Intro
Life is unpredictable; sometimes our health requires us to hit the pause button and take time off from work to care for ourselves. Medical leaves are designed for you to take time off of work to rest, recover, and heal from your disability while you're unable to perform your regular work tasks.
We understand that this can be an overwhelming and uncertain time. Rest assured that you're not on this journey alone — Cocoon has helped thousands of people take their leaves and we're here to help every step of the way.
Need to take medical leave urgently? Read our 10 things to know about medical leave checklist here to kick off your leave quickly. |
Goal of this guide
Our goal is to empower you to manage your medical leave with confidence.
In this guide, we'll walk you through the fundamental steps, tips, and information to help you navigate this process and any changes with ease.
Find videos a better way to learn? Watch how to plan, design, and submit a leave in this walkthrough.
TIP: This entire video is 22 minutes long, but you can skip to a certain "chapter" via links at the bottom based on what you want to learn
Your leave
To start, what is a medical leave?
A medical leave is a specified period of time away from work to care for an injury or serious health condition - be it mental or physical. You may need medical leave because you're dealing with a serious illness, a recent injury, need time to recover after a medical procedure, or while exploring a new treatment plan.
You'll play an active role throughout your medical leave by working closely with your medical provider. Together, you can determine the time you need, the support required, and the criteria for a smooth return to work.
Tell me some of the basics — how does my leave actually work?
When it comes to navigating a medical leave, it's important to understand how time and pay fit into the picture.
Broadly speaking, your medical leave can be thought of as a combination of two things:
Time — the amount of time away from work that is available to you through a combination of employer policy and state or federal entitlements (for example, FMLA). These often overlap and your leave timeline in the Cocoon dashboard will show you how they apply to your leave.
Pay — any benefit payments or employer pay you may receive to help replace your wages while on leave. (Note that some medical leaves may not have supplemental pay, only time.) Here are three common sources for pay during leave:
short-term disability benefits
state disability programs
employer paid medical leave policies ("top-up pay")
Depending on your specific leave, you may receive funds from one, two, all or none of these sources. As you design your leave plan, you'll be able to view the time and pay available to you throughout your leave.
What if my medical leave is for mental or behavioral health rather than a physical disability?
Medical leave may be the best choice for varying types of disability or injury, including treatment or care for mood or personality disorders. It's important to know though, that state and private disability claim entities often require additional medical documentation for disability claims related to mental or behavioral health. This might include historical visit notes, questionnaires or medical evaluations from your physician to substantiate your need for leave.
We recommend connecting with your medical provider to ensure their willingness to certify your need for leave and to complete any additional requested documentation, as needed.
What should I keep in mind as I get started planning my leave?
The need for a medical leave can arise anytime and a leave of absence might be available to you a few ways:
Your company may have a policy in place that allows you to take a medical leave.
You may have protections from federal or state entitlements, like FMLA.
If the first two options are unavailable to you, you can request a medical leave as an accommodation.
Leave as an accommodation
If you don't qualify for any federal, state, or employer protected time off, you can request leave as an accommodation via the Americans with Disabilities Act (ADA). In order to see what you qualify for or to get started on the ADA process, you can begin by designing your leave in the Cocoon dashboard.
In general, the ADA process starts with a medical recommendation from your healthcare provider that you take time away from work to focus on caring for your heath. If you are ineligible for medical leave you'll see the following pop-up when you attempt to design your leave plan:
From there, Cocoon will prompt you to request leave as an accommodation. We'll walk you through the required steps and facilitate communications between you
Your employer has the right to approve or deny your request, or ask for additional information.
We'll let you know and walk you through any next steps
💡 Under the ADA, you are not required to submit diagnoses information to your employer. The above form includes all of the relevant information you'll need to provide to make a leave accommodation request.
Time & Pay
Understanding the time that is available to you
Cocoon uses software to accurately represent the total amount of time available to use during your leave.
Leave time is calculated using a few variables:
Location: where you live and work (specifically, what state/locality you live and work in)
Length of service: how long you've been at your company
Employer details: where your employer is located, and how many employees they have
Employer policy: how much time your employer provides for medical leave
If you'd like to know more about how your time is being calculated, you can check out the "time" section of your leave dashboard (it's the little clock icon).
Once there, click anywhere on the green bars, and we'll expand them to show you which laws and policies (usually known as "entitlements") are in play for your leave:
As you plan your leave (and throughout its duration), we’ll coordinate your leave eligibility and entitlements to ensure compliance with federal, state, local, and employer policies. We'll also help guide the claims process and facilitate your employer pay to ensure you’re receiving all funds available to you throughout your leave.
While you may have leave entitlements protecting your time off, you'll need to work with your medical provider to complete your leave forms in order to finalize your request for time. Without completion and submission of these forms, your leave may not be protected.
