2.04 – Leaves of Absence

Family Medical Leave Act (FMLA):

A. Definition of Family and Medical Leave

The Family and Medical Leave Act of 1993 (FMLA) allows eligible employees to take unpaid, protected leave from their jobs in instances where the employee or the employee’s qualified family member has a serious medical condition (including pregnancy or adoption of a child) or where an employee’s qualified family member is a member of the armed services and becomes ill or injured while on active duty or receives an impending call or order to active duty status in support of a contingency operation.

B. Eligibility Requirements for Employees:

1. The employee must have completed a minimum of 12 months of service in the previous seven (7) years, consecutive or otherwise.
   
2. The employee must have worked a minimum of 1,250 hours in the previous 12-month period preceding the start of the leave.
   
3. There must be at least 50 employees of the company regularly working at locations within 75 miles of the employee’s work location.

C. Amount of Leave That May Be Taken:

1. For serious medical conditions, the employee is permitted to take up to 12 weeks of unpaid, protected FMLA leave.  The leave can be used all at once or intermittently, however, the employee may not use more than 12 weeks of FMLA in a 12-month period that begins with the first date of each designated Family and Medical Leave looking backward from the first date of leave.  (If the employee has exhausted leave and is still unable to return after 12 weeks, please refer to the Policy sections M and O below for details)
   
2. If the employee must take leave to provide care to a covered service member’s injury or illness, the employee is eligible to take up to 26 weeks of leave (outlined below). 
   
3. FMLA Leave may be taken in as little as one (1) hour increments

D. Calculation of Leave

The company will use a rolling year system for counting how much FMLA leave an eligible employee is entitled to.  When an employee requests FMLA leave, the FMLA Administrator will look back to the 12 months preceding the date of the request and see how much FMLA leave was taken during that period.  For example, if an employee needing leave for serious medical condition has taken 8 weeks of FMLA leave during the previous 12 months at the time they request FMLA leave, then the employee would have 4 weeks of FMLA leave remaining.

E. Reasons for Taking FMLA

1. The serious health condition of the employee or the employee’s spouse, child^[1], stepchild, parent, stepparent, legal guardian, or other persons that stand in place of a parent (in loco parentis).  A serious medical condition must satisfy one of the following:
   
   • Hospital Care:
     Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity[2] or subsequent treatment in connection with or consequent to such inpatient care.
     
   • Absence Plus Treatment:
     A period of incapacity of more than three (3) consecutive calendar days (including any subsequent treatment or period of incapacity relating to the same condition) that also involves
     1. Treatment[3] two or more times by a health care provider, by a nurse or physician’s assistant under the direct supervision of a health care provider, or by a provider of health services (e.g., physical therapist) under orders of, or on referral by, a health care provider[4], or
     2. Treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment under the supervision of the health care provider4.
        
   • Pregnancy:
     Any period of incapacity due to pregnancy, or for prenatal care.
     
   • Chronic Conditions Requiring Treatments defined as:
     1. Requiring periodic visits for treatment by a health care provider, or by a nurse or physician’s assistant under the direct supervision of a health care provider[5];
        
     2. Continues over an extended period of time (including recurring episodes of a single underlying condition); and
        
     3. May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.).
        
   • Permanent/Long-term Conditions Requiring Supervision:
     A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective.  The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider.
     
   • Multiple Treatment (Non-Chronic Conditions):
     Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health care services under the order of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention nor treatment.
     
2. The birth of the employee’s child and in order to care for that child:
   Leave related to the birth of the child must be taken within the first 12 months after the child is born and cannot be taken intermittently.  If the employee’s child has a serious medical condition separate from the actual birth, this would be considered a separate FMLA-qualifying event and will require additional certification from the healthcare provider.
   
3. The placement of a child with the employee for adoption or foster care.
   
4. Military Caregiver Leave:
   A leave allowing the spouse, child, parent, or “next of kin” (nearest blood relative) to take up to 26 workweeks in a single 12-month period of unpaid, protected leave to provide care to a family member with a serious illness or injury received while on active military duty, including the National Guard and Reserves.
   
5. Qualifying Exigency Leave:
   A leave allowing the employee to take a leave of absence to handle various non-medical exigencies arising out of the fact that the employee’s spouse, child or stepchild, parent or stepparent, or son or daughter is on active military duty or on call to active duty (applies only to members of the National Guard and Armed Forces Reserves) in support of a contingency operation.  There are eight (8) types of exigencies:
   
   1. Short-notice deployment: Leave to address any issue that arises from an impending call or order to active duty in support of a contingency operation seven days or less prior to the date of deployment;
      
   2. Military events and related activities: Leave to attend any military ceremony, program or event related to the active duty or call to active duty status or to attend certain family support or assistance programs and informational briefings;
      
   3. Childcare and school activities: Leave to arrange or provide for childcare or school-related activities;
      
   4. Financial and legal arrangements: Leave to make or update various financial or legal arrangements;
      
   5. Counseling: Leave to attend counseling (by someone other than a health care provider) when necessary as a result of the active duty or call to active duty status;
      
   6. Rest and recuperation: Leave to spend time with a covered military member who is on short-term, temporary, rest-and-recuperation leave during the period of deployment (up to five days);
      
   7. Post-deployment activities: Leave to attend arrival ceremonies (including funeral or memorial services), reintegration briefings and events, and any other official ceremony or program sponsored by the military for a period of 90 days following active duty status; and
      
   8. Additional activities: Leave to address other events arising from military duty agreed upon between the employee and the company.

