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2010 Managing Labor and Employee Relations Seminar

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This seminar was given to clients and friends of the Columbus, Ohio, law firm of Kegler, Brown, Hill & Ritter on March 11, 2010. Topics covered include USERRA, hiring and firing, employment law updates, workplace investigations, employee benefits, COBRA, HIPAA, ERISA, harassment, discrimination and more.

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2010 Managing Labor and Employee Relations Seminar

  1. 1. Welcome to Kegler Brown’s Managing Labor & Employee Relations Seminar!
  2. 2. <ul><li>Dog the Bounty Hunter </li></ul><ul><li>Judge Judy </li></ul><ul><li>Judge Mathis </li></ul><ul><li>Judge Reinhold </li></ul><ul><li>Judge Mentday </li></ul><ul><li>Home Shopping Network </li></ul><ul><li>NCIS </li></ul><ul><li>Martha Stewart </li></ul><ul><li>Kegler, Brown, Hill & Ritter </li></ul><ul><li>Gladys Knight & the Pips </li></ul>
  3. 3. WHEN IT’S OVER OVER THERE- WHAT YOU NEED TO KNOW ABOUT VETERANS & USERRA Lawrence F. Feheley Labor Seminar – March 11, 2010
  4. 17. <ul><li>All Employers Take Heed </li></ul><ul><ul><li>All employers, regardless of size or the nature of the business, are covered. </li></ul></ul>
  5. 18. <ul><li>Thou Shalt Not Discriminate </li></ul><ul><ul><li>USERRA prohibits discrimination on the basis of military service. </li></ul></ul>
  6. 19. <ul><li>Thou Shalt Tolerate Military Absences </li></ul><ul><ul><li>No required advance notice time periods or prescribed format. </li></ul></ul><ul><ul><li>Employees are permitted to take time off to prepare for leave (including intermittent leave). </li></ul></ul>
  7. 20. <ul><li>Thou Shalt Not Pick on Soldiers or Sailors </li></ul><ul><ul><li>Most courts extend USERRA protection to harassment on the basis of military service. </li></ul></ul>
  8. 21. <ul><li>Thou Shalt Not Screw with a Veteran’s Job </li></ul><ul><ul><li>Employee must give notice of intent to return; </li></ul></ul><ul><ul><li>The “Escalator Principle” controls; </li></ul></ul><ul><ul><li>Returning employees are entitled to reasonable training and/or retraining. </li></ul></ul>
  9. 22. <ul><li>Thou Shalt Not Fire Service Members </li></ul><ul><ul><li>USERRA requires “cause” for discharge in many situations. </li></ul></ul>
  10. 23. <ul><li>Thou Shalt Not Hold a Grudge </li></ul><ul><ul><li>USERRA prohibits retaliation against those who exercise their rights or oppose unlawful acts. </li></ul></ul>
  11. 24. Thank You! <ul><li>Larry Feheley </li></ul><ul><li>Kegler, Brown, Hill & Ritter Co., L.P.A. </li></ul><ul><li>65 E. State Street, Suite 1800 </li></ul><ul><li>Columbus, Ohio 43215, USA </li></ul><ul><li>Direct Dial: (614) 462-5432 </li></ul><ul><li>Fax: (614) 464-2634 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Web Address: www.keglerbrown.com </li></ul>
  12. 25. Margeaux Kimbrough Labor Seminar – March 11, 2010 AN OVERVIEW OF RECENT TRENDS IN LABOR LAW
  13. 26. <ul><li>Family Responsibilities Discrimination </li></ul>
  14. 27. What is Family Responsibilities Discrimination? <ul><li>Discrimination against an employee because of his or her family caregiving responsibilities </li></ul>
  15. 28. Caregivers
  16. 29. What is Family Responsibilities Discrimination? <ul><li>Discrimination against a worker with caregiving responsibilities is not unlawful per se </li></ul><ul><ul><li>may result in a violation of anti-discrimination or other federal statutes </li></ul></ul>
  17. 30. Family Responsibility Discrimination Claims <ul><li>Title VII of the Civil Rights Act of 1964: sex-based </li></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Men </li></ul></ul><ul><ul><li>Women of Color </li></ul></ul><ul><li>Americans with Disabilities Act (ADA) </li></ul><ul><li>Family Medical Leave Act (FMLA) </li></ul>
  18. 31. Sex-Based Disparate Treatment
  19. 32. Sex-Based Disparate Treatment <ul><li>Title VII: </li></ul><ul><ul><li>Prohibits employers from making employment decisions that adversely affect employees where the decision is rooted in discrimination based on sex </li></ul></ul><ul><ul><ul><li>regardless of whether the employer discriminates more broadly against all members </li></ul></ul></ul><ul><li>An employer who makes an adverse employment decision affecting a female employee with caregiving responsibilities may violate Title VII if the decision was rooted in sex discrimination </li></ul>
  20. 33. Sex-Based Disparate Treatment Example <ul><li>Employee is a mother of two preschool-age children </li></ul><ul><li>Employer rejects her for an opening in her employer’s executive training program </li></ul><ul><li>Employer reasoning: other candidates who were selected had better performance appraisals or more managerial experience </li></ul><ul><ul><li>Employee is not “executive material” </li></ul></ul><ul><li>Employee has more managerial experience or better performance and better qualified </li></ul><ul><li>Only selectees with preschool-age children are men </li></ul><ul><li>DISCRIMINATION </li></ul>
  21. 34. Sex-Based Disparate Treatment <ul><li>Stereotypes: </li></ul><ul><ul><li>Female employees cannot, should not, are not as dedicated to their jobs </li></ul></ul><ul><ul><li>Female employees assume caretaking responsibilities that will interfere with work performance </li></ul></ul><ul><ul><li>Female employees with young children will not or should not work long hours </li></ul></ul><ul><ul><li>Female caregivers who adopt part-time or flexible hours are less committed to the workplace </li></ul></ul>
  22. 35. Sex-Based Disparate Treatment Example <ul><li>Female Employee receives glowing reviews in her first 4 years with the company and is on track to be promoted early </li></ul><ul><li>Female Employee returns from leave after adopting a child in her 5 th year with the company </li></ul><ul><li>Supervisor asks Female Employee how she will handle her workload while caring for an infant </li></ul><ul><li>Female Employee continues to work same hours and handle same workload as before adoption </li></ul><ul><li>Supervisor removes Female Employee from high-profile projects and assigns smaller projects normally handled by less experienced workers </li></ul><ul><ul><li>points out that none of Female Employee’s superiors are mothers </li></ul></ul><ul><li>DISCRIMINATION </li></ul>
  23. 36. Sex-Based Disparate Treatment <ul><li>Stereotyping on Subjective Assessments of Work Performance: </li></ul><ul><ul><li>Working mothers are less capable and skilled </li></ul></ul><ul><ul><li>Working mothers are simultaneously “bad mothers” and “bad workers” </li></ul></ul><ul><li>What investigators will look for: </li></ul><ul><ul><li>Changes in assessments of performance not linked to actual performance </li></ul></ul><ul><ul><li>Subjective assessments not supported by objective criteria </li></ul></ul><ul><ul><li>Changes in assignments or duties not readily explained by nondiscriminatory reasons </li></ul></ul>
  24. 37. Sex-Based Disparate Treatment Example <ul><li>Female employee is a highly successful executive who recently became the primary caregiver of her two grandchildren </li></ul><ul><li>Female employee shows up late to a regularly scheduled meeting and was subsequently criticized by her boss for doing so </li></ul><ul><li>Female employee is passed up for a promotion </li></ul><ul><li>Male Employee receives the promotion because he is “more dependable, reliable, and committed to his work” </li></ul><ul><li>Supervisor admits she denied Female Employee the promotion because Female Employee arrived late to the meeting </li></ul><ul><ul><li>Having childcare responsibilities is no excuse </li></ul></ul><ul><li>Investigation reveals that the male employee had been late to the meetings on several occasions </li></ul><ul><li>Supervisor has not other articulable justification for her decision </li></ul><ul><li>DISCRIMINATION </li></ul>
  25. 38. <ul><li>Benevolent Stereotyping: </li></ul><ul><ul><li>“ It’s in her best interest” </li></ul></ul><ul><ul><li>Adverse actions need not be hostile </li></ul></ul>Sex-Based Disparate Treatment
  26. 39. Sex-Based Disparate Treatment Example <ul><li>Employer denies Female Employee a promotion based on the assumption that as a mother, she would not want to relocate to another city </li></ul>
  27. 40. Sex-Based Disparate Treatment <ul><li>Mixed-motive cases: </li></ul><ul><ul><li>Sex is a motivating factor in the adverse employment decision in addition to legitimate business reasons </li></ul></ul><ul><ul><li>Employer needs to show that it would have taken the same action absent the discriminatory motive </li></ul></ul><ul><ul><ul><li>Employee will not then be entitled to reinstatement, back pay, compensatory or punitive damages </li></ul></ul></ul>
  28. 41. Sex-Based Disparate Treatment Example <ul><li>Female Interviewee applies for a position as a marketing assistant </li></ul><ul><li>Employer asks how many children Female Interviewee has and how she would balance work and childcare responsibilities </li></ul><ul><li>Employer expresses concern to others in the company that Female Interviewee would not be compatible with a “fast-paced business environment” if she decided to become a mother </li></ul><ul><li>Female Interviewee is rejected </li></ul><ul><li>Employer reposts the position because “the applicants did not meet the requirements for experience” </li></ul><ul><li>Female Interviewee easily met requirements and was more qualified than other individuals who were recently hired for the same position </li></ul><ul><li>DISCRIMINATION </li></ul>