For more information around your entitlements, please see the following articles:
Understanding the pay that is available to you
Once you submit your leave, we'll coach you through the whole process! So if you're still in the planning phase, you don't need to sweat the details too much just yet.
In cases where you live in a state with a paid program, and/or your employer has a short-term disability policy on your behalf, you will prepare a "claim" to apply for and receive that pay. These are standardized forms that we'll provide to you — along with helpful, supportive in-product guides — once you submit your leave.
Additionally, your employer may or may not provide top-up pay to get your income to 100% of your typical salary for all of or for a portion of your leave plan.
To see how your pay is being calculated and where it will be coming from, you can check out the "pay" section of your leave dashboard (it's the $ icon). From there, click in to see the breakdown of pay sources:
What do I need to prepare for to ensure I get my pay?
Ensuring your claim forms are accurate, certified, and complete is the first step, but here are some best practices to make your claim process go smoothly.
Your leave forms in Cocoon already have the dates you entered pre-filled!
If your dates happen to change, make sure to update them on your dashboard and re-download your leave forms as necessary.
With that in mind, it's typically best to download your forms closer to the start of your leave so your leave forms have the most accurate dates for your medical provider to certify.
Make sure your claim forms are submitted as soon as possible once your leave has begun. While claim entities will not accept short term disability claims prior to your first day of disability, submitting them as soon as your leave begins ensures that the processing period kicks off as quickly as possible, so you can receive your benefits ASAP!
Your leave responsibilities
Throughout your medical leave, there are a few pieces that will require your direct involvement. The following items are your main responsibilities while out on leave. Later on, we'll go over each item in further detail.
Keep your leave plan in Cocoon up to date
Change happens. It's important that you let Cocoon (and by extension, your employer) know about these changes by editing your leave plan. Once your claim has been submitted, you may need to work with the state and or private disability carriers directly to make any changes to your claims.
Work with your medical provider to complete your leave forms
When completing your leave forms, it's important to make sure your medical provider has provided their complete certification on your leave forms and that you've reviewed the full forms for completion and accuracy. Each of your leave forms have certain deadlines that will be surfaced in your claims task list. Keep an eye out for deadlines to ensure your leave paperwork is being submitted timely.
Keep an eye out for notices or requests from the state and/or private disability carriers
If any follow up or additional information is needed while your claim is being processed, the state or private insurer will reach out to you directly. Be on the lookout for paper notices, emails, or phone calls from your claim entities. The sooner these are responded to or completed, the more quickly your claims will see approval!
What are the leave forms for medical leave and why are they necessary?
Once your medical leave plan is submitted, there are certain leave forms that require your medical provider's certification to ensure your leave can be approved for job protections and/or wage replacement.
To be approved, these forms must be completed by certain deadlines that will be made apparent in your Cocoon dashboard.
These may include:
Serious Health Condition form - determines leave approval and provides job protection, where applicable once approved
Your request to go on medical leave must be approved under your employer’s leave policy and leave laws, like the federal Family and Medical Leave Act.
To apply for approval, you must ensure that your medical provider completes all required fields. To make it easier, we've highlighted the required sections on the federally recommended Serious Health Condition form.
This form will also be used to ensure FMLA protections, as applicable to your leave plan.
The SHC form must be completed within 15 days of your leave submission.
Until the SHC form is submitted back to Cocoon, you may begin your leave, but it may not be job protected until your leave forms have been reviewed and your leave plan has shifted to an Approved state.
Short Term Disability claim forms - provides leave pay
This form is used to initiate your claim for short term disability benefit payments from your private disability carrier.
These forms collect important information about your medical condition, the duration of your disability, and other relevant details for processing your claim.
When reaching out to your provider for their completion of these forms, we recommend reviewing the following article and advising they complete, at minimum, the highlighted fields listed.
State-specific claim forms - provides leave pay
This form is used to initiate your claim for state disability benefit payments or job protection programs.
Forms vary depending on the state program, Cocoon will surface the leave forms specific to the state program you're eligible for as you go through the flow.
These forms collect important information about your medical condition, the duration of your disability, and other relevant details for processing your claim.
As a note, not every state offers disability insurance for leave-takers, the claims section of your Cocoon dashboard will identify any and all benefit programs you may be eligible for.
Getting ready to leave
I'm ready to share my plan
Amazing! It's a big step and we know sharing an intended medical leave can be intimidating.
Rest assured that your leave plan is taking everything it needs to into consideration, like your employer's policies, state and federal protections and entitlements, and any benefit programs that may provide wage replacement to you while you're out.
It's important to remember that up until this point, your leave planning has been entirely private. Once you finalize and complete the submission flow, your manager and your HR team will be automatically notified — so, should you want to tell them this news on your own before then, be mindful of that.