F. Required Employee Notice of Intent to Use FMLA

Employees are required to give a minimum of two (2) weeks notice to the FMLA Administrator in cases where the need for leave is foreseeable such as pregnancy, surgery, planned military deployment, etc.  This notification must be made in writing. 

In cases where leave is not foreseeable, particularly in emergency situations, the employee is required to follow the call-off procedure as outlined for the employee’s position and department in Policy & Procedure 2.08 – Attendance. 

Employees are required to give a 3-hour notice when calling off.  However, in defined emergencies, the notification must be made as soon as possible.  When calling-off with the intent to use FMLA for the first time (not previously requested) the employee must follow the call-off procedures for their department. Open Door’s FMLA Administrator will send the required notification to employees for absences which may meet FMLA qualifications including eligibility notice and rights/responsibilities documents per the Department of Labor Wage and Hour regulations.  The FMLA Administrator is responsible for communication with the employee.

In instances where the employee has pre-approved FMLA for a planned absence such as pregnancy, the employee will follow call-off procedures outlined in P&P 2.08 for the first day of the planned absence.  (S)he will not be required to call off for any other days during an extended absence.  In situations where a prearranged leave date has been decided, the employee will not have to call off.

G. Required Employee Notice for Intermittent FMLA

Intermittent FMLA is defined as leave needed by the employee for a reason outlined in “Chronic Conditions Requiring Treatments” (above) on an “as needed” basis and as prescribed in the Certification of Health Care Provider to be used in periods of not less than one (1) hour.  Typically, intermittent FMLA is used by an employee for reasons including but not limited to a “flare-up” in a chronic medical condition requiring the employee to abstain from work, medical appointments, or for activities allowed under the “Qualified Exigency Leave.”  Need for Intermittent Leave is subject to the same certification requirements as all other types of leave designated in this policy.

In instances where an employee has been granted intermittent leave, the employee must follow the call-off procedures outlined in P&P 2.08.  The employee will receive no attendance violation when the call-off procedure is followed and the employee states that (s)he is using FMLA.  However, the leave may not be classified as FMLA leave and attendance violations may be given when the employee fails to give a 2-hour notice of intended absence, fails to notify the correct person, or leaves early without notice.  The employee will not suffer an attendance violation for the absence itself but, is subject to any other appropriate disciplinary action for violations of the attendance policy.  Additionally, the employee must also notify the FMLA Administrator (see Section R – “Contacting the FMLA Administrator”) to state that FMLA is being used and the date and time of the work shifts that will be missed as a result of the FMLA.

When an intermittent absence is foreseeable, such as in cases where the employee or qualified family member has a scheduled medical appointment, the employee is required to notify the appropriate person in accordance with P&P 2.08.  Appointments and other activities that qualify under this policy should be made at times when the employee is not scheduled to work whenever possible.  Appointments and activities that occur during an employee’s regularly scheduled working time require prior written notification to the correct person designated by the Attendance Policy.

The FMLA Administrator will track all intermittent leave used by the employee.  The employee may request to know how much leave has been used no more than once every 30 days and must make his or her request in writing.

H. FMLA and Work-Related Injuries

Employees may use FMLA concurrently with any leave resulting from a work-related injury given that the reason for the leave also qualifies as FMLA.  Additional paperwork generally will not be completed.  FMLA will begin being counted from the first day the employee is off work due to the injury and continue to be counted until the employee returns to work, either for full duty, transitional work, or light duty.

I. Certification of Healthcare Provider and Other Certifications of Reason for Leave

All employees that intend to use FMLA for a qualified reason are required to provide official documentation of the reason needed for leave.  The company uses the approved and specific forms created by the U.S. Department of Labor which will be provided to the employee by the Open Door FMLA Administrator (as listed in section F. above).  The company will respond by providing those forms to the employee within the allotted amount of time outlined in the FMLA Fact Sheet (see attached).

Once provided, the employee will have a period of 15 days to return the required documentation including but not limited to the Certification of Health Care Provider.  The FMLA Administrator reserves the right to allow the employee an extension when the 15 day deadline is not practical as in certain cases where the certification cannot be filled out within the previously allowed time (i.e., doctor is being difficult, awaiting the arrival of call to duty orders, etc.).  Failure to return the certification may result in the leave being denied, and the employee will be subject to any and all disciplinary action or attendance violations as outlined in the Attendance Policy.

The FMLA Administrator has the right to request that the employee provide additional documentation in cases where the certifications are vague, are missing information, or are not adequately completed.  The employee will be given an additional seven (7) days to have the forms completed to the specification of the FMLA Administrator and may be extended when the 7 day deadline is not practicable.  The FMLA Administrator may not contact the employee’s health care provider unless the employee signs a waiver to allow the FMLA Administrator to do so (following HIPAA guidelines) or if the FMLA Administrator needs clarification on what is written or needs to authenticate the documents presented.

Additionally, the FMLA Administrator may use (but may not require the employee to submit) any other documentation that supports the need for the employee to use FMLA such as documentation used for the following purposes: Worker’s Compensation, Americans with Disabilities Act, or Short-term or Long-term Disability claims.

Once the Certification of Health Care Provider (or other form appropriate for the type of leave outlined in this policy) has been submitted to the FMLA Administrator, the company will send a Designation Form within five (5) days notifying the employee if the leave has been approved.

Depending upon the job responsibilities and the medical condition, Open Door, at its own expense, may require a second medical certification from a health care provider.  The company may choose the health provider for the second opinion.  If the opinion of the employee’s and Open Door’s designated health care providers differ, Open Door may require the employee to obtain certification from a third health care provider, again at Open Door’s expense.  The third opinion shall be final and binding.  The third health care provider must be approved jointly by the employee and the employer.