  29. 42. Sex-Based Disparate Treatment Example <ul><li>But… </li></ul><ul><ul><li>Male Interviewee subsequently hired </li></ul></ul><ul><ul><li>Male Interviewee has more experience (used as tiebreaker) </li></ul></ul><ul><ul><li>Employer would have hired Male Interviewee absent discriminatory motive </li></ul></ul><ul><ul><li>Female Interviewee is only entitled to attorney’s fees and/or injunctive relief </li></ul></ul>
  30. 43. Pregnancy Discrimination
  31. 44. Pregnancy Discrimination <ul><li>Title VII prohibits employers from making employment decisions that adversely affect employees where the decision is rooted in discrimination based on sex </li></ul><ul><ul><li>“ because of sex” or “on the basis of sex” includes “because of or on the basis of pregnancy, childbirth, or related medical conditions” </li></ul></ul>
  32. 45. Pregnancy Discrimination <ul><li>Employers should not make pregnancy related inquiries </li></ul><ul><ul><li>EEOC regards such inquiries as evidence of pregnancy discrimination where the employer subsequently makes an unfavorable decision affecting a pregnant worker </li></ul></ul><ul><li>Employers should not treat pregnant workers less favorably than workers who are restricted because of other medical conditions </li></ul>
  33. 46. Pregnancy Discrimination Example <ul><li>Pregnant Worker is employed at a bottling company and is required to carry certain materials weighing more than 20 pounds </li></ul><ul><li>Pregnant Worker is placed on restrictions by her doctor and may not lift more than 20 pounds </li></ul><ul><li>Pregnant worker asks supervisor to be reassigned job duties temporarily </li></ul><ul><li>Supervisor refuses </li></ul><ul><li>Investigation shows that within the past six months, supervisor reassigned the job duties of a man who injured his arm in an automobile accident and a woman who underwent surgery for a hernia </li></ul><ul><li>DISCRIMINATION </li></ul>
  34. 47. Discrimination Against Male Caregivers
  35. 48. Discrimination Against Male Caregivers <ul><li>The self-fulfilling cycle of discrimination: </li></ul><ul><ul><li>Stereotypes about women’s domestic roles are reinforced by parallel stereotypes presuming a lack of domestic responsibilities for men </li></ul></ul><ul><li>Employers may not treat either sex more favorably with respect to leave not related to pregnancy </li></ul>
  36. 49. Discrimination Against Male Caregivers Example <ul><li>Male Employee requests unpaid leave for a year to care for his newborn child </li></ul><ul><li>Although Employer has a collective bargaining agreement that allows for up to one year unpaid leave for various personal reasons, including to care for a newborn, Supervisor denied Male Employee’s request </li></ul><ul><li>Supervisor tells Male Employee that female employees have been granted this leave because the company “has to give childcare leave to women” </li></ul><ul><li>DISCRIMINATION </li></ul>
  37. 50. <ul><li>Discrimination Against Women of Color </li></ul>
  38. 51. Discrimination Against Women of Color <ul><li>Women of color may be subjected to discrimination based on two separate types of stereotypes: </li></ul><ul><ul><li>Stereotypes about working mothers </li></ul></ul><ul><ul><li>Stereotypes about individuals from a certain race or national origin </li></ul></ul><ul><li>Women of color may be subjected to intersectional discrimination </li></ul>
  39. 52. Discrimination Against Women of Color Example <ul><li>Employee is a Mexican-American female employee working as a server at a restaurant </li></ul><ul><li>Employee is reassigned to kitchen duty when she is 4 months pregnant </li></ul><ul><li>Supervisor makes comments about how Mexicans enter the country illegally and take jobs from citizens </li></ul><ul><li>Supervisor directs comments towards Employee that Mexican families are too large and come to the U.S. to “take over” </li></ul><ul><li>Supervisor explains to Employee that he reassigned her because customers would lose their appetites if they were served food by a pregnant woman </li></ul><ul><li>DISCRIMINATION – sex (pregnancy) AND national origin </li></ul>
  40. 53. Discrimination Against Individuals with Disabilities
  41. 54. Discrimination Against Individuals with Disabilities <ul><li>The Americans with Disabilities Act prohibits discrimination against a qualified worker because of his or her own disability AND prohibits discrimination because of the disability of an individual with whom the worker has a relationship or association </li></ul>
  42. 55. Discrimination Against Individuals with Disabilities <ul><li>Employers may not treat a worker less favorably based on the assumption that the worker will not be able to perform his or her job duties satisfactorily while also providing care to an individual with a disability </li></ul>
  43. 56. Discrimination Against Individuals with Disabilities Example <ul><li>Employer determines that Applicant is the most qualified individual who applied for the position </li></ul><ul><li>Applicant has sole custody of his son who has a disability </li></ul><ul><li>Employer rejects Applicant because Employer concludes Applicant’s caregiving responsibilities will have a negative effect on his attendance and work performance </li></ul><ul><li>DISCRIMINATION </li></ul>
  44. 57. <ul><li>The Family Medical Leave Act (FMLA) </li></ul>
  45. 58. The Family Medical Leave Act (FMLA) <ul><li>Employers may violate the FMLA by: </li></ul><ul><ul><li>Interfering with FMLA rights </li></ul></ul><ul><ul><li>Retaliating against an employee for exercising those rights </li></ul></ul>
  46. 59. Family Medical Leave Act (FMLA) <ul><li>Interference: </li></ul><ul><ul><li>Refusing to authorize FMLA leave </li></ul></ul><ul><ul><li>Discouraging an employee from using FMLA leave </li></ul></ul><ul><ul><li>Attempting to shorten the length of the leave </li></ul></ul><ul><ul><li>Using an employee’s decision to take FMLA leave as a negative factor in an employment action </li></ul></ul><ul><li>Retaliation: </li></ul><ul><ul><li>Taking adverse action against an employee because the employee engaged in FMLA protected activity </li></ul></ul>
  47. 60. Family Medical Leave Act (FMLA) Example <ul><li>Employee has worked at Company for 30 years and has received recognition for outstanding performance </li></ul><ul><li>Employee becomes responsible for caring for his two elderly parents </li></ul><ul><ul><li>Father is 80 years old with Alzheimer’s disease </li></ul></ul><ul><ul><li>Mother is 79 years old with deteriorating health </li></ul></ul><ul><li>Employee requests intermittent family leave to care for his parents </li></ul><ul><li>During Employee’s leave, Supervisor institutes a monthly performance standard that evaluates employees based on volume of work completed within a specified time </li></ul><ul><li>Employee is unable to meet the new standard while on FMLA leave </li></ul><ul><li>Employee is terminated </li></ul><ul><li>Employee shows: </li></ul><ul><ul><li>the performance standard was more rigidly applied to him </li></ul></ul><ul><ul><li>other employees who did not meet the standard were not terminated </li></ul></ul><ul><li>VIOLATION OF FMLA </li></ul>
  48. 61. Hostile Work Environment <ul><li>Workers with caregiving responsibilities may have a claim for harassment if they are subjected to offensive comments because of race, sex (pregnancy), or association with an individual with a disability </li></ul>
  49. 62. What can employers do? <ul><li>Don’t make employment decisions like the employers in the examples! </li></ul><ul><li>Be pro-active and institute the EEOC’s “Best Practices” </li></ul>
  50. 63. The Pro-Active Approach <ul><li>Spreading awareness of legal obligations </li></ul><ul><li>Developing a strong EEOC policy </li></ul><ul><li>Prohibiting retaliation </li></ul><ul><li>Focusing on actual qualifications </li></ul><ul><li>Developing qualification standards </li></ul><ul><li>Communicating job opportunities </li></ul><ul><li>Removing barriers </li></ul><ul><li>Monitoring practices </li></ul><ul><li>Providing reasonable sick leave </li></ul><ul><li>Developing employee potential </li></ul><ul><li>LEAVE A PAPER TRAIL! </li></ul>
  51. 64. Thank You! <ul><li>Margeaux Kimbrough </li></ul><ul><li>Kegler, Brown, Hill & Ritter Co., L.P.A. </li></ul><ul><li>65 E. State Street, Suite 1800 </li></ul><ul><li>Columbus, Ohio 43215, USA </li></ul><ul><li>Direct Dial: (614) 462-5437 </li></ul><ul><li>Fax: (614) 464-2634 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Web Address: www.keglerbrown.com </li></ul>
  52. 65. Break: Will Return at 10:35
  53. 66. Loriann E. Fuhrer Labor Seminar – March 11, 2010 HOW TO CONDUCT A PROPER INVESTIGATION AND WHAT CAN HAPPEN IF YOU DON’T
