Catastrophic Leave Program

Please read this prior to completing the package to ensure a timely determination on your case.

Application

  1. Complete all the requested information on the application including specific dates, even if provided in a prior certification for this illness or injury
  2. Sign and date the application

If any information is missing or incomplete, this may cause a delay or denial of Catastrophic Leave.

Health Care Provider (HCP) Statement

  1. Ensure your HCP completes all the requested information on the application including specific dates. If the date is unknown, the HCP should include the minimum date he/she expects that you will be released. This information can be updated later, if needed. You will need to re-certify on a monthly basis.
  2. It is critical that the HCP note why the case currently meets the criteria for Catastrophic Leave. The more supporting information the HCP provides the better. Incomplete information from the HCP may cause delay or denial of Catastrophic Leave.
  3. If the request is a subsequent medical appeal, please include additional medical information that was not provided previously. If there is no additional medical information, your appeal will not be considered.

Authorization to Request Health Information

  1. Complete the Authorization to Request Health Information completely. This authorizes the UNM's Employee and Occupational Health Services (EOHS) the ability to contact your Health Care Provider (HCP) if there are any questions. Failure to complete this may cause denial of your Catastrophic Leave if EOHS is unable to clarify questions with your HCP.

Forms

Notification

Employee Notification

The employee will receive a letter signifying approval or denial. If denied, the letter will identify the specific reason why the leave was not approved.

Manager Notification

The manager will receive notification from Human Resources signifying whether the leave was approved.

Policy

Please see Administrative Policies and Procedures Manual - Policy 3430: Catastrophic Leave Program for more information.

Frequently Asked Questions

Catastrophic Leave is addressed by Administrative Policies and Procedures Manual - Policy 3430: Catastrophic Leave Program. The policy defines a catastrophic illness and/or injury as "an acute or prolonged illness or injury that is considered life-threatening or with the threat of serious residual disability which results in the employee's inability to work."

Key identifiers of a catastrophic illness or injury include:

  • Terminal illness
  • High intensity/High frequency of treatments for chronic conditions
  • Serious*, debilitating illness, impairment, or physical/mental condition

*Note that policy further explains that, "The University retains the right to determine whether the illness is 'serious' based on the information it receives from the medical provider." Employee Occupational Health Services (EOHS) evaluates the medical documentation from the clinical provider based on medical standards for illnesses and injuries to determine whether or not a condition meets the definition of catastrophic. Therefore, it is extremely important that the medical documentation accurately portray the condition so the EOHS can properly evaluate whether or not it is catastrophic. Elective procedures are specifically excluded in policy from being identified as catastrophic.

Medical professionals review the application in accordance with medical disability guidelines in order to assess the qualifications of the condition with the guidelines for the Catastrophic Leave Program. Consideration is given to the intensity of medical treatment required, the acute nature of the condition, the functioning ability of the individual, and any recent progression in the applicant's condition. A complete review ensures consistency in the application process.

​Short-Term Disability covers most medical conditions. It is not just for catastrophic illnesses. A big difference between Catastrophic Leave and Short-Term Disability is that Short-Term Disability will cover maternity leave, sickness, disease, other medical conditions, and injuries, which do not meet the definition of catastrophic. As with medical insurance, Short-Term Disability will typically exclude pre-existing conditions, intentionally self-inflicted injuries or attempted suicide, disabilities due to war, cosmetic surgery, any work related injury or illness, or injuries incurred in participation of a felony. It is much broader than Catastrophic Leave. Short-Term Disability's coverage is similar to what is covered by medical insurance, the difference being that Short-Term Disability is wage replacement coverage with maximums (stated as a percent of salary along with a weekly, biweekly, or monthly max).

Please see the Short Term Disability page for more information.​

Each case is thoroughly evaluated based on the medical information provided by the health care provider. As such, the medical documentation must tell the complete story of the individual's condition. It is important to understand that this medical information is treated as confidential, and will not be shared by anyone involved in the review process. Individual's that hear of a claim second or third hand may not have all the details or specifics related to a claim, and therefore do not have the appropriate information to make a determination.

