Paid Leave – What Is It and How Does It Work?

Employees who want to learn more about how the Family Medical Leave Act, short- and long-term disability insurance, and paid leave help them protect their jobs – and receive an income – when they cannot work due to illness or caregiving responsibilities need to look no further than listening to this podcast.

Carol
Harnett
, president of The
Council for Disability Awareness
, interviewed Heather Cook from Lincoln
Financial Group
who is an expert on disability insurance, and paid and
unpaid leave.

If you’d rather read than listen, we captured the transcript
from the conversation below.

Carol Harnett: Hello! My name is Carol Harnett and I am the President of The Council for Disability Awareness. We are a nonprofit group whose mission is to educate employees and working adults — along with their employers and financial advisors — about benefits in general, the importance of income protection, and how people can insure their income so if they need to leave the workplace — most for a temporary period of time; some for a long-term period of time — they can still receive an income stream.

October is open enrollment month for us and for many people that are listening on the show. Our aim today is to provide people with a real primer – a step-by-step explanation of how leaving the workplace can operate particularly from the point of view of protecting your job number one, and number two receiving an income while you’re gone.

I’m really pleased to have someone who is a specialist in this area. My guest today is Heather Cook. Heather is a regional vice president for short-term disability and leave operations at Lincoln Financial Group

And we are happy to say that Lincoln is a member company and a supporter of The Council for Disability Awareness, and we thank them for that.

Welcome, Heather. I’m so pleased to have you on the show today.

Heather Cook: Very happy to be here. Thanks so much for having me

CH: Oh, it’s our pleasure. So, Heather, let me set the stage again.  Everyone is welcome to listen, but our real audience today are indeed employees and working adults. One of the things that captured my attention in 2017 was this: The Pew research group simultaneously did two surveys of Americans in general. This survey goes beyond working adults. They essentially asked them what benefits they thought were important for employees to receive, what the most important benefits were, and then asked very specific questions around paid leave.

And what was most interesting to me is that 85 percent of Americans believe working adults are entitled to paid leave for their own serious health condition. A slightly smaller percentage believe people should also receive paid leave for caring for a family member other than a child.

And then the lowest ranked category by the general American public was paid leave for the birth or adoption of a child. Following the Fall 2018 election, The Society for Human Resource Managers predicted that with a large group of women and minorities joining House of Representatives that paid leave is going to become an important topic again.

Heather, can you start where the concept of leave often started, which was in the in the 1990s with the passage of the federal Family Medical Leave Act and, since then, state, city and municipality leaves. Can you explain to people what protection exists for people who work who need to leave the workplace?

HC: Absolutely.
Yes. Thanks so much for the introduction there. So, the Family and Medical
Leave Act (which you’re right started back in 1993) is really a means to offer
employees 12 weeks of job protection within a 12-month period for very specific
qualifying reasons. If an employee needs to be out of work to care for a new
child, to take care of someone in their family with a serious health condition,
or for their own personal medical condition, then they can take FML.

FML applies as long as they work for an employer who is eligible. Basically, that means any company with about 50 employees or more within a certain radius. So, it’s a good benefit that is well-known and common, but it doesn’t apply to everyone. Employees really need to know and understand what the eligibility requirements are to qualify for the Family Medical Leave Act and in what situations it applies.

And it’s important to note as well that while FMLA is widely available, it is an unpaid leave. It protects your job while you’re out of work, but it does not guarantee you that income protection piece that so many of us are in need of and looking for when we have to take time off due to a stressful situation.

CH: Thank you for
that overview, Heather. I think some people forget that your employer has to be
of a certain size before some of these benefits and protections that we’re
going to be talking about apply. I think people are familiar now with some
aspects of leave because of all of the coverage in the media.

Can you comment for any employers that might be listening on the concept of intermittent leave? Can you explain to people a little bit about what that means and how that works?

HC: Absolutely. So intermittent leave is really beneficial to employees who have to be out of work for either treatment of a medical condition or because they are under a medical condition that just doesn’t allow them to perform their job duties, but it’s not on a continuous basis.

So maybe it’s a sporadic condition that flares up every now and again, and the employee needs to be out of work more sporadically either to attend treatment or to just deal with those flare-ups that pop up every once in a while. The Family Medical Leave Act does provide an option for employees to be out of work intermittently in addition to a continuous block of time.

And basically what happens then is they would just need to report the time that they are out of work to their employer or to their insurance carrier to make sure that the time is tracked against their overall bank of time. And, of course, it has to be supported either by a medical provider, or if they are out caring for a family member, have the appropriate documentation that indicates an intermittent time from work is what’s required and necessary for the life event the person is going through.