  54. 67. Two Important Investigation Prompts <ul><li>Alleged or suspected sexual harassment </li></ul><ul><ul><li>Did the employer exercise “reasonable care to prevent and correct promptly any sexually harassing behavior? </li></ul></ul><ul><li>Employee misconduct leading to discipline </li></ul><ul><ul><li>Goal is to provide a sound, factual basis for decisions by management. </li></ul></ul>
  55. 68. Key Elements of a Successful Investigation <ul><li>Selecting an appropriate investigator </li></ul><ul><li>Gathering all the documents </li></ul><ul><li>Conducting effective interviews </li></ul><ul><li>Documenting the investigation </li></ul>
  56. 69. Selecting an Appropriate Investigator <ul><li>Knowledge of law and workplace </li></ul><ul><li>Neutral, objective and independent </li></ul><ul><li>Good judgment </li></ul><ul><li>Rigorous – disciplined thinker </li></ul><ul><li>Effective communicator </li></ul><ul><li>Ability to make a good witness </li></ul>
  57. 70. Why is the Investigator Important? <ul><li>Inadequate investigator = inadequate investigation </li></ul><ul><ul><li>Smith v. First Union Nat’l Bank , 202 F.3d 234 (4 th Cir. 2000) (reversing grant of summary judgment) </li></ul></ul><ul><ul><li>Cadena v. The Pacesetter Corp. , 224 F.3d 1203 (10 th Cir. 2000) (investigation inadequate) </li></ul></ul>
  58. 71. Gathering All the Documents <ul><li>Refer to list in materials. </li></ul><ul><li>E-mails </li></ul><ul><ul><li>Review company policy on employee privacy and follow the policy. </li></ul></ul><ul><ul><li>Work with your I.T. department </li></ul></ul><ul><li>Document retention policy/procedures </li></ul><ul><ul><li>Avoid destruction of relevant documents </li></ul></ul>
  59. 72. Interview Mechanics <ul><li>Begin promptly </li></ul><ul><li>Tape-recording </li></ul><ul><li>One-on-one v. two-on-one </li></ul><ul><li>Preliminary statement or checklist </li></ul><ul><li>Confidentiality </li></ul><ul><li>Representatives </li></ul><ul><li>Refusals </li></ul>
  60. 73. Who to Interview <ul><li>Complainant </li></ul><ul><li>Accused </li></ul><ul><li>Known witnesses </li></ul><ul><li>Additional witnesses identified through interviews </li></ul><ul><li>Re-interviews </li></ul>
  61. 74. Investigation Techniques <ul><li>From general to specific </li></ul><ul><li>Sound of silence </li></ul><ul><li>Knowledge v. assumptions </li></ul><ul><li>Conclusions v. facts </li></ul><ul><li>He said/She said </li></ul><ul><li>Getting an answer to the question </li></ul>
  62. 75. Open-ended Questions <ul><li>“ What do you know about ______?” </li></ul><ul><li>“ What else?” </li></ul><ul><li>“ Tell me more about that.” </li></ul>
  63. 76. Knowledge, Hearsay, Assumptions <ul><li>Direct knowledge - perceive through senses </li></ul><ul><li>Hearsay - heard from someone else </li></ul><ul><li>Accumulated assumptions/conclusions/opinions </li></ul>
  64. 77. Fact or Conclusion? <ul><li>“ He harassed her all the time.” </li></ul><ul><li>“ He was very hostile toward us.” </li></ul><ul><li>“ It has been a very difficult department to work in.” </li></ul><ul><li>“ He hurt her.” </li></ul>
  65. 78. Conclusions v. Specific Facts <ul><li>He hurt her. </li></ul><ul><li>What, specifically, led you to believe he hurt her? </li></ul><ul><li>A. He grabbed her arm and when he let go I could see red marks where his fingers had been. </li></ul>
  66. 79. He Said/She Said <ul><li>Look for corroborating evidence </li></ul><ul><li>Example: A female employee alleges her supervisor engaged in offensive behavior towards her in private, when no one was around to hear or see it. </li></ul>
  67. 80. Corroboration <ul><li>Did the complainant complain to anyone around the time the offensive conduct occurred? </li></ul><ul><li>Did anyone notice a change in rapport between the complainant and her supervisor around the relevant time period(s)? </li></ul><ul><li>Do any e-mail communications or other documents between the complainant and her supervisor around the relevant time period(s) provide insight? </li></ul>
  68. 81. Corroboration (continued) <ul><li>Did complainant have increased absences or a drop in performance during the relevant time period? </li></ul><ul><li>Is there any information suggesting the complainant had a motive to lie or exaggerate? </li></ul><ul><li>**Look for the “ripple effect” </li></ul>
  69. 82. Getting an Answer to the Question <ul><li>As you know, I interviewed Sally yesterday. . . . She said you called her all sorts of names. Let’s start with this. When you came into the lunchroom last Thursday, did you call Sally a “skank”? </li></ul><ul><li>George B., he’s they guy I told you about in packaging, knows Sally since he’s a kid and says her whole family is trash. </li></ul><ul><li>Let’s focus on what you said in the lunchroom. Did you call Sally a “skank”? </li></ul>
  70. 83. Getting an Answer (continued) <ul><li>A. Here’s the thing. There’s like, a hundred people in that lunchroom everyday Everybody is saying everything. </li></ul><ul><li>Q. Okay, but did you call her a “skank” last Thursday? </li></ul><ul><li>I’m dead either way, right? If I say so, she’s just gonna say yes, and I’m dead, because she works up there in the office. </li></ul>
  71. 84. Getting an Answer (continued) <ul><li>No one is making any decisions here. Did you say . . . </li></ul><ul><li>. . . That whole family . . . </li></ul><ul><li>. . That to her? Did you? </li></ul><ul><li>[hesitating] Yeah, but it’s true. </li></ul><ul><li>What’s true? What’s a “skank”? </li></ul><ul><li>A. You know. Skank. She’s skanky. </li></ul>
  72. 85. Getting an Answer (continued) <ul><li>Have you completed an evaluation on the Complainant since she made these allegations against you? </li></ul><ul><li>A. I didn’t do anything to retaliate against her if that’s what you mean. </li></ul>
  73. 86. Documenting the Investigation <ul><li>Attempts to reach unavailable witnesses </li></ul><ul><li>Notes </li></ul><ul><li>Witness statements or affidavits </li></ul><ul><li>Investigative report </li></ul><ul><li>Investigative file </li></ul>
  74. 87. Note-taking <ul><li>Avoid subject impressions </li></ul><ul><li>Note credibility observations separately </li></ul><ul><li>Reconstruct what learned (detailed) </li></ul><ul><li>Clearly mark notes with logistics of the interview (date, time, place, names) </li></ul>
  75. 88. Statement/Affidavit <ul><li>Report of the facts learned during the interview </li></ul><ul><li>Forms: notes, summary, affidavit </li></ul><ul><li>Signed by witness </li></ul>
  76. 89. Investigative Report <ul><li>Avoid drafts and “updates” </li></ul><ul><li>Format depends on investigation, but generally sets out all the pertinent facts </li></ul><ul><li>Separate report for additional claims </li></ul><ul><li>Typically does not recommend particular action </li></ul>
  77. 90. Investigative File <ul><li>Discoverable in litigation </li></ul><ul><li>Contains notes, summaries/affidavits, materials gathered – by witness </li></ul><ul><li>Includes all documentary evidence </li></ul><ul><li>Stays with the investigator </li></ul>
  78. 91. Thank You! <ul><li>Loriann E. Fuhrer </li></ul><ul><li>Kegler, Brown, Hill & Ritter Co., L.P.A. </li></ul><ul><li>65 E. State Street, Suite 1800 </li></ul><ul><li>Columbus, Ohio 43215, USA </li></ul><ul><li>Direct Dial: (614) 462-5474 </li></ul><ul><li>Fax: (614) 464-2634 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Web Address: www.keglerbrown.com </li></ul>
  79. 92. Kristy N. Britsch Labor Seminar – March 11, 2010 ERISA, COBRA and HIPAA, Oh My! Your Guide to Employee Benefits
  80. 93. Topics Discussed <ul><li>COBRA </li></ul><ul><li>HITECH </li></ul><ul><li>GINA </li></ul><ul><li>Mental Health Parity and Addiction Act </li></ul><ul><li>Michelle’s Law </li></ul>
  81. 94. COBRA Subsidy <ul><li>Temporary Extension Act of 2010 (the “Extension Act”) </li></ul><ul><ul><li>Extends COBRA premium subsidy program created by the American Recovery and Reinvestment Act of 2009 (“ARRA”) </li></ul></ul><ul><ul><ul><li>ARRA provided COBRA premium subsidy for certain employees involuntarily terminated between September 1, 2008 and February 28, 2010. </li></ul></ul></ul><ul><ul><li>The Extension Act extends this eligibility period for an additional month (i.e., through March 31, 2010) </li></ul></ul>
  82. 95. COBRA Subsidy <ul><li>Addition of Qualifying Events That Are Reduction of Hours </li></ul><ul><ul><li>Only Assistance Eligible Individuals (“AEIs”) can qualify for the subsidy </li></ul></ul><ul><ul><ul><li>The Extension Act amends the definition of AEI to include an additional qualifying event that are reductions of hours occurring within the eligibility period (September 1, 2008 – Marc 31, 2010) but only if followed by an involuntary termination also within the eligibility period but occurring on or after March 2, 2010. </li></ul></ul></ul><ul><ul><ul><ul><li>Under the prior rules, a termination of employment would not be considered a COBRA qualifying event if it followed a reduction of hours that was itself a qualifying event </li></ul></ul></ul></ul>
  83. 96. COBRA Subsidy <ul><li>New Election Period for Reduction of Hours Followed by Termination of Employment </li></ul><ul><ul><li>The Extension Act requires a new election period in connection with the reduction of hours rules </li></ul></ul><ul><ul><li>Under this new requirement, if an eligible individual had a reduction of hours on or after September 1, 2008, but did not elect COBRA (or elected and then discontinued) and then had an involuntary termination of employment on or after March 2, 2010, the involuntary termination will be considered a qualifying event for which the individual can elect COBRA and be eligible for the COBRA premium subsidy. </li></ul></ul>
