Legal Question in Medical Leave in Florida

If someone is out on maternity leave & makes use of the FMLA concurrent with short-term disability and decides not to return to work, I realize that person would have to most likely pay back the insurance premiums the employer paid while they were out, but does this depend on the state they live in or simply the preference of the employer? Also, is there any reimbursement required for the medical bills that were paid by the insurance company while they were out?


Asked on 2/22/10, 12:52 pm

1 Answer from Attorneys

It's not a state issue, but depends on employer and insurance policy rules. (And you don't necessarily have to repay the employer-paid premiums.) First, you need to keep FMLA and insurance straight in order to understand your rights here. If you intended to return to work when you requested FMLA, then that FMLA protection is good. It is only when you do not intend to return that you are not entitled to FMLA protection. FMLA protection means you can not be disciplined or fired for using the leave. Since you are not returning, that is moot.

But the overlap between insurance and FMLA is that you would be entitled to keep your insurance while on FMLA-protected leave, and pay your share of the premiums and use the insurance. So if that is all you did, no problem.

But if you did not intend to return to work, and thus did not actually have FMLA protection, then you need to look to your employer's policies about using insurance while on leave. You might not be entitled to have used the insurance, and thus would have a repayment obligation, if the employer's policy (either the work policy or insurance policy) says that if you do not return to work, then you are not entitled to coverage.

If that is the case, then you need to determine when it is you decided not to return. If it is after leave began, then you at least had some FMLA protection and could not lose insurance up to that time. Arguably, the FMLA protection ended when you decided not to return. If you already intended not to return before you left, then you were never entitled to FMLA protection and thus might not have been entitled to use the insurance, again depending on what the employer and insurance policy say. (They might allow insurance use until you are actually off the payroll, regardless of intent.)

You can see that this can get complicated. Usually, though, the employee is allowed to pay for the premiums he or she missed while on leave. So, if they are trying to deny you coverage now, you need to review all the policies and find out exactly why. If you are just asking for information, then your best bet is to pay your share of the premiums and most likely it will not be a problem when you resign.

It sounds like you intended to return but changed your mind later, so you were entitled to FMLA protection and to use the coverage, so hopefully you will not have any problem. It happens frequently. Also, there is nothing wrong with asking your employer's HR dept. your question, once you are sure you will be resigning. (Just ask :"If I decide not to return, do I have to repay any insurance coverage I received while out on maternity?")

Congratulations and good luck!

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Answered on 2/28/10, 1:33 pm


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