CH: Thank you for explaining intermittent leave, Heather, because I know people get quite confused about that benefit. It is a good benefit for people going through treatments or having to intermittently take care of a loved one.

So maybe we should walk through next how employees can get the most out of leave benefits and employee benefits such as short- and long-term disability.

Let’s start with short-term disability. Can you help employees understand the difference between FMLA and a short-term disability plan?

HC: Sure. So FMLA, as I mentioned is really the job protection portion of your time out of work. It guarantees that when you’re able to return to work after you have a FML-protected absence that you have a job to come back to. But, remember, it doesn’t provide income replacement.

Short-term disability is going to be that benefit that provides you with a certain percentage of your pay for a defined number of weeks as long as you have restrictions from your own medical condition that prevents you from doing the core duties of your job or your occupation.

FMLA and short-term disability really work hand-in-hand to provide a more holistic benefit to the employee so that they don’t have to worry about their job protection or their income while they’re out of work. But it’s important to note that while there are some states that have mandated disability leave laws in place, most of the time short-term disability benefits are offered through an employer benefit plan.

And it’s very important as you’re going through open enrollment period to pay attention to what options you have from a disability perspective and whether that’s employee- or employer-paid, and really how much you can expect from a percentage of pay and a number of weeks benefit if you have to go out of work due to your own medical condition. 

CH: Heather, I’m really glad you brought that up because I think it’s a wonderful thing when employers provide and pay for our short-term disability benefits. But one of the things I think employees don’t realize until they have to use the benefit is – because the employer paid the premiums – that, when they receive the benefit, it is taxable.

HC: Absolutely,
and for employers who may be listening, this is an important time to talk about
the fact that it’s important for them to consider if they are going to be
generous and pay all the premium. If they are, they should consider providing a
larger percentage of coverage.

CH: Great point,
Heather. Can you talk about how part-time disability or intermittent disability
might work under STD?

HC: Absolutely. So, it depends upon whether your policy covers partial disability benefits. A lot of employers do offer it, which I think is a great benefit because what it does is incentivizes you to get back to work more quickly. I think it’s great when employers meet employees halfway and say: We don’t need you to be fully functional at a 100 percent to come back to work. Or, if it’s a day here or there, you can only work part of the work week, that’s fine. 

With a part-time or intermittent work provision, employers and the disability carrier work with you to make sure you can ease back into work in a way that is beneficial to you and really takes care of your health. Employers don’t want employees rushing back too soon and putting their own health at risk.

So, partial disability really allows for the employee and the employer to work together in a manner that is most beneficial and advantageous really to both sides and allows employees to work more of a partial schedule – whether that be 4 hours a day every day or maybe just a couple days a week until their medical condition allows them to ramp back up to full capacity. During that time employees are reaping the advantage of getting a little bit of income from their actual wages at work and then disability insurance is picking up a good portion of what’s left – sometimes up to 100 percent of your salary.

But even if it’s not 100 percent, at least it’s a little bit extra money to work with while you’re still out on disability.

CH: Great! Thank you for that overview, because, again, I feel like we never talked about some of the really helpful benefits that a lot of people have under short-term disability.

HC: I was just going to stress the importance of employees having a conversation with their managers and their HR benefits team when they’re ready to come back to work, because your employer might be willing to support you in a partial capacity. So, if you’re not sure, it doesn’t hurt to ask.

CH: That’s a really good point, Heather, as often claims examiners who are working on the claim will help with the process of setting up a partial return to work.

Since we’re talking about disability, let’s talk about long-term disability insurance. For people who are listening that are not familiar with long-term disability coverage, it’s worth going over some insurance terms.

There is a predetermined length of coverage for short-term disability that includes something called an elimination period. This is a waiting period for benefits. With short-term disability policies, an elimination period can be five, seven, 15 or 30 days – or another defined period of time. It depends upon how your employer designed the plan with their carrier. Long-term disability coverage usually has a three- or six-month elimination period.

Heather, can you explain for people some of the differences between short- and long-term disability, and how they could prepare potentially for using LTD benefits?

HC: Yes, absolutely, Carol. Once the short-term disability claim is coming to an end in terms of that defined duration, an employee’s case manager will reach out and let them know that they’re approaching the start of a possible long-term disability claim – if they have that benefit available to them. LTD is used a lot of times for absences related to chronic conditions that run a little bit longer than 3 to 6 months. Or maybe there’s a longer recovery time associated with a major surgery, or something of that nature and employees just need a little bit longer period of time to recover.  