J. Employee’s Responsibilities While on Leave

While on FMLA, the employee is required to furnish regular updates on his or her condition and intent to return to work whenever practicable, no less than once every 30 days.  Updates will be made by the employee to the FMLA Administrator.  When the employee fails to provide any required documentation and/or information, the FMLA Administrator will send a certified letter indicating a final request of information.  If the employee fails to comply the employee will be subject to the attendance policy.

K. Recertification of FMLA

Medical Recertification will be required upon the following circumstances:

1. Circumstances described by the previous certification have changed significantly, (i.e. the duration or frequency of absences, the severity of the condition, complications).
   
2. The minimum duration of the period of incapacity specified on the certification furnished by the health care provider has passed.
   
3. The employee requests an extension of leave.
   
4. The company receives information that casts doubt upon the employee’s stated reason for the absence.

The employee will be responsible for furnishing the recertification within 15 days that it is requested (unless otherwise determined not practicable in which case that an extension may be granted).  The recertification will also be at employee’s own expense. 

L. Use of Paid Time Off During FMLA

Employees are required to use any and all earned but unused paid time off concurrently with FMLA, whether it is for intermittent or extended leaves of absence.  An employee will be required to exhaust first his or her sick bank and then his or her vacation bank.  Using paid time off to extend FMLA beyond the allowed 12 weeks per rolling calendar is not permitted.

It is the employee’s responsibility to complete the request for leave form to receive their pay timely.

M. Extensions to FMLA

If the employee needs more time off than originally submitted in the FMLA paperwork, the employee must contact the FMLA administrator at least five (5) business days before the intended return to work date.  The FMLA administrator may require that the employee complete new Certification of Health Care Provider forms to extend the leave.

In cases where the employee has exhausted the allotted 12 weeks of FMLA, the employee may request an extension (if the FMLA was for his or her own serious medical condition).  The employee may request to extend his or her leave up to an additional 12 weeks with a Medical Leave of Absence as outlined in Policy & Procedure 2.04.3 – Medical Leave of Absence.  A Medical Leave of Absence is not the same as FMLA and does not guarantee the same rights as FMLA. 

In addition, any Open Door employee who is unable to return from any leave based on their own medical condition can request an extension and/or review of their ability to return.  Each extension/review request will be reviewed on a case-by-case basis by the Director or Associate Director to determine if a reasonable accommodation or extension may be provided.  The Director and/or Associate Director will discuss with the employee, and provide in writing, the results of their request for extension/review within 5 business days of the request.

In cases where the employee needs to extend his or her leave beyond the allotted 12 weeks of FMLA and the serious medical condition if for a reason other than the employee’s own serious medical condition (except for the Military Caregiver Leave), the employee may be asked to resign his or her position and reapply when able to return.

N. Benefits Continuation During FMLA

For eligible employees, for a period of 12 weeks, insurance coverage will be maintained at the current level of employee contribution while an employee is using FMLA leave.  Employees on unpaid FMLA leave must arrange to pay their contribution or co-pay for medical insurance.  After 12 weeks of FMLA leave, the employee will be considered eligible for COBRA, (refer to P&P 2.02.1).  Employees and their qualified beneficiaries have the opportunity to continue group health and dental insurance coverage as a qualifying even that would normally result in the loss of eligibility due to a leave of absence.  Under COBRA, the employee or beneficiary pays the full cost of the premium plus an administrative fee.

An employee who takes family medical leave will not lose any previously accrued seniority or employment benefits while on paid FMLA leave. 

Employees on paid or unpaid qualifying FMLA leave will not be eligible for holiday pay.  Employees on paid qualifying FMLA leave may use their accrued sick or vacation time for the holiday pay.

Retirement Plan – 401(k), any period of FMLA leave will not be treated as a no break in service for purposes of vesting and eligibility to participate in the plan.  However, FMLA leave is not required to count as credited service for accrual of benefits, vesting of benefits, or eligibility to participate.

O. Returning to Work After Leave and Fitness for Duty

If the employee will be absent more than three (3) consecutive days for the employee’s own serious medical condition, (s)he will be required to provide a Return to Work Certification (as per Open Door Attendance and leave policies) stating that (s)he is able to return to work and perform the essential functions of the job. The employee may be provided with a letter and form to present to his or her health care provider along with the employee’s job description to be reviewed by the health care provider in order to determine if the employee is able to meet the essential functions of the job.  NOTE: In situations where leave is being taken for reasons other than the employee’s own serious medical condition, the employee will not have to present a Return to Work Certification.

Additionally, in cases where the employee intends to take leave intermittently for more than three consecutive days for the employee’s own serious medical condition, the employee is also required to provide a Fitness for Duty statement (as per Open Door Attendance and leave policies). 

In situations where the employee’s health care provider will not grant a Return to Work Certification or has failed to provide information on the employee’s Fitness for Duty on the certification forms, the employee may be granted additional leave by Associate Director or designee.  The employee may be asked to have the health care provider review the forms and job description again. 

In addition, any Open Door employee who is unable to return from any leave based on their own medical condition may request an extension and/or review of their ability to return with reasonable accommodation.  Each extension/review request will be reviewed on a case-by-case basis by the Director or Associate Director to determine if a reasonable accommodation or extension may be provided.  The Director and/or Associate Director will discuss with the employee, and provide in writing, the results of their request for extension/review within 5 business days of the request.

