An employee gets hurt at work, and soon a family member requires care too. Or a spouse gets hurt, and the employee wants time off to help. It’s hard to tell which benefit answers which situation when you don’t work in insurance. The worry isn’t the forms. It’s assuming one benefit applies and learning late that it doesn’t.
At the Horan insurance agency, we work with multiple carriers across Central New York. That gives us a view of how these benefits come up for employers in the region.
This article explains which benefit fits which situation, what the Workers’ Compensation Board says about overlap, and what to ask the carriers.
Which Benefit Answers Which Situation in New York?
An employee’s own work injury goes through workers’ compensation. An injury or illness unrelated to the job may qualify for short-term disability benefits. Care for a family member with a serious health condition goes through Paid Family Leave. Employees can’t use Paid Family Leave for their own serious health condition.
Our article on how short-term disability and Paid Family Leave work covers those benefits on their own. Our guide to New York workers’ comp covers the workers’ compensation basics.
Can an Employee Take Paid Family Leave While Collecting Workers’ Comp?
Not for a total disability, according to the Board. An employee collecting workers’ compensation for a total disability can’t take Paid Family Leave. An employee on a reduced earnings schedule may still be eligible.
Suppose a machine shop employee in Baldwinsville returns to modified duty after a work injury, and the employee’s parent requires ongoing care after surgery. The employee’s status could decide whether Paid Family Leave is available.
Paid Family Leave offers up to 12 weeks at 67 percent of pay, up to a cap. Employees take leave in full-day increments. Eligibility starts after 26 consecutive weeks of work on a regular schedule of 20 or more hours per week, or after 175 days on a shorter schedule.
Our article on return-to-work programs for CNY employers covers the modified-duty side.
Can a Family Member Take Paid Family Leave to Care for an Injured Worker?
A family member may qualify if the injured worker is on the Board’s family list and has a serious health condition. The Board’s list includes:
- Spouse or domestic partner
- Child, stepchild, or anyone for whom the employee has legal custody
- Parent, stepparent, or parent-in-law
- Grandparent or grandchild
- Sibling
The Board defines a serious health condition as an illness, injury, impairment, or condition involving inpatient care or continuing treatment or supervision by a health care provider. Its examples include recovery from restorative surgery after an accident or other injury. The page doesn’t say whether an injury’s cause matters.
Imagine a spouse in Fayetteville whose husband requires weeks of recovery after a work injury. She works for a different Central New York employer, so she would send her request to that employer’s Paid Family Leave carrier, not to the carrier handling his workers’ compensation claim.
What Should Employers Avoid When a Family Care Request Arrives?
Employers can’t discriminate or retaliate against an employee for requesting or taking Paid Family Leave, according to the Board. They also can’t require an employee to use paid time off during the leave. An employee may use paid time off alongside the leave if the employer allows it.
Timing matters. Employees must notify employers at least 30 days before foreseeable leave. They must send the request package to the carrier within 30 days of the leave’s start to avoid losing benefits. For family care, that package includes Form PFL-1 and the health care provider’s certification on Form PFL-4.
Until the carrier approves the request, the employee isn’t on Paid Family Leave, and the employer decides how to treat the time off.
What Should You Ask the Carriers When a Claim and a Care Request Overlap?
Ask each carrier, because the Board’s pages on this topic leave some overlap questions open. Start with these:
- Which carrier handles workers’ compensation, and which handles Paid Family Leave and short-term disability for the business?
- Which forms apply to each benefit? The Board says each benefit requires its own request and documentation.
- How does each carrier treat a request that arrives during an open workers’ compensation claim?
- Does it matter that the family member’s injury happened at work?
- Do weeks spent on a workers’ compensation claim count toward the 26-week eligibility period?
The Paid Family Leave Helpline, (844) 337-6303, can also answer questions.
Sorting Out Overlapping Benefits Before Two Requests Land in One Month
We covered which benefit answers which situation, what the Board says about Paid Family Leave and workers’ compensation, and which questions to ask the carriers. Two benefits, two carriers, and one family can feel like too much at once. It’s natural to want one clear answer.
Sorting out the overlap before a claim and a care request arrive may give you composure and stability. Overlooking it may leave an employee, an employer, or a family member waiting on an answer no one saw coming.
As an independent agency working with multiple carriers across Central New York, the Horan insurance agency would like to be a resource. We can walk through how your workers’ compensation, short-term disability, and Paid Family Leave policies fit together. Our experience with Central New York employers helps us spot where a question may be worth raising with a carrier.
Click the Get a Quote button below to start that conversation.
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