Filing an STD/FMLA Claim

Read below for important information on what is required to ensure that your disability/leave is processed in a timely manner. In addition, you will find links to helpful information such as Unum’s Disability Brochure, your Leave Coordinator and answers to frequently asked questions.

  1. EMPLOYEE RESPONSIBILITIES

The Employee must:

  1. Whenever possible, notify Unum (toll-free at 1-866-762-8702), your leave coordinator and your manager at least thirty (30) days prior to or as soon as practicable of the occurrence of a planned or foreseeable illness or injury. If you are unable to call Unum due to your disability, someone else can call on your behalf. They must have your date of birth and home address when calling Unum.
  2. Review disability information on the Pearson Benefits Website. Download the STD/FMLA Claim Brochure & Authorization Form and provide a signed copy of the authorization form to Unum and your treating physician.
  3. Ensure the treating physician provides the appropriate medical documentation to Unum in a timely manner. STD benefits may be delayed or denied if the appropriate medical documentation is not submitted in a timely manner.
  4. If you are on disability/leave due to the birth/adoption of a child, log on to the Pearson U.S. Employee Portal or call Pearson People Services (PPS) at 1-877-311-0948 to add your child to your medical coverage within 31 days of the event. If the child is not added within the 31-day period, the child will not be covered under Pearson’s medical plan and you will have to wait until the next annual enrollment period.
  5. Obtain a written consent (medical release) from the treating physician prior to return to work. If no release is provided you will be sent home without pay until a release can be obtained.
  6. Notify Unum should the treating physician release you to return to work prior to an already approved date.
  7. Maintain contact with your manager and Leave Coordinator while on leave.
  8. Refer to the list of Frequently Asked Questions or contact your Leave Coordinator with any questions you may have.
  9. If you are released to return to work with temporary restrictions or on a part-time basis, contact your Leave Coordinator and Unum to determine if restrictions can be accommodated.
  10. Contact your manager/HR representative and Unum at least three (3) days in advance of the estimated return to work date in order to coordinate the return. The first day you return to work, advise Unum so that your claim can be closed and to protect any FML coverage, if applicable.
  11. Notify your local helpdesk about how to manage your email account while on leave.
  1. APPROVAL PROCESS

Approvals for leaves/disabilities are considered based on the treating physician’s diagnosis and the medical necessity of the individual case, in conjunction with the documentation of the appropriate treating physician. Additional medical records may be requested in order to finalize a decision.

The treating physician must provide documentation proving medical necessity for the employee to be away from work due to the illness or injury. If all applicable documentation has not been submitted, the claim will be closed 15 days (22 days if the leave is FML-related) after the filing of the initial claim. Documentation must include an anticipated date of return whenever possible. If a return date is not available, the documentation must include the date of the next scheduled appointment for the employee with his/her treating physician.

If a request for an STD leave is denied due to lack of supportive medical evidence, the employee is notified of such denial in writing. The employee has 180 days to either file a formal appeal in writing to Unum or submit new medical evidence for review. If the employee does not comply as required above, the employee is deemed to have voluntarily resigned employment.

The Company reserves the right to require any employee receiving STD benefits to submit additional information from the treating physician at any time during the approved benefit period. The Company also reserves the right to require any employee, applying for or receiving STD benefits, to be examined by a physician designated by the Company, at the Company’s expense, to verify an employee’s eligibility for such benefits.

  1. RETURN TO WORK

Employees must have a medical release from the treating physician to return to work. The medical release must be provided to the employee’s manager /HR representative. If no release is provided the employee is sent home without pay until a release can be obtained.

If the medical release provides for temporary restrictions on the type of work the employee may perform, and the Company is unable to place the employee in a job because of such restrictions, the employee may be returned to leave status, if medically appropriate, until released without restrictions. If the employee cannot be accommodated due to restrictions, and has exhausted his/her STD benefits, if eligible and properly submitted, the claim will be considered for LTD.

The employee is required to return to work on the release date determined by the treating physician. If the employee does not return to work or contact the company within three (3) business days of medical release, the employee is considered to have voluntarily terminated employment with the Company. If the employee is on an approved STD/leave and is unable to return to work for medical reasons after the end of the 26-week STD period, the eligible employee may apply for LTD benefits. Refer to the LTD Plan for more information.

Every reasonable effort is made to reinstate an employee to his/her previous position upon return from STD. However, there is no guarantee of a position being available upon return from a medical leave of absence, except as required by Federal and State regulations.

If an employee returning from STD is a qualified individual with a disability, who requires a reasonable accommodation to perform the essential functions of his/her job, the employee should request such accommodation by contacting the Corporate Employee Relations department at 201-236-3525. Pearson complies with the Americans with Disabilities Act (ADA), and will take all required actions in this regard.

  1. RESERVATION OF RIGHTS

This policy applies to eligible employees of Pearson Inc., and the affiliated operating companies of Pearson Inc. that participate in this Pearson-sponsored policy. The Company reserves the right to amend, modify or terminate this policy at any time and without advance notice, subject to the requirements of applicable law. Please keep in mind that this STD policy, any changes to it, or any payments to it, or any payments to you under its terms, does not constitute a contract of employment with the Company and does not give you the right to be retained in the employment of the Company. No one speaking on behalf of this STD policy or the Company can alter the terms of this policy.