FMLA
LeaveTech
Task Names
Process
Benefits
100

The four eligibility rules checked when evaluating a claimant for FMLA

1. Does the Employee have FMLA time remaining

2. Does the Employee work at an eligible job site

3. Has the employee worked for the employer for greater than 12 months.

4. Has the employee worked more than 1250 hours in the 12 months prior to the absence date

100

The only section of the 'Person Details' screen that may be updated by a claim manager

What is the contact details section of the person details screen?

100

The task that 'pulls' the claim manager back to the claim to make a decision if no documentation has been received. 

What is the claim determination?

100

The timeframe in which an initial call MUST be completed

What is two business days?

100

The standard eligibility waiting period for (almost) all TMO benefits

180 days

200

The number of hours alotted for an employee that works 40 hours per week (on average)

What is 480 hours?

200

The section of the AC claim that may contain information obtained at the time of claim creation

What is Claim Intake notes?


200

Tasks like 'Run Eligibility Rules' and 'Send Employer Notification Email' are reminding you to do this. 

Confirm the system has performed the appropriate new claim processes and correct where needed.

200

The first step in almost every process when a claimant has a request.

Call the employee and confirmt the details of the request

200

The TMO New Claim task in a C-claim is directing you to do this.

Complete the New Claim Triage action plan template
300

The relationships covered by Care of a Family Member under FMLA

Parents, children, spouses, and 'in loco parentis'

300

The method by which a claim manager may approve, deny or even add pending time to a claim.

What is the physician statement button?

300

The two tasks that indicate the end of a certified claim, typically created upon claim approval.

What are 'Confirm RTW' or 'Claim Closure Review'?

300

A claimant may be given this long when submitting incomplete documentation

What is 7 days or until their original due date, whichever is longer.
300

The percentage at which COFM and STD benefits are paid.

What is 85%?

400

This is the way that an employer MAY calculate the '12 month' period (and the way TMO currently uses)

What is a fixed year calculation?

400

The location of a claimant's previous claims for review

The absence claims section of the person details screeen

400

The task by which a claim manager is expected to obtain a 'manager sign-off' prior to a denial

What is a denial review?

400

When a claimant has failed to turn in paperwork by the original due date and is denied on an continuous claim they are expected to do this.

Return to work immediately.

400

The field to be updated to indicate the approved through date for the benefit in the C-claim

What is the Adjusted Benefit Through Date?

500

The number of days in which an employer must provide an eligibility notice to an employee 

What is 5 business days?

500

The defining difference that sets the "Leave Letters for Managers" button apart from it's companion; "Leave letters for Employees"

The return address on the letter sent will allow a response to the associated liaison inbox

500

A task that indicates immediate intervention is required and should be treated as a same-day PG.

What is 'Claim Note - Action Required?'

500

The due date for documentation when a claimant is recertifying a claim

What is 15 days from the start date of the new certification?
500

The next step when a provider recommends a leave greater than ODG Max+30 in a non-behavioral health claim.

Approve through ODG Max+30, Request additional supporting medical, CA Review

600

The process by which an employee may become eligible for FMLA despite failing to meet the hours worked

What is the inherited FMLA eligibility policy?

600

The System will not allow an AC claim to be closed due to the presence of...

A pending absence

600

The task indicating a voicemail has been received, to be left open until the callback is completed.

What is 'Voice Message Received'?

600

When recertifying an approved leave the claimant's new date falls on this date.

The fifteenth day following the first absence date of the new time period

600

The primary reason the employee receives an amount less than what is communicated to them at the time of approval

Taxes/Deductions applied via client payroll

700
The timeframe which must be considered when calculating previous employment duration when evaluating FMLA eligibility

What is 7 years?

700

The method by which automated return to work communications may be stalled to prevent confusion

What is the 'Stop RTW Email' button?
700

The tasks to be opened indicating a new due date after either a paperwork extension has been provided or paperwork has been deemed incomplete.

What is an 'Extended Determination' or an 'Incomplete Determination'?
700

The process by which we verify a document was either completed by or certified the provider

What is the authentication process?

700
The denial communication to be sent when a CA review deems that a claimant's submitted documentation does not support.

TMO STD Denial - Meds Do Not Support

800

The three primary questions to ask yourself when evaluating previous claims for FMLA inherited eligibility

1. Is the previous claim in the same 12-month period (calendar year for TMO?)

2. Does the previous claim share the same or similar diagnosis as the new claim?

3. Does the previous claim contain approved FMLA absence time in the same 12-month period


800

The method by which the 'Last Day Worked' field may be updated.

Hover over the claim intake link and click the edit button to access the LDW field for update.

800

The task to be assigned to the claim manager of an existing intermittent claim to indicate that the claimant is now on an ongoing continuous claim.

What is 'Transition to Continuous'?

800

If a claimant seeks a COFM leave and is not eligible for FMLA they may only take the leave if....

They are eligible for a company leave/benefit or a state benefit in lieu of FMLA

800

The next step when the Date of Disability is updated in the BC 

Calculate the BC and payment specification

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