P. Reinstatement to Employment

The employee will be required to notify the FMLA Administrator of the employee’s intent to return to work no less than five (5) business days before the end of the leave.  In situations where the employee is returning to work after leave for the employee’s own serious medical condition, the employee will be required to furnish a Return to Work Certification (as described above).

An employee will generally be restored to his or her prior position or to an equivalent one in terms of pay, benefits, responsibilities, and authority.  In certain circumstances, job restoration may be denied to certain highly compensated “key” employees if necessary to avoid substantial and grievous economic injury to Columbus Center for Human Services, Inc.  Additionally, an employee might not be restored to his or her position if a job elimination has occurred which would have terminated the employee’s job or placed the employee in a different job.

Q. Contacting the FMLA Administrator

The FMLA Administrator is Cassandra Miller (Employee Benefits Manager) and can be reached as follows:

Mailing Address:
Open Door
540 Industrial Mile Road
Columbus, OH 43228

Phone:
(614) 641-2900 x3048

Fax:
(614) 278-1125

[1] Child/Stepchild generally refers to a son or daughter under age 18 unless (s)he is incapable of self-care due to a mental or physical disability that limits one or more of the “major life activities” defined by the Equal Employment Opportunity Commission (EEOC) under the Americans with Disabilities Act (ADA).

[2] “Incapacity”, for purposes of FMLA, is defined to mean inability to work, attend school, or perform other regular daily activities due to the serious health condition, treatment therefor or recovery therefrom.

[3] Treatment includes examinations to determine if a serious medical condition exists and evaluations of the condition.  Treatment does not include routine physical examinations, eye examinations, or dental examinations.

[4] First visit must occur within seven (7) days of the commencement of condition and the minimum of two (2) visits must occur within 30 days of each other.

[5] Requires a minimum of two (2) treatments/health care provider visits per year.

Medical Leave:

A. Eligibility

All employees may request a medical leave of absence.  Medical leaves of absence are granted at the sole discretion of Open Door.  Employees who require a medical leave of absence during their initial divisional orientation and training may be required to be placed in inactive status until such time as all necessary licenses and certifications can be obtained. 

After completion of initial divisional orientation training and mentoring, a medical leave will be applicable when employees and/or circumstances are not covered by an occupational injury leave or Family Medical Leave. (A medical leave of absence is available only for an employee. Employees cannot take a medical leave of absence for a qualifying immediate family member.)

1. If the employee does not qualify for FMLA leave, the employee is subject to P&P 2.08 – Attendance
   
2. If the employee’s medical leave is for their own serious health condition or qualified disability that renders the employee incapable of performing the functions of his or her job and they have exhausted all their FMLA time off, they may apply for unpaid medical leave.

B. Notification Requirements

Medical leaves of absences will typically require a minimum of two (2) weeks advance approval through submission of Leave Form on Open Door online employee hub.  Emergency requests can be granted through approval by HR Benefits Coordinator and Director.

C. Pay

Employees are required to exhaust all accrued sick time and vacation time before approval of unpaid time off will be granted.  Upon depletion of approved paid time off, the remainder of the medical leave of absence will be unpaid.  Employees on unpaid medical leave will not be eligible for holiday pay.  Employees on paid medical leave may use their accrued sick or vacation time for the holiday.  It is the employee’s responsibility to submit their Leave Form through Open Door online employee hub to receive their pay timely.

D. Duration

The typical duration of a medical leave of absence is twelve (12) weeks maximum.  The 12-week period shall be measured from a 12-month rollover window from the first date leave is used. 

If the medical condition extends beyond the twelve-week maximum, the employee may request an extension and/or review of their ability to return to work.  Each extension/review request will be reviewed on a case-by-case basis by the Director and/or Associate Director to determine if reasonable accommodation or extension may be provided.  The Director and/or Associate Director will discuss with the employee, and provide in writing, the results of their specific request for extension of leave/further review of situation within 5 business days of the request submission.

If the employee discovers after beginning their leave that the circumstances changed and the amount of leave originally anticipated is no longer necessary, the employee must provide advance notice, preferably within two business days, of their change of circumstances where foreseeable, for an early return. If an employee fails to return by the projected return date and does not provide notice either in person or by telephone or in writing for a leave extension, the employee will be considered to have resigned without notice.

E. Insurance Continuation

For eligible employees, insurance coverage will be maintained at the current level of employee contribution while an employee is using accumulated paid time off.  For approved, unpaid medical leaves over thirty days, the employee will be considered eligible for COBRA, (refer to P&P 2.02.1).  Employees and their qualified beneficiaries have the opportunity to continue group health and dental insurance coverage as qualifying event that would normally result in the loss of eligibility due to a leave of absence.  Under COBRA, the employee or beneficiary pays the full cost of the premium plus and administrative fee.

F. Medical Certification Requirements

A request for a medical leave must be accompanied by an acceptable medical certification.  Periodic certifications of an illness or disability while on a leave may be required.

G. Return from Leave

1. Before the employee is able to return to work, a completed acceptable medical release stating that the employee can perform the essential functions of their position. 
   
2. In situations, where the employee’s health provider will not grant such a return to work or fails to provide information on the employee’s return to work forms, the employee may be granted additional leave through the Associate Director or Executive Director pending further evaluation or review.  The employee may be asked to have the health care provider review the forms and job description again.
   
3. In addition, any Open Door employee who is unable to return to work from any absence or leave time due to their own medical/physical condition, may request an extension and/or review of their ability to return to work with reasonable accommodation. 
   