Other times employees are on long-term disability for an indefinite period of time and even up until retirement age. So, long-term disability coverage is really serving a lot of different needs for a variety of individuals. One thing to note with long term disability is the percentage of pay that you get may be different than what you received during your short-term disability claim.

It’s important to just be aware of what your specific policy covers and the percentage of pay it replaces, as well as any applicable offsets that might be taken from your benefit.  For instance, if you’re required to apply for Social Security benefits, that may be a deduction from your long-term disability payments. LTD can get a little bit more complicated in terms of understanding the benefit. This is why it’s really important to do your research ahead of time and know what your policy covers and what you can expect in terms of income replacement.

The other thing that is sometimes different in long-term disability is the way that your claim is evaluated. During short-term disability, we’re really looking at whether or not you can perform your job as you did it for your employer before you went out of work. But in long-term disability, a lot of times we’re looking at whether you can do your occupation as it’s understood in the national economy.

Taking that a step further, LTD broadens the definition of disability to see if there’s any other place you could get back to work in a similar occupation. The threshold for meeting long-term disability benefits is sometimes a little bit different and I think that’s important for employees to be aware of.

CH: It’s very important, Heather. It might sound like a negative to some listeners, but I always remember when I was involved in claims one of the examples we would give people to understand was this: A cashier at a traditional supermarket for lack of a better term where you’re not moving or swiping large boxes like you would as a Costco cashier, or any of the other big box container types of stores, is classified the same way as the Costco cashier. But the Costco cashier may have different physical requirements. So, in long-term disability, the way the cashier job is classified for a regular supermarket becomes the definition used for the Costco cashier during LTD. 

Vocational rehab counselors often get involved in cases like the one I just described or in cases where someone can’t go back to their own occupation at all. The counselors assess the out-of-work employee’s skills for what we would call “transferable skills” that they could use potentially at a new job or a new occupation.

HC: Vocational resources can be a huge help to claimants, and they’ll even go as far as helping you with your resume if you’ve been out of work for a while, and really helping to identify what a comparable occupation might look like. Vocational counselors leverage the skills, training and experience that you have to make sure a new job or occupation is the right fit for the person who’s out of work. 

CH:  A lot of people in the United States might not know that there’s a group in the UK which is similar to The Council for Disability Awareness called the Income Protection Task Force. They did a study called the 7 Families Project where they helped seven people who did not have disability benefits and paid them a benefit for a year. They also gave them all the services that come with a long-term disability or individual disability policy, including vocational rehabilitation services. It turned out that the most important benefit was the vocational rehab counseling. Five of the seven people in the program were back to work in less than a year. Personally, the 7 Families Project is such a great example of how important vocational rehabilitation benefits are.

I want to move on to the thing that really is in the news. We have a good chunk of the 10 remaining minutes to talk about “paid leave.”

For people who work for employers, you should know that there are sometimes different levels of protection and generosity under the various kinds of family medical leave. The most generous one is the one that’s always applied to your situation by your employer. 

Sometimes you might live in a city or a state that has a more generous set of leave regulations than the federal law does. The most generous provisions always apply to you and your situation.

So, to review, we have unpaid leave that protects your job when you can’t work. Not everyone has short- and long-term disability benefits, but we know that at least a third of people have long-term disability provided by their employer. And at least 40 percent have short-term disability benefits provided by their employer – meaning that their employer pays either all of the insurance premiums, or pays a portion of them.

From there, we move to paid leave and this idea that if people leave the workplace they actually receive compensation. Heather, can you start to walk us through the basics of paid leave and how that works –  let’s say starting with your own health condition?

HC: Yes, absolutely. Starting with your own health condition and thinking about paid leave – there are a few states across the country that offer a paid leave program and mandate that employers that operate in those states provide it to their employees. States like California, New Jersey, Rhode Island and, most recently, New York all have their own paid family leave benefits. They can be used typically for your own medical condition, to bond with a child, or to care for a family member. Paid leave is becoming more and more prevalent.

Let’s walk through paid leave for your own medical condition for a minute. I think one of the most basic and common forms of paid leave is simply using your sick and vacation time. I think that’s often overlooked because we hear a lot more about these about paid leave programs that are starting to roll out lately and are getting more and more popular. But sick and vacation time are more prevalent – a lot of employees have access to them. I would say more and more employees do have access to some type of paid sick or vacation time that they can draw from and utilize that to supplement their job protection under FMLA or unpaid state leave.