  84. 97. COBRA Subsidy <ul><li>Plan administrators must provide the ARRA “General Notice,” including information about this new election period, to affected individuals within 60 days of the individual’s involuntary termination. </li></ul><ul><li>COBRA coverage period is measured from the date of the reduction of hours, but premiums do not have to be paid for COBRA coverage between the reduction of hours and the involuntary termination </li></ul><ul><li>The period between the reduction of hours and the involuntary termination of employment reduces the number of months of COBRA available to the affected individual so that there may be fewer than 15 months of subsidy left following the termination of employment. </li></ul><ul><ul><li>This could be interpreted to permit a retroactive period of coverage with no COBRA premium, but that was probably not Congress’ intent. </li></ul></ul>
  85. 98. COBRA Subsidy <ul><li>Protection For Employers Making Involuntary Termination Determinations </li></ul><ul><ul><li>The Extension Act amends Section 6432 of the Internal Revenue Code (the “Code”) to provide a deemed involuntary termination for purposes of the premium reimbursement if an employer makes a reasonable interpretation that an employee was involuntarily terminated. </li></ul></ul><ul><ul><li>To rely on this new rule, the employer must maintain supporting documentation, including a written attestation of the involuntary termination. </li></ul></ul><ul><ul><li>This new rule formalizes the IRS position as provided in its COBRA Q&As. </li></ul></ul>
  86. 99. COBRA Subsidy <ul><li>New Penalty Provisions </li></ul><ul><ul><li>The Extension Act amends ARRA to make clear that either affected individuals or the Department of Labor (“DOL”) may sue to enforce determinations made under expedited review proceedings regarding an individual’s entitlement to premium assistance. </li></ul></ul><ul><ul><li>A new $110 per day penalty provision is added allowing the DOL to assess a penalty against a plan sponsor or health insurer who fails to comply with such a determination within 10 days of receipt. </li></ul></ul><ul><ul><li>Effective March 2, 2010 (not retroactive) </li></ul></ul>
  87. 100. COBRA Subsidy <ul><li>Action Items: </li></ul><ul><ul><li>Employers should review their procedures and records to determine whether they have current employees who previously lost group health plan coverage due to a reduction of hours and who may become entitled to a new COBRA election and premium subsidy rights if involuntarily terminated in the future </li></ul></ul><ul><ul><li>Congress is considering extending the COBRA subsidy further, so stay tuned! (may be extended through December 31, 2010). </li></ul></ul><ul><li>Reminders: </li></ul><ul><ul><li>COBRA notices must be sent to last known address of employee and covered spouse. </li></ul></ul><ul><ul><ul><li>One notice may be sent to both the employee and the spouse if they live at the same address and the spouse’s coverage begins on or after the date of coverage for the covered employee. </li></ul></ul></ul><ul><ul><li>It should also be noted that coverage provided under the FMLA is not COBRA coverage, and FMLA leave is not a qualifying event under COBRA. </li></ul></ul>
  88. 101. HITECH <ul><li>Breach notification requirements passed under HITECH Act (passed as part of ARRA) </li></ul><ul><li>“ Covered Entities” and “Business Associates” under the Health Insurance Portability and Accountability Act (“HIPAA”) are subject to new notification requirements when an individual’s unsecured protected health information (“PHI”) is breached. </li></ul><ul><li>The notification mandate is required under the Health Information Technology for Economic and Clinical Health (“HITECH”) Act, as part of the American Recovery and Reinvestment Act of 2009 (“ARRA”), signed into law by President Barack Obama on February 17, 2009. </li></ul><ul><li>The new breach notification requirements became effective September 23, 2009. </li></ul><ul><ul><li>HHS will use its discretion not to enforce the new breach notice requirements and will not impose sanctions or financial penalties for breaches discovered before February 22, 2010. </li></ul></ul>
  89. 102. HITECH: Who is Affected? <ul><li>Covered Entities </li></ul><ul><ul><li>Health care providers, health plans, health care clearinghouses </li></ul></ul><ul><ul><ul><li>Health plan means an individual or group plan that provides, or pays the cost of, medical care (e.g., health insurance issuers, HMO’s, welfare benefit plans, self-funded plan sponsors) </li></ul></ul></ul><ul><li>Business Associates </li></ul><ul><ul><li>Person or entity that performs certain functions or activities that involve the use or disclosure of PHI on behalf of, or provides services to, a Covered Entity </li></ul></ul><ul><ul><ul><li>Health care operation activities, claims processing, administration, billing </li></ul></ul></ul><ul><ul><ul><li>Data analysis, processing or administration </li></ul></ul></ul><ul><ul><ul><li>Utilization review </li></ul></ul></ul><ul><ul><ul><li>Re-pricing </li></ul></ul></ul><ul><ul><ul><li>Attorneys whose legal services to a health plan involve access to PHI </li></ul></ul></ul>
  90. 103. HITECH <ul><li>Covered Entities </li></ul><ul><ul><li>Face stricter HIPAA enforcement </li></ul></ul><ul><li>Business Associates </li></ul><ul><ul><li>Must now comply with HIPAA privacy and security rules and will face direct liability for violations of such rules </li></ul></ul>
  91. 104. What Constitutes a Breach Under HITECH? <ul><li>The unauthorized acquisition, access, use or disclosure of protected health information in a manner not permitted under the privacy regulations which compromises the security or privacy of the protected health information </li></ul><ul><li>A breach will compromise security or privacy if it “poses a significant risk of financial, reputational or other harm to the individual.” </li></ul><ul><li>Determining whether there is significant risk of harm to an individual will require assessing a number of factors, such as who impermissibly used the information, and the type and amount of the information. </li></ul>
  92. 105. What is Unsecured PHI? <ul><li>Unsecured PHI is any patient health information that is not secured (not protected) through a technology or methodology specified by HHS </li></ul><ul><ul><li>PHI must be unusable, unreadable, or indecipherable to unauthorized individuals. </li></ul></ul><ul><li>Unsecured PHI (i.e., patient’s full name, patient’s address, social security number, diagnosis) can be in any form or medium including electronic, paper, or in oral form. </li></ul>
  93. 106. When is Notification of a Breach Required? <ul><li>General Rule: Notification generally is required in the case of an impermissible use or disclosure of unsecured PHI that compromises the privacy or security of the information. </li></ul><ul><li>Exception: There are 3 exceptions to this general rule </li></ul><ul><ul><li>A breach of privacy will not occur if the access, acquisition, or disclosure of PHI falls within one of three exceptions </li></ul></ul>
  94. 107. Three Exceptions <ul><li>Unintentional acquisition, access or use. Applies where the acquisition, access or use was made in good faith, within the course and scope of employment or other professional relationship, and does not result in further use or disclosure. </li></ul><ul><li>Inadvertent disclosure. Covers disclosures from an otherwise authorized individual to another similarly-situated individual at the same facility, if the information is not further used or disclosed without authorization. (The preamble to the regulations clarifies that “facility” does not mean the particular building, but the same covered entity or business associate). </li></ul><ul><li>Inability to retain the information. Applies where the unauthorized person to whom the PHI was disclosed would not have been able to retain the information. </li></ul>
  95. 108. What About Secured PHI? <ul><li>Creating secured PHI will avoid a breach and will eliminate the notification requirements </li></ul><ul><ul><li>Must mitigate any damage caused by the breach. </li></ul></ul><ul><li>Safe-Harbor: </li></ul><ul><ul><li>Using HHS accepted technologies and methodologies creates a safe-harbor </li></ul></ul><ul><ul><li>No breach; no notification required </li></ul></ul>
  96. 109. REMEMBER: PHI Is Required <ul><li>Be certain you are dealing with “protected health information” under HIPAA. </li></ul><ul><li>Employment records, such as FMLA leave certifications or medical documentation obtained in the ADA interactive process, in the hands of the employer do not constitute protected health information, even though the records include individually identifiable health information. </li></ul><ul><li>Breaches of employment records containing health information or other personal information still may require notification under state or other federal regulations. </li></ul>