4. Each extension/review request will be reviewed on a case-by-case basis by the Director and/or Associate Director to determine if reasonable accommodation or extension may be provided.  The Director and/or Associate Director will discuss with the employee, and provide in writing, the results of their specific request for extension/further review of the situation within 5 business days of the request submission.
   
5. Depending upon the job responsibilities and the medical condition, Open Door, at its own expense, may require a second medical certification from a health care provider.  The company may choose the health provider for a second opinion.  If the opinion of the employee’s and Open Door’s designated health care providers differ, Open Door may require the employee to obtain certification from a third health care provider, again at Open Door’s expense.  The third opinion shall be final and binding.  The third health care provider must be approved jointly by the employee and the employer.
   
6. Unless otherwise required by law, if approved time off is four (4) consecutive weeks or less, the employee may be returned to the same position formerly occupied.  If approved time off is longer than four (4) consecutive calendar weeks, the employee may be assigned to an existing position equivalent in pay, benefits, and other terms and conditions of employment.

Jury Duty Leave:

A. Eligibility

Upon hire, all employees may be eligible for a jury duty leave of absence.  Employees may be excused from work for required court duty as a juror including time away from work for the selection of the jury and/or the actual hearing of cases.

B. Pay

During an approved jury duty leave of absence, employees may maintain their average hourly or weekly rate of pay without any loss to their accumulated paid time off up to a maximum of two weeks per calendar year. 

After two weeks, employees will be permitted to take an unpaid jury leave of absence or use accrued vacation time for the duration of the required jury duty.  Employees may also retain any funds provided to them by the court system for jury duty.  It is the employee’s responsibility to complete their Leave Form through Open Door online employee hub to receive their pay timely.

C. Documentation Requirements

Employees are required to show proof of a written statement reflecting the days summoned.  Employees must also obtain a written statement from the court which shows the days were served.  Failure to provide the required documentation may result in denial of the leave.

D. Witness Duty

Employees who are summoned to court as a witness will be provided with time off as legally required.  Time off will not be paid under the policy.

E. Limitations

No employee shall be paid for any court appearance in which he/she is a defendant or a plaintiff since this would fall within the realm of personal business.  Employees are expected to return to work when the official process does not require participation during the major part of the day or does not interfere with their regular working hours.

Military Leave:

A. Eligibility

Upon hire, all employees who are drafted or who volunteer for military duty may be eligible for a military leave of absence.

B. Pay

Employees who are members of the Ohio National Guard or another reserve component of the armed forces may be granted annual training and/or emergency leave for mob, riot, flood, civil defense, or similar duties when so ordered by the Governor or the US President to assist civil authorities. 

Accrual of seniority and benefits will continue while on approved Military Leave.  Employees on Military Leave have the option to use accumulated paid time off.  Approved military leave over the thirty (30) days annual limit may be taken without pay if the employee has no accumulated paid time off.  After thirty (30) days, insurance benefits are subject to policy 2.02.1.

It is the employee’s responsibility to submit their Leave Form through online Open Door employee hub to receive their pay timely.

C. Documentation Requirements

A copy of military orders may be required prior to approval of a military leave of absence.

D. Clarification

Employees who are drafted or who volunteer for military duty may be considered on a military leave of absence without pay for the duration of the service.

E. Notification Requirements

Military leaves will typically require a minimum of two (2) weeks advance approval.  However, exceptions for official emergency periods will be granted.

Workers Compensation Leave:

A. Eligibility

Upon hire, all employees may be eligible for a worker’s compensation leave of absence.  When an employee suffers from a job-related illness or injury while employed, he/she may qualify for benefits through the Bureau of Worker’s Compensation and may be provided with a leave.

B. Medical Certification

A request for a Workers Compensation Leave of Absence must be accompanied by form BWC#110.  A completed acceptable physician’s release will be required before the employee is able to return to work.  Medical releases will be reviewed for approval by the Associate Director or designee.

C. Procedures for Reporting a Work-Related Injury

1. Contact per department
   • PWCA Staff must call the nurse on duty and Incident Hotline
   • SCL Staff must call the Incident Hotline phone
   • CAC Staff must call the CAC nurse and Incident Hotline
   • All other ADS staff must call the Incident Hotline phone
   • All CCHS staff are to notify the Employee Benefits Manager of their work-related injury at extension 3048.
     
2. Report the accident immediately to your supervisor
   
3. Fill out an Employee Accident Form within 24 hours of the injury – recommended to be completed immediately (through Open Door online employee hub)
   
4. If outside medical attention is required:
   • Complete the Worker’s Compensation Claims Policy Employee Acknowledgement Form and forward to the Employee Benefits Manager
   • Complete the Bureau of Workers’ Compensation First Report of Injury and give it to the treating physician. Complete the Bureau of Workers’ Compensation Authorization to Release Medical Information Form and forward to the Employee Benefits Manager
   • Regardless of which CCHS department you work for, tell the medical provider that you work at Open Door. Our MCO is – CareWorksComp
   • The employee may go to the medical provider of their choice.  Local providers around CCHS are: Mt. Carmel Big Run Clinic and Doctor’s West Hospital
   • Employees are required to have a post-accident drug test
   • Physician statements must be turned into the Employee Benefits Manager after each medical treatment
     
5. Before the employee is able to return to work, a completed acceptable medical release stating that the employee can perform essential duties of their position. 
   
6. In situations, where the employee’s health provider will not grant a release for the employee to perform essential functions of positions or fails to provide information on the employee’s Fitness of Duty forms, the employee may be granted additional leave through the Associate Director or Executive Director pending further evaluation or review. 
   