There are two appeal processes in place depending on the reason for denial. If an application is denied by a manager due to misuse or abuse of leave, the applicant can appeal to the next level manager. If an application is denied by Employee Occupational Health Services (EOHS) due to medical reasons, the applicant can have their health care provider resubmit with additional medical details. The application will then be reevaluated based on the new information provided.

The severity of the illness or injury may change over time which is why a recertification process is necessary. If the individual's health has improved, he/she may no longer be in a catastrophic situation. Conversely, someone may have a progressive illness that originally is not catastrophic but later reaches the catastrophic level.

The Catastrophic Leave Program is administered under an opt-out approach. This means that eligible employees are automatically enrolled unless they choose to opt-out. The opt-out is offered once before the beginning of the fiscal year and is administered via a link that is sent to all eligible employees. Careful consideration should be given to opting-out. Once an employee has chosen to opt-out, they will not be eligible to receive benefits from the program for the entire fiscal year. However, the next fiscal year, they will again have the option to opt-out of participation in the new-year.

When an employee accrues annual leave, there is no immediate cost to the department and there is no immediate "set aside" of funds to pay for the annual leave. When an employee takes annual leave, the expense is charged to their department index in lieu of regular pay. Therefore, the financial impact to the department is the same whether the employee worked or took annual leave.

When an employee gives to the Catastrophic Leave Program, they are donating leave (and the associated dollars) above and beyond what they are being paid. In order to move this money to the index that will pay for catastrophic leave, it has to be taken from somewhere. That is where the expense comes from. It is the first and only time the expense is recorded to the departmental index of the donor. While it appears this is a double charge, it should not be confused with the payment to the employee for time worked or leave taken.

One item that complicates this issue is the annual leave accrual. Once a year, the University "sets aside" the money needed to pay out up to 168 hours of annual leave to eligible employees, as required if the employee were to voluntarily leave their employment. This shows up as an expense on the departmental index that is reversed when the next calculation is applied at the end of the next fiscal year. The catastrophic leave donation is always taken before this entry is done so that donated hours do not get charged a second time in the annual leave accrual.

Medical professionals review the application, along with medical disability guidelines, to assess the qualifications of the condition with the guidelines for the Catastrophic Leave Program. Consideration is given to the intensity of medical treatment required, the acute nature of the condition, the functioning ability of the individual, and any recent progression in the applicant's condition. A complete review ensures consistency in the application process.

The employee submits the application to his/her manager, who will work with Human Resources to evaluate the request based on basic eligibility requirements, including contribution to the program, length of service, length of request, and any history of misuse or abuse of leave. Human Resources and the manager do not determine whether the medical requirements of the Catastrophic Leave Program are met. Human Resources will forward the information to EOHS, who will evaluate the medical information submitted by the medical care provider. In some cases, EOHS may contact the physician directly for additional information. EOHS will then forward the final determination back to HR, who will work with the manager in notifying the employee.

The annual and sick leave programs are governed by University Business Policies and Procedures Manual (UBPPM) #3400, Annual Leave, and UBPPM #3410, Sick Leave. These policies provide specific information on each program and establish the parameters for appropriate use. In addition, you may contact your HR Consultant to respond to specific questions.

Unfortunately, leave above the amount of 252 hours does not get recorded (or expensed) in any way, and so there is no financial savings to apply to the catastrophic leave program or anywhere else. Here is how it works: When an employee accrues annual leave, there is no immediate cost to the department and there is no immediate "set aside" of funds to pay for the annual leave. When an employee takes annual leave, the expense is charged to his/her department index in lieu of regular pay. Therefore, the financial impact to the department is the same whether the employee worked or took annual leave. Without getting into the details of the once-a-year annual leave accrual, suffice it to say that this entry also ignores hours lost above 252. In short, UNM never charges for these lost hours, and therefore, they cannot be used to fund the catastrophic leave program.

Administrative Policies and Procedures Manual - Policy 3400: Annual Leave states that "Annual leave is accrued at the end of the pay period and cannot be taken until the pay period following the date in which it was accrued." The same would apply for donations. They cannot be taken until the following pay period. It is suggested that employees monitor their annual leave balances by referencing Lobo Web. This will help you monitor whether you have enough time to donate to the program.