  97. 110. Reporting a Breach <ul><li>Covered Entities </li></ul><ul><ul><li>HHS </li></ul></ul><ul><ul><li>Individuals </li></ul></ul><ul><li>Business Associates </li></ul><ul><ul><li>Covered Entity </li></ul></ul><ul><ul><li>No notice to individuals unless otherwise agreed </li></ul></ul>
  98. 111. <ul><li>Business Associates must notify the Covered Entity of a breach of which it becomes aware </li></ul><ul><ul><li>No later than 60 calendar days after discovery of the breach </li></ul></ul><ul><li>Not required to notify affected individuals </li></ul><ul><li>Must identify each affected individual whose PHI was breached </li></ul><ul><li>Agency Issues </li></ul><ul><ul><li>If the Business Associate is an agent of the Covered Entity, the Covered Entity’s 60 day notice period will begin to run upon the Business Associate’s discovery of the breach </li></ul></ul>New Breach Notification Rules: Business Associates
  99. 112. <ul><li>Must mitigate any damages </li></ul><ul><li>Must notify individuals without unreasonable delay, but no later than 60 days after the discovery of the breach </li></ul>New Breach Notification Rules: Covered Entities
  100. 113. <ul><li>Breaches Affecting Over 500 Individuals </li></ul><ul><ul><li>If the breach involves more than 500 individuals of a state or jurisdiction, notice of the breach must be provided to prominent media outlets serving that state or jurisdiction within 60 days after discovery of the breach </li></ul></ul><ul><ul><li>Must also immediately provide notice to the Secretary of HHS to be listed on the HHS’ website </li></ul></ul>New Breach Notification Rules: Covered Entities
  101. 114. New Breach Notification Rules: Covered Entities <ul><li>Breaches Affecting Less Than 500 Individuals </li></ul><ul><ul><li>Maintain a log of any and all breaches to be submitted annually to the Secretary of HHS no later than 60 days after the end of each calendar year </li></ul></ul>
  102. 115. When is a Breach Discovered ? <ul><li>The first day that the breach is known, or reasonably should have been known, to the Covered Entity or its Business Associate </li></ul><ul><ul><li>Knowledge of any employee, officer or agent is imputed to either the Covered Entity or the Business Associate for purposes of the first day of discovery </li></ul></ul>
  103. 116. Amendments to Business Associate Agreements <ul><li>Covered Entities should revise existing business associate agreements to cover new breach mandates, in particular, with regard to the time for providing the notice and its contents. </li></ul><ul><li>While Business Associates need to notify only the Covered Entity, and the Covered Entity (i.e., the health plan) must notify the affected individuals, the parties are permitted to agree that the Business Associate will provide notice to all of the affected individuals directly. </li></ul><ul><li>Many entities functioning as Business Associates with regard to “protected health information” also handle “personal information” as defined under an increasing number of state laws. Some of these state laws require contract provisions with such vendors. </li></ul>
  104. 117. Action Plan for Covered Entities and Business Associates <ul><li>Review policies and develop a plan for responding to a breach, should one occur. </li></ul><ul><li>The breach notification plan should cover steps for determining, among other things: </li></ul><ul><ul><li>(i) whether a breach has occurred; </li></ul></ul><ul><ul><li>(ii) whether the breach requires notification; </li></ul></ul><ul><ul><li>(iii) the content of the notification; </li></ul></ul><ul><ul><li>(iv) how to coordinate conflicting state and federal notification laws; and </li></ul></ul><ul><ul><li>(v) the vendors who will assist in the notification process – such as data monitoring providers, public relations consultants, call center services, legal counsel and so on </li></ul></ul><ul><li>When investigating whether a breach has occurred, Covered Entities and Business Associates should think carefully about the nature of the information involved and how the access to that information could cause harm to an individual. </li></ul>
  105. 118. Action Plan for Covered Entities and Business Associates <ul><li>Covered Entities </li></ul><ul><ul><li>Revise policies and procedures and Notice of Privacy Practices to reflect the HIPAA Breach Notification Rule. </li></ul></ul><ul><ul><ul><li>For example, Covered Entities should make sure that their practice’s HIPAA compliance program, including record retention practices, address risk assessments for determining whether a breach of unsecured PHI has occurred; </li></ul></ul></ul><ul><ul><li>Train their workforce members on the practice’s policies and procedures with respect to the notification requirements; </li></ul></ul><ul><ul><li>Allow individuals to complain about those policies and procedures, or whether the notification requirements have been violated; </li></ul></ul><ul><ul><li>Sanction workforce members who violate the notification requirements; and </li></ul></ul><ul><ul><li>Refrain from retaliating against those who exercise their rights. </li></ul></ul>
  106. 119. Enhanced Enforcement <ul><li>HHS </li></ul><ul><ul><li>Must formally investigate any complaint of a violation </li></ul></ul><ul><ul><li>Periodic audits to ensure Covered Entities and Business Associates are compliant </li></ul></ul><ul><li>Employees </li></ul><ul><ul><li>Subject to criminal penalties </li></ul></ul><ul><li>State Attorney Generals </li></ul><ul><ul><li>Can now file civil suit actions in federal court for HIPAA violations </li></ul></ul><ul><ul><li>Damages are limited to $100 per violation with an annual limit of $25,000 per requirement or prohibition, plus an award of attorneys’ fees to the state </li></ul></ul><ul><ul><li>Must first notify HHS, in writing, that it will file suit. </li></ul></ul><ul><ul><ul><li>Notice is to provide an opportunity to intervene in the lawsuit </li></ul></ul></ul>
  107. 120. Penalties Under HITECH <ul><li>Any violation of the HITECH Act is subject to HIPAA civil and criminal penalties </li></ul><ul><li>New Tiered Penalty Structure </li></ul><ul><ul><li>No Knowledge </li></ul></ul><ul><ul><ul><li>$100 per violation, not to exceed $25,000 for identical violations during a calendar year, but no more than $50,000 per violation not to exceed $1.5 million during a calendar year. </li></ul></ul></ul><ul><ul><li>Reasonable Cause </li></ul></ul><ul><ul><ul><li>At least 1,000 per violation, not to exceed $100,000 for identical violations during a calendar year, but no more than $50,000 per violation not to exceed $1.5 million during a calendar year. </li></ul></ul></ul><ul><ul><li>Willful Neglect and Corrected (cured within 30 days) </li></ul></ul><ul><ul><ul><li>At least $10,000 per violation, not to exceed $250,000 for identical violations during a calendar year but no more than $50,000 per violation not to exceed $1.5 million during calendar year. </li></ul></ul></ul><ul><ul><li>Willful Neglect and Not Corrected </li></ul></ul><ul><ul><ul><li>At least $50,000 per violation not to exceed $1.5 million during a calendar year. </li></ul></ul></ul>
  108. 121. Penalties For HITECH Violations <ul><li>HHS will collect penalties, which will be used for purposes of enforcing the new HIPAA privacy and security rules </li></ul><ul><ul><li>Prior to HITECH, audits by HHS were possible, but rare due to lack of funding </li></ul></ul><ul><ul><li>Expect increased HIPAA audits and enforcement </li></ul></ul><ul><li>Individuals who have been harmed by a HIPAA violation may receive a percentage of the civil monetary penalty </li></ul><ul><ul><li>Prior to HITECH, it was almost impossible for individuals to receive a percentage of civil penalties or monetary settlements </li></ul></ul><ul><ul><li>This change alone may cause an increased interest in enforcement activity as individuals now have a financial incentive to bring HIPAA complaints and allegations of HIPAA violations </li></ul></ul>
  109. 122. New Individual Rights under HITECH <ul><li>Notice of Privacy Practices </li></ul><ul><ul><li>Covered Entities are required to provide a notice of their privacy practices to each individual who is the subject of PHI that describes: </li></ul></ul><ul><ul><ul><li>The uses and disclosures of PHI that may be made by the covered entity; </li></ul></ul></ul><ul><ul><ul><li>The individual's rights; and </li></ul></ul></ul><ul><ul><ul><li>The covered entity's legal duties with respect to the PHI </li></ul></ul></ul><ul><li>Before ARRA, an individual was permitted to request a restriction on a Covered Entity's use or disclosure of PHI for purposes of treatment, payment or health care operations purposes, but a Covered Entity had no obligation to agree to the restriction. </li></ul><ul><li>Now, under ARRA (Section 13405(a) of ARRA), the Covered Entity must comply with the requested restriction if: </li></ul><ul><ul><li>The disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and </li></ul></ul><ul><ul><li>The PHI pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full. </li></ul></ul>