7. The employee may be asked to have the health care provider review the forms and job description again.
   
8. In addition, any Open Door employee who is unable to return to work from any absence or leave time due to their own medical/physical condition, may request an extension and/or review of their ability to return to work.  Each extension/review request will be reviewed on a case-by-case basis by the Director and/or Associate Director to determine if reasonable accommodation or extension may be provided.  The Director and/or Associate Director will discuss with the employee, and provide in writing, the results of their specific request for extension/further review of the situation within 5 business days of the request submission.
   
9. Depending upon the job responsibilities and medical condition, Open Door, at its own expense, may require a second medical certification from a health care provider.  The company may choose the health provider for the second opinion.  If the opinion of the employee’s and Open Door’s designated health care providers differ, Open Door may require the employee to obtain a certification from a third health care provider, again at Open Door’s expense.  The third opinion shall be final and binding.  The third health care provider must be approved jointly by the employee and the employer.

D. Management has the Option of Certifying the Claim

If the accident investigation shows that the employee’s injury was not work-related, or if the accident was not reported within 24 hours, and/or if the post-accident drug test is positive, the claim may be denied.

E. Workers Compensation Leave Will Run Concurrently with FMLA (if applicable)

For all questions and inquiries regarding Work Related Injury procedures contact the Open Door Employee Benefits Manager.

Open Door Transitional Work Program

It is the policy of Open Door to effectively manage workers’ compensation losses and invoke cost containment measures for worker’s compensation claims while maintaining the working status of our employees.

The aim of this program is to provide employment after the onset of a work related injury, accident, or illness; allowing for reasonable accommodations and/or alternative positions within the company based upon any restrictions established by the treating physician.  Transitional work is a temporary accommodation on a case by case basis.

Our goal is to return all employees, if possible, to their original employment positions within the timeframe of the program.  If the injured worker is not able to return to his/her original position, an alternative assignment may be pursued.

A. Eligibility and Entry Guidelines

The Transitional Work Program (TWP) is available to any employee who sustains a work-related injury, occupational disease, or illness that is likely to result in lost time from the job.  Each transitional work assignment will be treated independently of others.  The injured worker must return to his/her regular full duty assignment, his/her original job with permanent modifications, or another targeted job by the end of the transitional work assignment. 

Employees who are expected to have a temporary period of job performance limitations (defined as a limitation that is anticipated to last no more than 30 days) will be considered for participation in the program.  Employees must also meet all of the following criteria:

1. The employee must have had an injury, accident, illness, or a reoccurrence/exacerbation of a pre-existing condition;
   
2. Has been released by the physician of record to participate in a TWP; and,
   
3. Has the potential of returning to his/her original job, the original job with permanent modifications, or another targeted job that may be identified and performing the essential job functions after recovery.

B. Definitions

• Transitional Work Program (TWP):  Temporary work assignment within the injured employee’s current restrictions per the treating physician’s instructions with the goal of returning the employee to full-time employment.
  
• Temporary Period of Work Restrictions:  A work restriction that is anticipated to last no longer than 30 calendar days.
  
• Physician of Record (POR):  The physician who is treating the injured employee.
  
• Managed Care Organization (MCO):  Responsible for the medical management of a workers’ compensation claim.  As part of this medical management process, the MCO is responsible for securing return to work restrictions, full duty release to return to work, and ensuring that the injured employee is not having trouble with his/her return to work.  Additionally, the MCO is responsible for the authorization of any medical treatment and payment of the subsequent bills, in workers’ compensation claims.

• Initial Treating Provider (ITP):  The Company’s designated medical provider who initially treats the injured employee.
  
• Transitional Work Committee (TWC): Monitors the transitional work participants to identify modified duty work tasks, to ensure that the policy is adjusted as the Company’s needs change, to provide dispute resolution, assist with the program evaluation, and to educate the Company about the program.  The TWC will meet quarterly to review the TWP.  The members of the Committee are identified in Attachment A.
  
• Transitional Work Team (TWT):  Monitors the progress of the injured employee who participates in the program with the goal of decreasing the restrictions and increasing work tasks to full duty.  The TWT may be made of the following individuals:
  • Injured Employee
  • Return to Work (RTW) Coordinator
  • Immediate Supervisor
  • Physician of Record (POR)
  • Managed Care Organization (MCO)
  • Field Case Manager
  • On-Site Therapist
  • Third-Party Administrator (TPA)
  • Bureau of Workers’ Compensation (BWC)
    
• Third-Party Administrator (TPA):  Employer representative that ensures that the best interests of the employer are met.  This may include representation at workers’ compensation hearings, advice on cost savings, and rate verification.
  
• Bureau of Worker’s Compensation (BWC):  Administers Ohio’s insurance system for employees who are injured on the job or who contract a disease through their occupation.

C. Responsibilities

• The Transitional Work Team:
  Key to ensuring that the injured employee returns to full duty by monitoring and progressing each employee that participates.  Communication will be done on an as-needed basis.
  
• Injured Employee:
  Responsible for maintaining regular, consistent attendance during the program.  The employee must perform only those work tasks identified by the supervisor, therapist, or the POR as a part of the TWP while observing safe work practices. 
  
  • The employee must provide the immediate supervisor and/or RTW Coordinator with the First Report of Injury (FROI), MEDCO 14 form (Attachment B) to participate in the TWP, and any restrictions the same day or one day after seeing an Initial Treating Provider (ITP).  The employee will complete all TWP agreement forms that will be provided by the RTW Coordinator. The forms include the following:
    
    • Transitional Work Program (TWP) Participation Agreement
      
    • TWP Employee’s Rights and Responsibilities (Attachment D)
      
• Return to Work Coordinator: 
  Facilitates all case management activity. They will be responsible for:
  
  1. Providing the injured employee with an injury packed and Job Analysis/Description (if applicable) to be taken to the physician and returned. 
     
