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Follow the steps for appealing the claim decision. Give a few sentences why the claim should cover the 2 additional weeks.
No option for appeal has been given to me. Neither has the examiner or his supervisor explained the reasoning for their decision. I don't know what to do.
I noticed that there are two approval letters in my matrixabsense file.
The first letters states:
06/21/2022 - 07/10/2022: Denied (Absence outside cert range), Family and Medical Leave Act
07/11/2022 - 07/24/2022: Approved, Family and Medical Leave Act
The second letter states:
06/21/2022 - 07/24/2022: Approved, Family and Medical Leave Act
I would like to clarify if I am approved for leave 06/21/22 - 07/24/22.
Thank you
Examiner (06/2/22)
The letter indicating approval from 7/11 through 7/24 is the correct letter. Your doctor noted that your procedure is scheduled for 7/11 and that you will need to quarantine prior to surgery. Per FMLA and Short Term Disability, the need to quarantine in and of itself if not covered under those policies.
Me (06/2/22)
That is disappointing.
I cannot help the fact that I need to travel to Taiwan for this surgery and Taiwan is requiring me to quarantine for this period prior to allowing me to have surgery.
Can you point me to the policy that states FMLA would not cover me for this period? Is there any way to work around it?
Examiner (06/2/22)
Good evening,
I understand that you are required to quarantine due to your condition and the location of your procedure however, the FMLA protects eligible employees who are incapacitated by a serious health condition, as may be the case with COVID-19 in some instances, or who are needed to care for covered family members who are incapacitated by a serious health condition. Leave taken by an employee solely for the purpose of avoiding exposure to COVID-19 is not protected under the FMLA. Therefore, according to the medical certification provided there will be no change in your ability to perform your normal job duties until the date of your procedure. This is not our policy. This falls under the guidelines that are directed to us by the Federal and State Departments of Labor. You can find further information regarding this at the Federal and State Department of Labor websites.
Me (06/03/22)
Thank you for providing an expanded explanation.
In reading your response, I get the impression that I have miscommunicated the preparation requirements for the medical procedure.
I will not be quarantined at home prior to the surgery. Rather, I am required by Taiwan’s government and the Chang-Gung memorial hospital to travel to Taiwan beginning 06/22 and must quarantine in their country for 1 week at a designated facility while I submit routine Covid test results. The second week is a semi-quarantine period during which I will continue to submit Covid test results while making several trips to the hospital to get various work up tests done prior to surgery.
As you can see the preparation and work-up process is stricter and more extensive than I originally communicated. I will as such not be able to perform my job duties during this time. For your reference, I have attached a complete guide to the quarantine and treatment protocol that must be followed.
Please understand that this is a major medical procedure and that this already a stressful time for me as I seek to resolve a medical condition which has haunted me for over 20 years. Contending with a claim denial presents additional hardship. I kindly ask that you consider the extenuating circumstances of the pandemic and international travel, and please reconsider approving my claim for the duration of the time I will be away from work.
I certainly am not asking you to expose yourself to any liability. If it would be helpful, I can ask the surgeon’s office to resubmit the medical certification form with more appropriate wording.
Thank you again. I do appreciate your time and attention to this matter.
Examiner (06/03/22)
Good afternoon,
I escalated your inquiry about your upcoming claim to my supervisor and it was confirmed that your leave cannot begin prior to the date of your procedure. My supervisor has been CCed on this email, so you can follow up with him directly for any additional questions regarding the claim decision.
Me (after speaking with supervisor over the phone) (06/03/22)
My discussion with (supervisor) did not reveal a substantial explanation for denial.
Merely telling me that quarantine isn't covered by FMLA does not appreciate the circumstances of the pre-surgical workup that I am being required to do. Neither of you have been able to cite any specific policy, nor precedent that has been set, that bars me from using the hours in my family leave bank for my medical treatment itinerary. My belief is that you may easily interpret this situation as being eligible for FMLA, but you are simply choosing not to do that.
I believe you are violating my FMLA rights. I will now be filing an additional claim with the department of labor.
Thank you for injecting a last minute hardship on me prior to surgery. Real class acts.
At the beginning, your Doctor supposed to write a note for you saying: "AirDroz is going to be absent of work from d/m/y to d/m/y due to medical reason". And you should just submit that note to your employer. You would not need to give any specific explanation due to PIPA (Personal Information Protection Act). If you gave too much information to your employer about this surgery already, it's too late to take it back.