  110. 123. New Individual Rights under HITECH <ul><li>Electronic Health Record </li></ul><ul><ul><li>Effective February 17, 2010, an individual has the right to an electronic copy of his/her electronic health record and may designate another person or entity to receive a copy </li></ul></ul><ul><ul><ul><li>Covered Entity may charge a fee for its labor costs. </li></ul></ul></ul><ul><ul><ul><li>Prior to HITECH, Individual could access his/her records in whatever form the individual requested, so long as it was readily available in that form. </li></ul></ul></ul>
  111. 124. New Individual Rights under HITECH <ul><li>Accounting of Disclosures </li></ul><ul><ul><li>Effective January 1, 2011 (or later), an individual has the right to an accounting of disclosures of his/her PHI that is maintained in an electronic health record during the previous 3 years, including those for treatment, payment and health care operations. </li></ul></ul><ul><ul><ul><li>Prior to HITECH, an individual had the right to request an accounting of disclosures of his/her PHI for the previous 6 years, but Covered Entities were not required to render an accounting of disclosures of PHI if used to carry out treatment, payment or health care operations. </li></ul></ul></ul>
  112. 125. New Individual Rights under HITECH <ul><li>Minimum Necessary Standard </li></ul><ul><ul><li>New guidance will be issued by the HHS in 2010 </li></ul></ul><ul><ul><li>Currently, HIPAA requires, with a few exceptions, that a Covered Entity that uses or discloses PHI, use reasonable efforts to limit the PHI to the “minimum necessary” to accomplish the purpose of the disclosure. </li></ul></ul><ul><ul><ul><li>Minimum necessary is not defined under HIPAA </li></ul></ul></ul><ul><ul><ul><li>ARRA states that minimum necessary standard is accomplished if the Covered Entity limits PHI to the “limited data set” as defined in the HIPAA privacy rule </li></ul></ul></ul>
  113. 126. New Individual Rights under HITECH <ul><li>Restrictions on Marketing </li></ul><ul><ul><li>Effective February 17, 2010, Covered Entities will be limited in its ability to use PHI for marketing purposes without the individual’s authorization </li></ul></ul><ul><ul><li>Communications with an individual about products or services that encourage the individual to purchase or use the product or service will be permitted without the individual’s consent only if the communication is made: </li></ul></ul><ul><ul><ul><li>To describe a product/service provided for in the Covered Entity’s plan; or </li></ul></ul></ul><ul><ul><ul><li>For treatment purposes; or </li></ul></ul></ul><ul><ul><ul><li>For case management, care coordination or to recommend alternative therapies </li></ul></ul></ul>
  114. 127. New Individual Rights under HITECH <ul><li>Restrictions on the Sale of PHI </li></ul><ul><ul><li>Effective no later than February 17, 2011, a Covered Entity or Business Associate will not be permitted to receive direct or indirect remuneration in exchange for PHI unless specifically authorized by the individual. </li></ul></ul>
  115. 128. GINA <ul><li>On October 7, 2009, the DOL, the Treasury Department and the Department of Health and Human Services (“HHS”) issued interim final regulations implementing the Genetic Information Nondiscrimination Act of 2008 (“GINA”). </li></ul><ul><li>Prohibits discrimination in health coverage based on genetic information as well as the collection of such information in certain circumstances </li></ul>
  116. 129. GINA <ul><li>Effective for group health plans in plan years beginning after May 21, 2009 </li></ul><ul><ul><li>This means that group health plans that have calendar year plan years must be compliant on January 1, 2010 </li></ul></ul><ul><ul><li>Employment nondiscrimination requirements were effective on November 21, 2009 </li></ul></ul>
  117. 130. GINA <ul><li>Nondiscrimination </li></ul><ul><ul><li>GINA prohibits group health plans and group health insurance issuers from: </li></ul></ul><ul><ul><ul><li>Increasing group premium or contribution amounts on the basis of genetic information; </li></ul></ul></ul><ul><ul><ul><li>Requesting or requiring an individual or family member to undergo genetic testing; </li></ul></ul></ul><ul><ul><ul><li>Requesting, requiring, or purchasing genetic information prior to or in connection with enrollment, or at any time for underwriting purposes </li></ul></ul></ul><ul><ul><li>Insurance providers are NOT prohibited from increasing premiums based on the manifestation of a disease or disorder in an individual enrolled in the plan, but the disease or disorder cannot be used as genetic information about other group members (e.g., family members) </li></ul></ul>
  118. 131. Genetic Information in Connection with Enrollment <ul><li>Requesting, requiring or purchasing genetic information for underwriting purposes </li></ul><ul><ul><li>Wellness programs violate GINA if they provide rewards, such as reduced deductibles, discounts, additional benefits or rebates, for completing health risk assessments that request genetic information. </li></ul></ul><ul><ul><li>Examples in rules illustrate that questions in a health risk assessment about family medical history violate GINA if they may result in an individual becoming eligible for a disease-management program because determining eligibility for the disease-management program is considered an underwriting process. </li></ul></ul><ul><ul><li>For purposes of determining whether a benefit is medically appropriate, plans and insurers may use genetic information, limited to the minimum necessary amount, without violating the prohibition on using genetic information for underwriting. </li></ul></ul><ul><ul><ul><li>Medical appropriateness exception: Prohibition does not apply if an individual is seeking benefits under the plan and the plan conditions the benefit upon a determination of medical appropriateness and the medical appropriateness of the benefit depends on the individual’s genetic information. </li></ul></ul></ul>
  119. 132. GINA <ul><li>Genetic Information </li></ul><ul><ul><li>Information about an individual’s genetic tests, genetic tests of the individual’s family members and the manifestation of a disease or disorder in a family member. </li></ul></ul><ul><ul><ul><li>A disease or disorder is manifested when an individual has been, or could reasonably be, diagnosed by a health care professional with appropriate training and expertise in the field of medicine involved. </li></ul></ul></ul><ul><ul><li>Also includes an individual’s request for or receipt of genetic services, including genetic research, counseling regarding a genetic condition, and genetic education as well as information about an individual’s or family member’s fetus or embryo. </li></ul></ul><ul><ul><li>DOES NOT include information about an individual’s sex or age. </li></ul></ul>
  120. 133. GINA And HIPAA <ul><li>HIPAA Privacy Rule </li></ul><ul><ul><li>The HIPAA Privacy Rule has been amended to conform with GINA’s requirements. </li></ul></ul><ul><ul><li>GINA amends HIPAA Privacy Rule as follows: </li></ul></ul><ul><ul><ul><li>Explicitly provides that genetic information is health information </li></ul></ul></ul><ul><ul><ul><li>Prohibits health plans from using or disclosing PHI that is genetic information for underwriting purposes (even if an individual has signed an authorization) </li></ul></ul></ul><ul><ul><ul><li>Revised the provisions relating to the notice of privacy practices for health plans that perform underwriting </li></ul></ul></ul>
  121. 134. GINA: Employment Discrimination <ul><li>Employment Nondiscrimination Requirements </li></ul><ul><ul><li>Prohibits employers from discriminating against an employee with respect to compensation, terms, conditions, or privileges of employment, including employment based on health benefits, because of genetic information about the employee. </li></ul></ul><ul><ul><li>Employers are prohibited from requesting, requiring or purchasing genetic information about an employee or an employee’s family member unless an exception applies </li></ul></ul><ul><ul><li>If an employer has genetic information about an employee, the information must be maintained in a separate file and treated as a confidential record within the meaning of the Americans with Disabilities Act (“ADA”) </li></ul></ul><ul><ul><li>Disclosure of genetic information is permitted only for limited circumstances (i.e., in response to court order or for purposes of FMLA certification) </li></ul></ul>
  122. 135. GINA: What Should Employers Do? <ul><li>Group health plans that provide incentives for completing health risk assessments, that require completion of health risk assessments to enroll, or that use health risk assessments as a means of identifying individuals who would benefit from certain disease management programs will need to revise their practices in or order to comply with GINA. </li></ul><ul><ul><li>Employers who request completion of health risk assessments should remove the reward or incentive for completing the assessment; or </li></ul></ul><ul><ul><li>Prepare a health risk assessment containing only questions about the individual’s medical history and exclude genetic test questions. Completion would result in reward/incentive; or </li></ul></ul><ul><ul><li>Prepare a health risk assessment containing family medical history questions and question about the individual’s genetic tests. Completion is voluntary; or </li></ul></ul><ul><ul><li>Delete questions that involve family medical history or that relate to an individual’s genetic tests. </li></ul></ul>