  2. Reviewing all forms to ensure that they are fully and accurately completed by the appropriate individual(s). 
     
  3. Forwarding the First Report of Injury (FROI) to the Managed Care Organization (MCO) within 24 hours of the injury. 
     
  4. Follow up with the ITP one day after the injury if the necessary paperwork has be not been returned. 
     
  5. Informing the MCO and on-site therapist (if applicable) when a physician is not complying with the request for return to work. 
     
  6. Issuing the Offer of Transitional Work Letter (Attachment G) to the injured worker (by regular and certified mail when necessary) and contacting the Third Party Administrator (TPA) to initial filing the appropriate form when non-compliance is an issue. 
     
  7. Orienting all new hires to the program. 
     
  8. Making the necessary referral to the MCO for on-site therapist when an injured employee has returned to work with restrictions or orders for therapy. 
     
  9. Informing the employee involved of the benefit options and procedures. 
     
  10. Initiating and maintaining contact with the injured employee, TPA, BWC, MCO, and any medical personnel involved. 
      
  11. Acting as the main employer contact for the rehabilitation professional. 
      
  12. Maintaining a thorough knowledge of worker’s compensation reporting procedures.
      
• Immediate Supervisor
  Facilitates immediate medical treatment when necessary. The supervisor will also:
  
  1. Report the incident, investigate the cause, and initiate corrective workplace measures. 
     
  2. Validate the job analysis, assist the RTW Coordinator with the placement of the injured employee, and establish Modified Work Tasks with the RTW Coordinator and on-site therapist (if applicable).
     
  3. Be responsible for reinforcing that the employee is utilizing safe work practices and is performing only those tasks allowed in the TWP.
     
  4. Provide the employee with support and encouragement If the employee is off of work for a period of time.
     
  5. Monitor the employee’s progress and coordinate the return to work date with the RTW Coordinator.
     
• Physician of Record (POR) & Initial Treating Provider (ITP):
  Responsible for providing restrictions for work and indicating whether the employee will be able to return to full duty within the policy’s limit. The medical provider will:
  
  1. Provide work restrictions to the employer no later than 24 hours after the initial visit.
     
• Managed Care Organization (MCO):
  Responsible for the medical management of worker’s compensation claims. The MCO will:
  
  1. Assist in obtaining the restrictions and prescriptions as needed.
     
  2. Monitor the claims to ensure that the injured worker is receiving appropriate medical care.
     
  3. Assist in providing a history of past claims and accidents to spot trends.
     
  4. Recommend physicians, rehabilitation consultants, and other outside support.
     
• Field Case Management Services:
  Assists with case management services for Remain at Work (“medical only” claims who are having difficulties remaining at work) or employees in need of a Transitional Work Plan. The case manager may if requested by the employer:
  
  1. Receive approval and restrictions from the POR and write a return to work program which incorporates all of the elements necessary to implement and ensure the success of the TWP.
     
  2. Coordinate the communication between parties involved in the TWP and the On-Site Therapist.
     
     • The on-site therapist will perform any therapeutic exercises and/or modalities, progress work tasks as appropriate, and provide education in job modification, body mechanics, and pacing techniques.  Functional Capacity Evaluation and job analyses will be performed as needed.  The on-site therapist will provide written communication on a weekly basis with all parties involved in the TWP and verbally with the employer on each visit.
       
• Third-Party Administrator (TPA):
  Ensures that the employer is taking appropriate measures to protect themselves from future workers’ compensation liability. The TPA will:
  
  1. Advise the employer of the financial risk should the injured worker not return to work. 
     
  2. Make recommendations to assist the employer in reducing the risk of workers’ compensation reserves that can be set on lost-time claims. 
     
  3. Make sure that the employer has all the necessary paperwork completed and available to the TPA in the event that a hearing is scheduled.
     
• Bureau of Worker’s Compensation (BWC):
  Responsible for making the initial determination on the compensation of claims, processing claims, and referring claims to the Industrial Commission for hearing. The BWC also:
  1. Recommends premium rates
     
  2. Collects and invests premiums
     
  3. Disperses money to pay compensation, medical, and other benefits to injured workers
     
  4. Maintains accounts
     
  5. Conducts audits
     
  6. Oversees the Division of Safety and Hygiene, whose primary duty is to educate employers in creating a safe work environment.

D. Procedures

1. The injured employee will be advised that Open Door has established a Transitional Work Program.  The POR, if not aware, should be provided with the job analysis. The employee will be made aware that the work assignments are made with the feedback from his/her physician (i.e. work restrictions).  The employee will complete the Participation Agreement that identifies the restrictions and given the employee’s Right and Responsibilities form.  This agreement is signed by the employee, supervisor, and the RTW Coordinator.  The supervisor and RTW Coordinator will maintain contact with the injured employee, co-workers, and support services (if applicable) to ensure good communication and positive reinforcement.  An emphasis should be made on the temporary aspect as well as the dynamic nature of the position and review the employee’s progress at regular intervals. 
   