FMLA is to protect you from losing your job for you to be absent of work for how many months. It does not cover to pay for everything for the whole time you are off work. If you have an immediate family member who is sick, and you need to be off to take care of that person, you can be off for how months, as your company's policy, but you don't get pay. If you have medical issue yourself and you need time off, then you get pay. Since if you told your employer that you will need two weeks for quarantine in Taiwan before the surgery, your employer can say that you are not sick during these two weeks, so you cannot get pay for the time off when you are not sick, no matter your reason is that is the Taiwan's government's law.
I understand you are upset and anxious because of the bad luck about your health, and you have sick leave accumulation through the years and at this time you need it (with pay) but your employer does not want to pay for the whole time you need to be off including the quarantine time. But employers' sick/medical leave policy is they pay you when you are sick, not when you are not sick. That's the way it is.
At my company, we are in Union, we are entitled for 1.5 day sick leave each month. Thus we have 18 days per year. Many employees call in sick a lot, and many other rarely call in. Many, many years ago, the Policy said for those who rarely called in sick, they would get pay for 70% of the sick leave accumulation when they resign. Then eventually, the employer changed to 50%. Then they changed to for only those who work till retirement, not for the ones who resign. And now, there's only payment for this sick leave accumulation to employees who started working from many years ago, no more for the ones who started from 2015. Everybody realizes that if you don't call in sick a few times a year, and by the time you resign or retire, you only get 70% or 50%, it's nothing (in amount of money) to compare with if you called in sick through the years. We don't even know if someday the company may change to pay nothing for sick leave accumulation anymore to those who rarely called in sick through the years.
Many years ago, our company used to give four days off with pay to employees who did not call in sick the whole year. Then they changed two days. Then gave $100 gift card instead of 4 or 2 days off. Then $50. Then now, there's nothing. I think they wanted to save those money to cover for those who call in sick often (I think the amount of money saved is nothing to be comparable). And now, soooooooo many people call in sick everyday. We are always short of staff. Employees who work hard are exhausted. Eventually, they call in sick also. Whoever call in sick a lot does not have to do much work and expect sympathy from the company. Whoever rarely call in sick and care too much will have lots more work to do, and then get burnt out and depressed eventually. That makes the hard-working, caring too much, think they are stupid. That is from my observation and experience.
Life is not fair. Who says life has to be fair, eh? Haha. That is upsetting. But what can you do? That's why so many good employees are dissatisfied and have become discouraged to go above and beyond.
Please do not say "Your company is toxic. Get out of there as fast as you can." LOL. It seems like everywhere is like this nowadays. It's hard to find a good company. And companies don't know how to find and keep good employees either. They just believe in smart A people who can sweet talk to their ears. They just want to hear what they want to hear. And soon, those people get in, earn some experience, and get out very fast. Or the ones who are in, they know how to sweet talk and bribe the higher-ups and co-workers, and can just sit there to socialize and talk about their sickness to get sympathy and call in sick a lot and still can keep their job. These employees have big influence on others also because many people are attracted to their "sweet" and "interesting" talks. These employees are like bad apples to spoil the barrow. But the employer cannot do anything about them.
I do have a few good leaders who are supportive to me, so I feel encouraged a little bit.
Last edited by AnOrdinaryCitizen; 06-04-2022 at 12:04 PM..
You might want to talk to an employment attorney asap in your local area that knows FMLA as well as your state guidelines on that time bank that you are dealing with. You already threatened your claim department that you would file a complaint with the Dept of Labor.
This attorney might assist you with what the correct FMLA rules are, and have that attorney get involved in the complaint and proper wording for a Formal Appeal and the attorney could assist with the wording of the appeal, perhaps quoting FMLA rules and how your situation meets the FMLA criteria. I would assume travel for surgery should be part of the FMLA days and in a nutshell, your travel for surgery is longer due to quarantine. Check with attorney ahead of time for cost to help you. Might be a few hundred dollars.
Did your employer approve the time off for the quarantine part? Sounds like it's not approved so could you be fired for leaving earlier? Can your employer allow you to work remotely from during the quarantine period, from the hotel?
You might want to talk to an employment attorney asap in your local area that knows FMLA as well as your state guidelines on that time bank that you are dealing with. You already threatened your claim department that you would file a complaint with the Dept of Labor.