  123. 136. GINA: What Should Employers Do? <ul><li>Review and make necessary changes to health risk assessments and to programs using those assessments to ensure compliance with the prohibition against collection of genetic information for underwriting purposes </li></ul><ul><li>Review and make necessary changes to enrollment procedures to ensure compliance with the prohibition against collection of genetic information in connection with or prior to enrollment </li></ul><ul><li>Review and make necessary changes to group health plan documents and procedures to ensure compliance with the prohibition against requesting or requiring genetic testing </li></ul>
  124. 137. Mental Health Parity and Addiction Equity Act of 2008 <ul><li>Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA) </li></ul><ul><li>Applies to group health plans and group health insurance issuers for plan years beginning on or after July 1, 2010 (January 1, 2011 for calendar year plans). </li></ul><ul><li>Imposes new requirements on group health plans that offer mental health and substance abuse benefits </li></ul><ul><li>Employers with more than 50 employees that sponsor self-funded or fully insured group health plans must comply with MHPAEA. </li></ul><ul><ul><li>Insured plans may have additional requirements under state insurance laws. </li></ul></ul>
  125. 138. <ul><li>Congress first mandated parity for mental health benefits provided through employer health plans in 1996. </li></ul><ul><ul><li>Current law prohibits health plans from imposing lower annual and lifetime limits on mental health coverage than on other types of medical coverage. </li></ul></ul>Mental Health Parity and Addiction Equity Act of 2008
  126. 139. <ul><li>MHPAEA expands the mandated parity requirements to benefits for addictions and substance abuse. </li></ul><ul><li>MHPAEA further limits other types of financial and non-financial limitations that plans may impose on mental health coverage and substance abuse benefits. </li></ul>Mental Health Parity and Addiction Equity Act of 2008
  127. 140. Mental Health Parity and Addiction Equity Act of 2008 <ul><li>Key Provisions: </li></ul><ul><ul><li>Financial limitations, including limitations on deductibles, copayments, coinsurance, and out-of-pocket expenses, imposed on mental health and substance abuse benefits may not be higher than those imposed on other types of medical coverage; </li></ul></ul><ul><ul><li>Group health plans may not place limits on the scope or duration of treatment for mental health or substance abuse that are not more restrictive than for other types of medical treatment; </li></ul></ul><ul><ul><li>Group health plans must provide, upon request, information to plan participants and providers regarding the criteria for determining whether mental health or substance abuse treatment is medically necessary, and the reasons for denial of coverage; and </li></ul></ul><ul><ul><li>Coverage of mental health and substance abuse benefits by out-of-network providers must be on par with out-of-network coverage for medical coverage. </li></ul></ul>
  128. 141. <ul><li>Key Provisions Continued: </li></ul><ul><ul><li>Prohibits separate but equal deductibles for mental health/substance abuse treatment versus medical treatment. </li></ul></ul><ul><ul><li>Parity is required with respect to financial requirements and quantitative treatment limitations. A plan may not apply a financial requirement or a treatment limit to mental health/substance abuse benefits which is more restrictive than the “predominant” financial requirement or treatment limit applied to “substantially all” medical/surgical benefits in the same class. </li></ul></ul>Mental Health Parity and Addiction Equity Act of 2008
  129. 142. Mental Health Parity and Addiction Equity Act of 2008 <ul><li>Requirements Under MHPAEA: </li></ul><ul><ul><li>Mental health and substance use disorder benefits must be defined by plans in ways that are consistent with generally recognized independent standards of current medical practice. </li></ul></ul><ul><ul><li>The reason for any claim denial must be made available, upon request, to the participant or beneficiary. </li></ul></ul><ul><ul><ul><li>For ERISA plans, disclosures must be made in a form and manner consistent with the rules for group health plans in the ERISA claims procedure regulations, which provide that such disclosures must be provided automatically and free of charge. </li></ul></ul></ul><ul><ul><ul><li>For governmental and church plans, MHPAEA provides that compliance with the form and manner of the ERISA claims procedure regulations for group health plans satisfies this disclosure requirement. </li></ul></ul></ul>
  130. 143. <ul><li>Action Items: </li></ul><ul><ul><li>Review lifetime limits and annual limits; </li></ul></ul><ul><ul><li>Review administrative practices; </li></ul></ul><ul><ul><li>Review deductibles, copayments, coinsurance amounts. </li></ul></ul>Mental Health Parity and Addiction Equity Act of 2008
  131. 144. Michelle’s Law <ul><li>Effective for plan years beginning on or after October 9, 2009 </li></ul><ul><ul><li>January 1, 2010 for calendar year plans </li></ul></ul><ul><li>Prohibits group health plans and health insurers from terminating coverage of dependent students who are on a medically necessary leave of absence from post-secondary education </li></ul>
  132. 145. Michelle’s Law <ul><li>Most group health plans condition coverage for a dependent child over age 18 on enrollment as a full-time student in a post-secondary educational institution. </li></ul><ul><li>Michelle’s Law requires group health plans and health insurers to maintain existing coverage for up to one year for a seriously ill child who takes medical leave from school. </li></ul><ul><ul><li>Child would otherwise lose dependent status for purposes of coverage. </li></ul></ul><ul><li>Also requires group health plans to describe the right to continued coverage in any plan notices regarding certification of student status for plan coverage. </li></ul>
  133. 146. Michelle’s Law <ul><li>Dependent Child </li></ul><ul><ul><li>Child must be enrolled as a dependent under a health plan and qualify for coverage on the basis of being a student at a post-secondary educational institution, immediately before the medically necessary leave of absence. </li></ul></ul><ul><li>Physician Certification </li></ul><ul><ul><li>Written certification must be provided by a treating physician of the dependent child certifying that such individual is suffering from a serious illness or injury that would require a medically leave of absence. </li></ul></ul>
  134. 147. Michelle’s Law <ul><li>Action Items </li></ul><ul><ul><li>Update plan documents, summary plan descriptions and enrollment materials to ensure that they accurately provide for such coverage. </li></ul></ul>
  135. 148. Thank You! <ul><li>Kristy N. Britsch </li></ul><ul><li>Kegler, Brown, Hill & Ritter Co., L.P.A. </li></ul><ul><li>65 E. State Street, Suite 1800 </li></ul><ul><li>Columbus, Ohio 43215, USA </li></ul><ul><li>Direct Dial: (614) 462-5412 </li></ul><ul><li>Fax: (614) 464-2634 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Web Address: www.keglerbrown.com </li></ul>
  136. 149. Brendan P. Feheley Labor Seminar – March 11, 2010 FROM PAY STUBS TO PINK SLIPS: HIRING AND FIRING IN OHIO
  137. 150. Introduction <ul><li>“ Time spent on hiring is time well spent.”  -Robert Half </li></ul><ul><li>&quot;Getting fired is nature's way of telling you that you had the wrong job in the first place.&quot; -- Hal Lancaster </li></ul>
  138. 151. <ul><li>The practical stuff </li></ul><ul><ul><li>Have an Application! </li></ul></ul><ul><ul><ul><li>Resumes allow applicants to determine what you see about them. </li></ul></ul></ul><ul><ul><ul><li>What do you gain from yours? </li></ul></ul></ul><ul><ul><ul><li>How would you look on the application? </li></ul></ul></ul><ul><ul><ul><li>Actually read the answers to the application and ask about them </li></ul></ul></ul><ul><ul><ul><ul><li>Résumé fraud and application fraud </li></ul></ul></ul></ul><ul><ul><li>Do your homework </li></ul></ul><ul><ul><ul><li>Check references </li></ul></ul></ul><ul><ul><ul><li>Verify employment </li></ul></ul></ul>“ Let's start at the very beginning- a very good place to start”
  139. 152. Applications (continued) <ul><li>The legal stuff </li></ul><ul><ul><li>Have your application reviewed by counsel periodically </li></ul></ul><ul><ul><ul><li>Include at-will language </li></ul></ul></ul><ul><ul><li>Look for and ask about gaps in employment </li></ul></ul><ul><ul><ul><li>Negligent Hiring </li></ul></ul></ul><ul><ul><li>Reference waivers??? </li></ul></ul><ul><ul><li>Shortening statute of limitations </li></ul></ul>