2. The immediate supervisor, working with the employee, the RTW Coordinator, and the on-site therapist (if applicable) will identify assignments that may be accomplished while the injured employee has restrictions.  In constructing a TW assignment, the following will be considered:
   
   • The focus is on the employee’s current skills rather than the task he/she cannot perform
     
   • The value of the alternative work to the total work unit and to other employees will be considered, providing transitional work will be a meaningful assignment
     
   • Task selection should include tasks not being done by other at the present time, jobs that are only done occasionally, tasks not being performed that, if assigned to someone on transitional work duty, would allow co-workers time to accomplish additional work assignments
     
3. Whenever possible, the injured employee should perform components of the original job or some other targeted job within his/her current physical abilities and restrictions as listed by the POR
   
4. All injured employees in the TWP will comply with all personnel policies, procedures, and safe work practices.  Employees are required to follow all injury reporting policies and procedures
   
5. Procedures to follow when returning an injured employee back to work through the TWP:
   
   • If the injured employee, POR, and/or ITP do not return the MEDCO14, or Prescription for TWP, the RTW Coordinator contacts the POR.  If the POR does not respond, the RTW Coordinator contacts the MCO for assistance.
     
   • If the injured employee has been given restrictions, the immediate supervisor and the RTW Coordinator identify work accommodations and initiate the TWP.  The Modified Work Tasks form may be utilized to identify accommodations.
     
   • If the POR and/or ITP have released the injured employee to return to work utilizing an onsite occupational/physical therapist, a C9 will be forwarded to the MCO.  The immediate supervisor, RTW Coordinator, and the onsite therapist will identify work accommodations and initiate the TWP.  Modified Work Tasks may be utilized to identify accommodations.
     
   • If the injured employee has been given a prescription for physical/occupational therapy the RTW Coordinator contacts the MCO for a VocWorks on-site therapy referral.
     
   • If the employee loses more than 7 consecutive days, MCO will continue case management services to assist in the return to work.  The case manager will contact the medical provider again and request the appropriate return to work documents.  Once the documents are received, the employer will send the employee a certified letter advising him/her of their return to work date with a copy of the restrictions enclosed, and the TWP will begin.  If the physician does not feel that the employee is able to return to full duty work within the time frame established (per MCO DODM guidelines, if applicable) for the particular injury, MCO will refer the injured worker to vocational services, if the case qualifies according to BWC standards.
     
   • If the employee misses 7 or fewer days of work and the claim is considered medical-only by the BWC, the claim can be considered for a Remain at Work (RAW) referral. A RAW referral may be made by the MCO or the POR and must meet the criteria established by the BWC. A VocWorks case manager will be assigned to the claim and they will assist the employee in maintaining a working status.
     
   • Once the POR has released the employee to full duty or the TWP has been closed for another reason (lack of progress, medical instability, etc.) the RTW Coordinator completes the Transitional Work Completion/Closure Form.
     
6. The employee will be paid at his/her normal rate of pay for the hours worked while participating in the TWP.  The employee will be considered in an active pay status for the purpose of contractual pay increases.  The employer may be eligible for an incentive program (compensating an employer for a loss in productivity and hours worked) through the BWC.
   
7. If an employee refuses to participate in the TWP, the RTW Coordinator and/or TW Committee will follow up with the employee to determine his/her reasons for not participating.  After determining the reasons, the employee is given the option of going through the dispute resolution process.  Depending upon the outcome of the dispute resolution process, the BWC Claim Services Specialist and/or TPA may be notified of the employee’s refusal to participate.
   
8. At the completion of the TWP, the employee will be given a copy of the TWP Completion/Closure form and the Interview form to complete.  The supervisor will be given a copy of the Interview Form to completer.
   
9. If ADA compliance has become an issue, the company will contact their TPA and/or legal counsel.

E. Limitations

The duration of the TWP assignment is based on medical need.  Continuation of individual programs will require ongoing documentation of medical necessity.  All participants will have their case reviewed by the Transitional Work Team/Committee on an as needed basis.  In an on-site physical/occupational therapist is involved, the case will be reviewed weekly.

All TWP assignments will have a maximum duration of 30 days.  The program period will begin with the date of release to limited or restricted work established by the POR and will end upon the removal of the restrictions or at the end of the 30-day period, whichever occurs first.

Exit Closure Criteria:  The TWP may be closed if the employee no longer meets the necessary requirements (medical instability, lack of progress, non-compliance, etc.).  The TWP may also be closed if the employer is no longer able to meet accommodations.  The TWO assignment may be extended beyond 30 days depending upon the circumstances of individual cases as determined by the TW team.

Extensions beyond the 30-day timeframe will be handled on an individual basis.  Timeframe is dependent upon medical necessity and progress.  Decisions regarding extension timeframes will be determined by the TW team.

All information discussed by the TW Committee/Team regarding the specific injured worker will be held confidential and not disclosed to anyone other than those with a legitimate need to know.

F. Administration

• Misuse:  Any employee who misuses this benefit by not following specified procedures, falsifying records, or the like, is subject to discipline, up to and including discharge.
  
• Disagreements:  Disagreements arising out of this policy are to be discussed by the employee and the supervisor.  If not resolved, the employee and the supervisor will discuss the matter with the TW Committee who will make the final decision.
  
• Program Evaluation:  The Company will track the claim costs, cost savings, and the number of transitional workdays.  The company will also have each TW participant and supervisor complete the Interview Form at the completion of his/her program.  The RTW Coordinator will be responsible for maintaining the data and having each participant complete the form.  The TW Committee will review the program annually and will consult with the TW Developer as needed.  Program improvement and modifications to the TWP, if applicable, will be made annually.  This information will be shared with management, supervisors, and employees annually. 
  
• Education and training: All employees will receive training on the RTW program.

Last Revised: 3/14/22