What do I need to do before I head out?
Here's a handy checklist for you:
Ensure your dates are as accurate as they can be, especially your leave start date
Educate yourself on your claims and paperwork responsibilities, if applicable (found in the "Claims" section of your dashboard)
Educate yourself on how your pay will work on leave so there are no surprises (found in the "Pay" section of your dashboard)
Finalize your leave transition plan with your manager
Set up your out of office plan
Explore our Employee Help Center where we provide in-depth resources to help you throughout your leave
My claim has been filed, what's next?
Once your claim has been filed, most claim entities finish processing your claim within 2-3 weeks of submission. However, there are a few things that may come up before you start to receive your benefit payments. It's not uncommon for the state or private insurance carriers to reach out for additional information from you, your medical provider, or your employer before approving your claim.
We recommend you keep an eye out for any communications via phone, email, or in the mail after your claim has been submitted. It's important to respond promptly to these requests to prevent delays in the approval of your claim.
If you receive any requests and you're unsure what steps to take next, reach out to our Support team and we're happy to help or guide you through next steps wherever we can!
How long will it take to receive benefit payments?
Benefit payments often take 2-4 weeks to arrive once a claim is approved. Make sure to budget accordingly, as you may be receiving less pay than you're accustomed to during your leave while you wait for your claims to process; or if you're receiving reduced employer pay while you're out.
To stay updated on the status of your claim or benefit payments, it's best to contact the state or your private disability insurance providers directly. They will have the most up-to-date information and can provide you with detailed insights regarding your claim.
How will I receive my pay while on leave?
Cocoon does not collect your banking information during the leave submission process, so all private disability benefits will be paid to you via check or pre-paid debit card, unless otherwise indicated on your claim forms. |
If you would like to explore other options for payment distribution:
Once your claims have been submitted, you can reach out to your claim entities directly to explore alternative benefit payment options that may be available to you. Options will vary by entity.
What is the "waiting period"?
When you start receiving benefit payments you might notice that the initial 7 days of your leave are unpaid.
This period is referred to as an unpaid waiting period, or elimination period. When it comes to disability claims, some states and all private insurance carriers establish a waiting period during which no benefits are provided at the beginning of your leave. Typically, the waiting period spans 7 days, which means that the first week of your medical leave will not provide wage replacement by either the state and/or private insurance carrier.
The waiting period can vary, but you'll be able to see when different pay sources kick in via your leave timeline.
I've still got questions about pay — and I want to understand this better before submitting my leave
That's understandable! This guide to your leave pay goes into a lot more depth.
Change happens
Leave is inherently uncertain, and change is normal and expected!
My dates have changed — is that okay?
Rest assured, it's perfectly okay for changes to occur, and here is some helpful guidance to handle them efficiently.
Once you're aware of any date changes, you can update your dates in your Cocoon dashboard. We'll automatically email your manager and HR team to let them know.
If your claim(s) have already been filed, you'll want to reach out to the state and/or private insurance provider to update your dates with them and see if they need any additional information to process the change.
If you're receiving any "top-up" pay from your employer and your dates change:
This may affect your payment schedule. It can take around 2 weeks from the date the change was made to update and issue corrected payments.
I don't actually know when I'm going to need leave — what should I do?
We understand that it can challenging to predict the exact timing of your medical leave. In situations like this, it's essential to consult with your medical provider so that together you can assess your situation and determine if and when medical leave might be necessary. Design your leave plan to align with the dates that you and your provider determine are best for you.
Your medical provider may advise you to take leave from work on a reduced schedule:
Within Cocoon, you're able to design your leave in full day increments. If you need to take a partial day off or any combination of full and partial days, reach out to your HR/People team, as you may need to plan your leave outside of Cocoon.
Returning from medical leave
What is a fitness for duty (FFD) certification?
Fitness for duty certifications are written statements from healthcare providers confirming that employees are able to resume work after a complete medical leave. Depending on the reason for your medical leave, a request for a FFD certification may require a healthcare provider to evaluate an employee’s physical or mental abilities to perform jobs.
Cocoon will email you and prompt you to upload a completed FFD certification to the Your Tasks tab prior to returning to work. If you do not, your employer can refuse to allow your to resume work.
Do I have to use Cocoon’s standard FFD template?
No. Cocoon provides a standard template for your convenience, but you are welcome to use an alternative form preferred by you or your medical provider.
Conclusion
Our intention is to set you up for a successful medical leave. We know that taking a leave of absence can be scary and there a lot of moving parts to navigate. The Cocoon team is here to support you however we can to ensure that you're able to use this time as intended: to care for your own medical health and needs. We hope this guide proved to be valuable to help you kick off your medical leave effectively.
Have Questions? We're here to help!
Email us at [email protected]