Special Tidbits for NFP’s in New York
MSC employee’s moving to a newly form Coordinated Care Organization (CCO)or another similar type newly formed organization.
Once an employee resigned from a NFP and are hired at a newly formed Coordinated Care Organization (CCO) or similar type organization, they will lose their existing PFL rights under their current employer even if they are currently in an approved PFL claim. Employees will have to meet the 26 consecutive weeks/175 days eligibility period before they are eligible for PFL under the new CCO.
Example: Employee at a NFP is expecting a baby in May and has resigned from the NFP effective June 29, 2018 in anticipation of being hired by the CCO on July 1st.
Employee delivers on May 25th, has a 7-day waiting period for DBL and DBL coverage starts June 1st. The employee request that the doctor take her off disability after 4-weeks, so her disability ends, and she is cleared to return to work June 21st.
The employee then files a PFL bonding claim with the NFP and it is approved but will only be under the NFP’s PFL carrier until June 29th (9 days) which corresponds with the employees’ termination date.
The employee is not eligible for PFL under the CCO until they have worked 26 consecutive weeks, so they would not be eligible for bonding for at least 6 months.
In this scenario, depending on the employee’s weekly wage of course, she could have a better financial result if she remained on the NFP’s DBL for another 2/4 weeks because the DBL claim stays with the employer/carrier where the claim originated.
A NFP may want to consider advising employees impacted by this, so they are fully aware that they will have to meet the eligibility requirements for PFL again with the new CCO.
Employee currently on PFL and resigns……………
Lisa’s Question: If an employee is on PFL for 3 weeks already and then resigns are they still eligible for the remaining 5 weeks of their approved PFL?
Worker’s Compensation Board: PFL is a benefit for employees in employment in NYS. If the employee is no longer in employment, he or she is no longer eligible for PFL. Whether or not an employee is in employment is very fact-specific.
However, it seems likely that if the employee has a completed and approved request for PFL and gave (2 week or 4 week) notice of a resignation during PFL that will take effect on his or her scheduled return date from PFL, then he or she is still employed until the effective date of her resignation. If she resigned with an immediate effective date or an effective date during PFL, then her employment arguably terminates on that date.
If an insurance carrier issues a denial because they believe the employee is no longer in employment and the employee disagrees, he or she may request arbitration.