Compliance August 22, 2006

San Francisco Voters to Ponder Sick Leave Measure

August 22, 2006 (PLANSPONSOR.com) - San Francisco voters are set to decide later this year whether the California city will become the first US municipality to require firms to give workers paid sick days.
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According to a news report in the San Francisco Sentinel, four members of the San Francisco Board of Supervisors formally submitted the ballot proposal to the Elections Department with a request for the November ballot consideration.

The Coalition for Paid Sick Days said t he ballot measure would provide paid sick days for workers to care also for parents and legal guardians, siblings, children, spouses or registered domestic partners, grandparents, and one designated person not included in those categories.Categories of sick days refer to biological, adopted, and foster family relationships, according to the Coalition:

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The ballot measure details how paid sick days would be accrued:

  • Every worker in San Francisco shall accrue one hour of paid sick leave for every 30 hours worked.
  • New workers shall start accruing sick leave after a three-month probation period.
  • Sick day accrual has a cap of nine days or 72 hours for businesses with more than 10 employees.
  • Sick day accrual has a cap of five days or 40 hours for small businesses, defined as 10 or under employees.
  • Employees may use sick hours to miss part of a shift to attend medical appointments.
  • In the case of a union contract the legislation has a collective bargaining op-out.
  • Accrued leave may carry over from year to year but employers are not required to provide more than 72 hours (or 40 hours for small businesses) to workers.
  • Workers may not cash out or be reimbursed for unused hours upon the termination or resignation of employment.

The law is set to go into effect 90 days after election certification.

Employers are not required to provide additional sick leave or modify existing leave policies if a sick leave policy is already in place which meet ballot measure requirements.

Earlier this year, San Francisco Mayor Gavin Newsom signed into law a universal health care bill for the city (See Current Newsom Health Plan Expands Earlier Coverage Program ).

Compliance August 21, 2006

Court Finds SPD Created Expectations of Benefits

August 21, 2006 (PLANSPONSOR.com) - The US District Court for the Northern District of California has ruled that accidental death and dismemberment claims for a man who completely lost vision in his left eye should be based on the plan's summary plan description (SPD) and not the plan document itself.
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In its opinion, the court noted that, although Robert Weis had an eye disease since birth, he had partial vision in his left eye until an accident which caused him to poke his eye. A doctor’s note stated the pre-existing condition did not likely contribute to Weis’ injury.

The court found that the SPD had determined Weis’ reasonable expectations for benefits. Weis was not provided with a plan document, according to the opinion. The court noted, if language in the SPD could create different expectations than language of the document, the language most favorable to the plaintiff controls.

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Weis was a participant in the Accidental Death & Dismemberment Benefit Plan of Kaiser Foundation Health Plan, Inc. The policy defined “injury” as “bodily injury caused by an accident . . . and resulting directly and independently of all other causes in a covered loss,” according to the court opinion. The policy excluded “any loss caused in whole or in part, or resulting in whole or in part from, . . . sickness, disease or infections of any kind.” The SPD more generously stated that “Accidental Death and Dismemberment benefits are not payable for death and dismemberment due to: most natural illnesses or diseases.”

Weis was born with congenital cataracts and surgery at age five left him with partial vision in his left eye, the court opinion said. Thirty years later Weis tripped and fell in his home and poked his thumb into his left eye. He was diagnosed with a severely detached retina.

Weis underwent surgery to repair the retina and, though he initially regained his pre-existing limited vision, complications from the surgery caused him to lose total vision in his left eye. He applied for benefits from his AD&D plan, and his claim was denied.

The case is Weis II v. Accidental Death & Dismemberment Benefit Plan of Kaiser Foundation Health Plan Inc.

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