When an FMLA Claim Ends and We Cannot Return to Work

What happens when an employee’s FMLA time runs out and they are unable to work?:

A fellow worker has had heart surgery and is off on FMLA leave because our company does not provide sick time. The company is trying to revoke his insurance because he has not worked the requisite amount of time (per month) to qualify for insurance. They are telling him that he can continue coverage through COBRA, but COBRA is for employess that resign or are fired. He has neither resigned nor been fired. What are his options? What are his rights under Michigan law? Can the employer drop coverage to an employee out on medical leave with a serious medical condition?
Note during the Medical leave by law his insurance cannot be dropped.
This guys pretty much SOL then huh???

Talk about a crap system…
This question is archived as part of the Absence Management Resource Center in an effort to track the most commonly asked FMLA claim questions. It is important that, as absence management professionals, we understand the sort of concerns that are out there in terms of Family Medical Leave and absences.

6 thoughts on “When an FMLA Claim Ends and We Cannot Return to Work

  1. I’m happy to help you with your question.

    COBRA insurance coverage is for any employee that loses their insurance, not just those who leave the company. If the company’s policy states that an employee must work a certain number of hours to qualify for the insurance, they may cancel his coverage when he is not working. The FMLA only protects his job for twelve weeks. After that, he may be terminated if he is not able to return to work.

    Does that help with your FMLA issue?

  2. Under the Family Medical Leave Act, he still gets the regular health plan and doesn’t need to meet the minimum hourly requirements (see the plan document which must be provided to him. It is under the FMLA section.

    After he exhausts his FMLA, then he qualifies for COBRA. He can get coverage through COBRA because he has had a “Qualifying event.” COBRA is expensive though. At this point, he can be terminated from the plan for not meeting the minimum work hours provision. If he can’t work after exhausting FMLA, he is unemployed, so he may be able to qualify for Medicaid and unemployment insurance, and apply for disability income as well.

    Hope this helps. I’m not an authority on FMLA, but I do know a lot about FMLA issues.

  3. It is true – COBRA is not only offered in the event that an employee resigns or is terminated. COBRA is offered to any one who has had what’s called a “qualifiying event” when they lose their insurance. In this case, he doesn’t have to lose his job to lose his insurance. If he is not meeting the minimum number of hours worked to be covered by the employer health plan, then technically they can cancel coverage – and offer COBRA. It wouldn’t be prudent for a company to continue to pay health premiums on an employee who may not even return to work due to health reasons. It’s sad to see someone lose coverage in the middle of all the chaos of major heart surgery – but business is business (at least that’s the way most employers see it). Most employers pay all or a portion of health premiums as a perk for being a full-time employee, or at least close to full-time. That’s why they’re called benefits – it’s definitely not owed. FMLA is 12 weeks of JOB PROTECTED leave….once that runs out it’s at the discretion of the employer as to whether or not they want to hold his position – they don’t have to. Best of luck. Hope this helps

  4. Did you know that COBRA is not just for terminated employees. It is for people like your fellow worker, too. Cobra is probably his only option. Most health insurance companies won’t give health insurance to someone in his position if he tried to get it outside of COBRA.

    Health benefits are part of your salary and if you aren’t working and the employer doesn’t have paid leave you are out of luck in most cases.

    Several people a year working for my employer end up having to get their coverage through COBRA when they are on FMLA for long periods. It doesn’t seem fair, but that is the way life is sometimes.

    Google COBRA and FMLA for more information.

  5. Look to Cobra for continuing health insurance.

    Well, if he can’t work, they’re terminating him. He’s NOT a current employee, and isn’t entitled to health insurance if he isn’t working the required 30 hours a week.

    As I said, Cobra is his main option.

    The employer doesn’t get the option of “dropping” a non-working employee – the INSURANCE company requires that in order for them to be eligible for group coverage, they work usually 30 hours a week minimum.

    Yes, this is legit. You may not like it, but it’s legitimate.

  6. Well, it is, unfortunately, the way things work. Tell your friend to try applying for disability. If he feels he’ll be able to return to work soon, tell him to speak with the human resources department, maybe they’ll let him have his job back. Either way, he’s going to be paying for COBRA once the plan terminates. Like I said, call social security, and start the process of applying for disability.

    Good luck. I hope you get the answers you are looking for. Definitely have him get the ball rolling in regards to disability.

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