This attorney might assist you with what the correct FMLA rules are, and have that attorney get involved in the complaint and proper wording for a Formal Appeal and the attorney could assist with the wording of the appeal, perhaps quoting FMLA rules and how your situation meets the FMLA criteria. I would assume travel for surgery should be part of the FMLA days and in a nutshell, your travel for surgery is longer due to quarantine. Check with attorney ahead of time for cost to help you. Might be a few hundred dollars.
Did your employer approve the time off for the quarantine part? Sounds like it's not approved so could you be fired for leaving earlier? Can your employer allow you to work remotely from during the quarantine period, from the hotel?
I'm going to call the department of labor on Monday and file a claim. I spoke with them this past Friday and they said the FMLA should be approved and to call back and file a claim if it isn't.
My employer has approved the time off for the duration of my trip. However, I'm not sure if that approval is contingent on my FMLA being approved. I doubt it will be a problem if I ask to use PTO time instead, but you never know.
No, I can not work remotely. My work requires manual labor.
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.
The OP is getting PAID family leave under the mandatory family leave policy in NYS. Interestingly, no where does it say you can use paid family leave for one's own illnesses.
"As of January 1, 2018, paid family leave is mandatory in New York State. Almost all employees are eligible for paid family leave, and employers must give their employees paid family leave.
Paid Family Leave allows for employees to take paid time off work to care for family members who are very ill or have a serious health condition. Family members include:
Spouses, of any gender;
Domestic partners, of any gender;
Children;
Parents;
Parents-in-law;
Grandparents; and
Grandchildren;
Siblings (starting in January 1, 2023)
Serious health conditions are illnesses, injuries, impairments, or disabilities that involve inpatient care in a hospital or other health facility, or continuing long-term treatment. Temporary minor conditions such as the flu, cold, earaches, upset stomach, or routine care do not meet this definition.
Employees may be eligible to take up to 12 weeks of Paid Family Leave at 67 percent of their pay, up to a cap. Employers can allow employees to take vacation or sick leave so that the employee can earn a full salary. However, employers cannot require employees to take vacation or sick leave for paid family leave.
Also, these benefit payments are non-wage taxable income, but your employer will not automatically withhold taxes from these benefits; you may request voluntary tax withholding. They are reported as 1099 income.
'
The OP is getting PAID family leave under the mandatory family leave policy in NYS. Interestingly, no where does it say you can use paid family leave for one's own illnesses.
.....
'
I am not going out on NYS paid family leave. I am seeking to go out on FMLA.
NYS paid family leave is a NY state program which I am not eligible for.
FMLA is a federal program which I am eligible for.
Looks like you may have giving too much information to the employer.
Im in NYC, when i need FMLA, the doctor signs the paperwork, there is some privacy for the worker. One is entitled to 12 weeks fmla per year.
Since you have a STD claim with the FMLA , this get slightly complicated.
You can take time off without pay, then the FMLA which includes recovery time. Employer cant force you to use your hard earned benefits when they decide, its for you to use when you decide!
Sure they can. Most of my employees have required all accrued paid time be exhausted before time off without pay was possible. You don't get to save your time bank to take even more time off later because you "prefer" to use it for something different.
Yes, I agree with the previous poster. I remember my employer made me use some of my accrued paid time off. I do not remember all the details, but it stands to reason that you cannot expect to take off for 12 weeks of FMLA and then take 4 weeks of vacation. Remember all of this affects your department a lot. Your coworkers have to do double work because you're out.
I would assume travel for surgery should be part of the FMLA days and in a nutshell, your travel for surgery is longer due to quarantine.
and that assumption would be wrong.
If you read all the DOL interpretive letters and court rulings regarding this issues, clearly 825.114 excludes travel quarantine. Unless the quarantine meets the "continued health care" provision of FMLA (medical procedures or testing are being performed as part of that medical quarantine such as on those who contracted a disease) government impose travel quarantines are not covered. Even under those continued health care provisions for procedures and testing while quarantined, it must be under the continued and active care of a health care professional.
In other words, the medical professional and only the medical professional is imposing the quarantine as part of and within a health care facility as part of the standard recognized treatment. If the quarantine is required because the government requires it, (even on those with no heath visit purpose), its a travel quarantine, not a mandated medical procedure. So, based on FMLA regulations, it's not covered.
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