  140. 153.   So, they’re in the Door! <ul><li>“ When you go in for a job interview, I think a good thing to ask is if they ever press charges.”-Jack Handy </li></ul><ul><li>Practical Stuff about Interviewing </li></ul><ul><ul><li>Know the job you’re interviewing for… </li></ul></ul><ul><ul><li>Don’t talk, listen… </li></ul></ul><ul><ul><li>Don’t sell, be sold… </li></ul></ul><ul><ul><li>Ask broad questions that require a thoughtful response </li></ul></ul><ul><li>Have an accurate job description </li></ul><ul><ul><li>Job duties </li></ul></ul><ul><ul><li>Lifting requirements </li></ul></ul>
  141. 154. Interviewing (continued) <ul><li>The legal stuff </li></ul><ul><ul><li>The toothpaste out of the tube… </li></ul></ul><ul><ul><ul><li>Impermissible questions </li></ul></ul></ul><ul><ul><ul><ul><li>Inquiries into age, race, ethnicity, orientation, religion </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Questions about child bearing, familial roles </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Union affiliations </li></ul></ul></ul></ul><ul><ul><li>If you insist… </li></ul></ul><ul><ul><ul><li>When job related, you can ask about… </li></ul></ul></ul><ul><ul><ul><ul><li>Ability to work weekend or overtime requirements? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Can you read and write in English? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Do you possess a driver’s license? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Convictions </li></ul></ul></ul></ul>
  142. 155. Interviewing… <ul><li>You’re in the clear… </li></ul><ul><ul><li>Ability to perform job duties </li></ul></ul><ul><ul><li>Questions regarding education obtained (not dates when obtained) </li></ul></ul><ul><ul><li>Prior work experience </li></ul></ul><ul><ul><li>Ability to work in the United States </li></ul></ul><ul><ul><li>Leadership roles </li></ul></ul>
  143. 156. Post-Interview / Offer Steps <ul><li>“ Whenever you are asked if you can do a job, tell 'em, ‘Certainly, I can!’ Then get busy and find out how to do it.” –Theodore Roosevelt </li></ul><ul><li>Background Checks </li></ul><ul><ul><li>You get what you pay for </li></ul></ul><ul><ul><li>Remember the FCRA </li></ul></ul><ul><li>Snooping on the Millennials </li></ul><ul><ul><li>Google </li></ul></ul><ul><ul><li>Facebook </li></ul></ul><ul><ul><li>Myspace </li></ul></ul><ul><ul><li>Twitter </li></ul></ul>
  144. 157. Post-Interview / Offer Steps <ul><li>Reference checks </li></ul><ul><ul><li>Verify duration of employment, position worked, and salary (if you can get it). </li></ul></ul><ul><ul><li>If former employer will tell you about the job the employee did (you never know) </li></ul></ul><ul><li>Educational checks </li></ul><ul><ul><li>The curious case of George O’Leary </li></ul></ul><ul><li>Examinations </li></ul><ul><ul><li>Post offer (really should be job-related) </li></ul></ul><ul><ul><ul><li>Job descriptions (again…) </li></ul></ul></ul>
  145. 158. You’re Hired!!! <ul><li>Handbook </li></ul><ul><ul><li>Go over expectations </li></ul></ul><ul><ul><li>Go over “at-will status” </li></ul></ul><ul><ul><ul><li>Not a contract! </li></ul></ul></ul><ul><ul><li>Get signed acknowledgement </li></ul></ul><ul><ul><li>Exempt vs. Non-Exempt </li></ul></ul><ul><li>Confidentiality/Non-Compete </li></ul><ul><ul><li>Now’s the time! </li></ul></ul>
  146. 159. You Fooled Me! (now I want you gone) <ul><li>“ I mean, there's no arguing. There is no anything. There is no beating around the bush. ‘You're fired’ is a very strong term.” -Donald Trump </li></ul><ul><li>What’s the Goal of Discipline? </li></ul><ul><ul><li>Positively influencing performance </li></ul></ul><ul><ul><li>Protecting against legal action, </li></ul></ul><ul><ul><ul><li>The “Hot Stove Rule” </li></ul></ul></ul><ul><li>Why do employees sue their former employers? </li></ul>
  147. 160. Keys to Successful Terminations <ul><li>TRAINING!! </li></ul><ul><li>Avoid the Gentlemen’s B </li></ul><ul><ul><li>Insist on accurate, if uncomfortable performance evaluations </li></ul></ul><ul><li>Remember the Policy </li></ul><ul><ul><li>Make sure you supervisors and managers are trained on the progressive discipline policy </li></ul></ul><ul><li>Use a Pen and Paper </li></ul><ul><ul><li>Write things down, consistently… repeatedly… </li></ul></ul>
  148. 161. Keys (cont.) <ul><li>“ You never ask why you've been fired because if you do, they're liable to tell you.”-Jerry Coleman </li></ul><ul><li>Tell the whole story </li></ul><ul><ul><li>Review documentation from managers as it occurs </li></ul></ul><ul><ul><li>Try to be objective </li></ul></ul><ul><li>Use your resources… </li></ul><ul><ul><li>Spending a little money can save a lot of money later… </li></ul></ul>
  149. 162. Gee, thanks…How do I do that? <ul><li>Know your policy. </li></ul><ul><ul><li>Know how your policy is applied… </li></ul></ul><ul><li>Follow the steps </li></ul><ul><ul><li>Progressive Discipline </li></ul></ul><ul><ul><li>Verbal Warnings </li></ul></ul><ul><ul><li>Verbal is not Verbal (Document) </li></ul></ul><ul><ul><li>Is verbal warning consistent/sufficient? </li></ul></ul><ul><ul><li>Does employee understand it was a verbal warning? </li></ul></ul><ul><li>The straw that broke the camel’s back… </li></ul>
  150. 163. <ul><li>The tree view </li></ul><ul><li>Have the prerequisites to written warnings (e.g. verbal warnings) been given? If so, when? </li></ul><ul><li>Has each written warning been explained to the employee and has the employee been given a chance to tell his or her version of what occurred? </li></ul><ul><li>Does each written warning inform the employee of what will happen if the problem continues? </li></ul><ul><li>Has each written warning been issued in a timely fashion (how much time has passed between the infraction and the issuance of the written warning)? </li></ul><ul><li>Is each written warning readily understandable to an average person? </li></ul>Written Warnings
  151. 164. Written Warnings (cont.) <ul><li>The forest view… </li></ul><ul><ul><li>Is the discipline consistent with past discipline of others for similar events or misconduct? </li></ul></ul><ul><ul><ul><li>Review other similar situations… </li></ul></ul></ul><ul><ul><li>Did the employee explain the incident? </li></ul></ul><ul><ul><ul><li>Does the explanation require a deviation from the normal course? </li></ul></ul></ul><ul><ul><li>Look back at the job description… </li></ul></ul>
  152. 165. A word about RIFs <ul><li>RIFs are NEVER fun… </li></ul><ul><ul><li>Preparation is the absolute key to a organized, successful RIF </li></ul></ul><ul><ul><li>An RIF requires a close examination of your business </li></ul></ul><ul><ul><ul><li>Remember to USE THE PEN AND PAPER </li></ul></ul></ul><ul><ul><li>Create a matrix </li></ul></ul><ul><ul><ul><li>What qualities are important to the business? </li></ul></ul></ul><ul><ul><ul><li>Which ones are important to have in an employee? </li></ul></ul></ul>
  153. 166. NO FMLA??? <ul><li>Remember the FMLA is a floor, not a ceiling. </li></ul><ul><ul><li>Consult your employee policies regarding permissible leave </li></ul></ul><ul><li>The new regulations actually HELP! </li></ul><ul><ul><li>Requirement that employee follow call-in procedure </li></ul></ul><ul><ul><li>New forms require more information from the doctor </li></ul></ul><ul><ul><li>Definite procedure regarding medical certifications </li></ul></ul><ul><li>The absolute key to successful FMLA terminations is COMMUNICATION. </li></ul>
  154. 167. Retaliation <ul><li>Retaliation claims are on the rise </li></ul><ul><ul><li>Workers Compensation </li></ul></ul><ul><ul><li>Harassment </li></ul></ul><ul><ul><li>Safety </li></ul></ul><ul><li>Key is to thoroughly train supervisors on the types of things that require investigation. </li></ul><ul><ul><li>Resolve the complaint. Communicate the resolution. </li></ul></ul><ul><ul><li>Proximity plays an important role. </li></ul></ul><ul><ul><li>Where employee has complained prior to termination, consistency in discipline is key. </li></ul></ul>
  155. 168. Tips on avoiding ADA claims <ul><li>Engage in the process. Early. </li></ul><ul><li>Document any mentions of difficulty performing job duties or medical conditions </li></ul><ul><ul><li>Tell the whole story… “What did we do about the problem?” </li></ul></ul><ul><li>Remember that additional leave can be a reasonable accommodation </li></ul><ul><ul><li>Deviation from normal practice? </li></ul></ul><ul><li>Be as objective as possible </li></ul><ul><ul><li>Avoid adopting manager or supervisor frustration </li></ul></ul>
  156. 169. Miscellaneous Claims <ul><li>Breach of contract/implied contract </li></ul><ul><ul><li>Handbook language can be key. </li></ul></ul><ul><ul><li>Train supervisors not to promise things to employees. </li></ul></ul><ul><li>Public Policy </li></ul><ul><ul><li>Don’t react to employee threat of getting counsel </li></ul></ul><ul><ul><li>Document any complaints regarding employee safety and what was done about them. </li></ul></ul>
  157. 170. <ul><li>Now that wasn’t very hard. Was it? </li></ul>
  158. 171. Thank You! <ul><li>Brendan P. Feheley </li></ul><ul><li>Kegler, Brown, Hill & Ritter Co., L.P.A. </li></ul><ul><li>65 E. State Street, Suite 1800 </li></ul><ul><li>Columbus, Ohio 43215, USA </li></ul><ul><li>Direct Dial: (614) 462-5482 </li></ul><ul><li>Fax: (614) 464-2634 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Web Address: www.keglerbrown.com </li></ul>
  159. 172. Thank You For Attending Hope to See You Next Year!