Medical Related HR Risk in the Workforce

Medical Related HR Risk Workforce

The workplace is riddled with unique challenges, some more easily solved than others. If specific actions or behaviors violate company policy or can be measured objectively, the path forward is relatively easy to navigate. However, medically related situations can be particularly complex and sensitive, especially since they are primarily subjective. While not an everyday occurrence, medical benefit misuse does happen and, if suspected, warrants the need for an HR investigation.

In these situations, leaders must be thoughtful, and many times strategic, in both the prevention of medical benefit misuse and effective resolution.  

Levels of Risk

Medically related situations come with numerous risk factors that organizations need to be mindful of. Unfortunately, many examples exist of mishandled medical situations that eventually escalated into the legal system for resolution. This route can cost hundreds of thousands of dollars and become a significant drain on resources within a company. Let’s take a look at some employee medical scenarios.

Scenario 1

We have two employees experiencing medical situations. Employee A is having a child, and Employee B is having a standard medical procedure (e.g., torn ACL surgery). Generally speaking, there is a defined start and end date for each medical procedure in both instances. I should note that every situation is different, and recovery times can vary. Both of these employees may have a brief period where a modified schedule or work restrictions are required. Still, the employer can expect to have them resume regular work duties in a reasonable amount of time.  

In this example, the level of risk is minimal if the employee fully recovers and the company has followed its obligations for providing time off.

Scenario 2

Employee C falls off a ladder at work and injures their back. This example can be described as a slippery slope situation because it is difficult to measure the pain or reduced ability to perform work duties.  

In this example, there is no defined recovery period for this type of injury, and in some instances, the employee may need to be on pain management medication long-term. Workers Compensation is at play since the incident happened on the job site, and the insurance company will help manage the process. 

Depending on the company size, there may be an obligation to provide FMLA (Family Medical Leave Act) or reasonable accommodations under the ADA (American Disabilities Act). Understanding how to navigate these legal obligations, continuing to staff the job or protect it, and making sure all documentation is handled appropriately can burden the organization. There may be a point where an attorney needs to be engaged to help a company successfully move forward.

In this example, the level of risk is elevated because the situation has unknowns. There is no defined period of returning to full capabilities, and the case cannot be objectively measured.  

Connecting the appropriate strategic partners (i.e., HR professional, insurance company, attorney, etc.) is critically important for the best outcome. The short-term investment will minimize any significant financial burden on the backside.

Combating Benefit Misuse

Medical benefits are positive for both employees and employers most of the time. However, the reality is that subjective, open-ended situations sometimes lead to misuse and downright abuse of those benefits. Minimizing misuse opportunities should be a priority, including having policies and procedures in place that track and monitor requests, leave, and medical certifications.  

Join our upcoming webinar, where we’ll take this topic even deeper and look at FMLA/ADA/Workers Comp misuse and how to navigate subsequent HR investigations.


Kristi Weierbach

Categories: Workforce Management