Paid sick or vacation time is definitely an avenue for people to pursue if they need to take time off from work for their own medical condition and they don’t have access to other benefits that we just walked through.

CH: You’ve made a really important point, Heather. Some employers require that their employees take at least some of their paid time off or vacation or sick leave before they access FMLA or while they’re accessing FMLA. Is this still a requirement? 

HC: It can be, Carol. It’s really at the employer’s discretion. We still see a lot of employers who require employees to utilize some of their PTO time before as they go out on FML. But it’s not required across the board. Some employers elect to just allow employees to hang on to that time.

CH: This is a good example of another question employees should ask their employer during open enrollment. 

HC: It’s really important that employees understand how all their leave and disability benefits work together because a lot of these options that we’re talking about today overlap with one another and can create a complicated landscape. And not one that you really want to be trying to navigate for the first time when you have a life event. The more you can think about what you would do if you couldn’t work ahead of time, and plan and ask questions and do your research, the more confident and comfortable people will feel should they have to utilize these benefits in the future.

CH: That’s a great summary, Heather. Can you walk people through an example now about how they would coordinate their benefits if, for example, a woman is going to go out of work on maternity leave?. How does she coordinate FML, short-term disability, paid leave and even vacation or sick time? 

HC: Absolutely. The first step is really to let your employer know that you need to take time off from work. From there, your employer can point you in the right direction to file the appropriate benefits. Some employers manage this process in-house.

It may simply involve going to your HR department and filing a formal leave of absence. You can do this ahead of time and don’t have to wait until you’re in the delivery room to move forward with a claim request. Doing this well in advance can provide you peace of mind.

If your employers use a disability or leave carrier to manage pregnancy claims, typically all you have to do is make one call to get that process going. Then the case manager who’s assigned to help you through that process will reach out and have a conversation. They’ll let you know if you meet the eligibility requirements for the benefit. They’ll explain how different benefits such as disability and paid parental leave may overlap with one another. They’ll also tell you what documentation you might need to supply in order to get those benefits approved. 

The key questions you would want to ask in preparing for something like having a child is what percentage of my pay would I receive if I’m out on these benefits? How long can I use my bank of time, and how do I know if I’m eligible? And then, finally, what paperwork do I need to submit?

CH: Thank you, Heather. So, as we close down our conversation, what can we walk people just briefly through about taking a leave for the care of a child, or for the care of another loved one (where that is covered)?

HC: So more and more we’re seeing family members take time off not for themselves, but to care for a new child or for a family member. A lot of these leaves are now being covered not just by FMLA and state leaves (which we know are unpaid). A lot now is covered under some type of paid family leave program.

It’s important to also ask the question of whether or not your employer has benefits that cover you to take that time off. The process is actually very similar to filing a claim for your own medical or health condition. The first step is really making sure that your employer is aware of your need for time off, determining whether you meet the eligibility, and having the benefits available to you. Then you submit whatever paperwork is required, which is typically a birth certification or a medical certification form to document that the family member is in need of care, or that you recently had a child to bond with.

It’s not a whole lot of burden of proof on you. It’s more about completing a couple of forms and confirming the dates that you’ll be out of work with your employer. The process really can go pretty smoothly from there.

CH: We’ve talked a lot about how you can prepare ahead of time for filing a claim. But what happens to someone who perhaps has an accident or something they haven’t planned? And let’s say it’s not a minor accident – it’s a bigger accident. And they wind up hospitalized for a short period of time. How do they go about filing a claim? Can someone who is a relative or a friend start a claim process for them? 

HC: Sure, life happens certainly, and there are going to be situations that come up that we don’t expect. So employers and insurance companies really try to make it as easy as possible for that person to get the help they need when they need it. Anybody can file a claim on your behalf. A lot of times even your employer can do it for you.

It’s really just making sure you have the phone number to call. Other people can call in that claim or leave request on your behalf and get the process moving. Then your claim case manager (whether they be at your employer or with the insurance company) will do all of the heavy lifting after that. They will make the phone calls to the hospital, confirm your admission, and get any medical records that might be necessary.

It is possible if you’re incapacitated, or not able to advocate for yourself, that your claim can continue to move on and you get the benefits you need by other people helping you and being advocates on your behalf.

CH: Thank you so much, Heather, for your time and the great information you’ve provided on family medical leave, short- and long-term disability insurance, and paid leave. I know our listeners have learned a great deal. 

HC: Thanks very much for having me. I appreciate the opportunity to be a guest on this show.

CH: As a reminder for our listeners, you can access more information on the topics we discussed today at either realitycheckup.org or disabilitycanhappen.org