shouldn't of said that though. I'm sorry.
Actually, they were explaining to you what is going on with your situation and why things are happening the way they are, so... yes, they were helping.
Actually, they were explaining to you what is going on with your situation and why things are happening the way they are, so... yes, they were helping.
I am not blaming my employer. My employer is actually so far supporting me and saying they believe I should be eligible for FMLA benefits the entire time I am out for the surgery. It is the asshat claims processing company, Matrix Absence Management, which is making this difficult and not providing an explanation for their decision.
I'm confused as to why there is an outside entity involved in this at all. When I used FMLA to adopt my two children, the whole process was entirely done in-house with my employer. I was entitled to use up to 12 weeks of leave per occurrence (in separate years), and that's what I did. It was unpaid, of course, which I knew going in. But I never had to deal with anyone other than my employer. Maybe it's different between adopting a child and having a medical procedure? I don't know.
I'm confused as to why there is an outside entity involved in this at all. When I used FMLA to adopt my two children, the whole process was entirely done in-house with my employer. I was entitled to use up to 12 weeks of leave per occurrence (in separate years), and that's what I did. It was unpaid, of course, which I knew going in. But I never had to deal with anyone other than my employer. Maybe it's different between adopting a child and having a medical procedure? I don't know.
A lot of companies use outside companies to handle all employment leave requests.
It is actually something along those lines. I will be having my sympathetic chain worked on. It is a fairly major procedure. There are 2 surgeons in the US who perform it, both have poor results. I had the procedure done by one of them 3 years ago and it was a failure. I am now having to have a redo attempt which makes me a high risk candidate.
The claim examiner initially approved the leave. At one point last week, he must have noticed the word "quarantine" in one of my claim forms and decided to be an asshat and pull the rug out from under me 2 week before I am scheduled to leave and reissued an approval letter that does not cover the full time I am out.
As another poster said, too much information was shared with him.
It's not something I'm familiar with. I have a google page up, I'll have to read about it. I'm surprised I've never heard of it with all of my spine issues.
I can't even imagine having any kind of spine surgery in another country because just sitting on the plane would kill me. I hope your surgery is a success.
Quote:
Originally Posted by AirDroz
Maybe. I'm too upset right now to think straight.
You owe them an apology because they were trying to explain to you why and why not with quarantine because they know the FMLA better than anyone else posting.
You're stressed out due to this, so you are reading it with that kind of tone in your head that you can not read it neutrally to see all they were doing was giving you advice.
Hopefully they will come back and try to help you out more so you can get this figured out.
Since there is no paycheck when you take FMLA, does it really matter if they cover that quarantine? It's just shown as time out verses FMLA approved time out of work.
I'm confused as to why there is an outside entity involved in this at all. When I used FMLA to adopt my two children, the whole process was entirely done in-house with my employer. I was entitled to use up to 12 weeks of leave per occurrence (in separate years), and that's what I did. It was unpaid, of course, which I knew going in. But I never had to deal with anyone other than my employer. Maybe it's different between adopting a child and having a medical procedure? I don't know.
And that's the difference. The OP is complaining that his employer won't provide paid leave for his period of quarantine and the OP doesn't want to use his own PTO.
What's confusing to people is that the OP's issue really has nothing to do with the federal FMLA with which most people are familiar, but rather is specific to a NY program that provides paid family leave under similar circumstances to the federal act.
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