One of my clients had a serious staff problem recently.  He had been in the habit of allowing his team members to take Paid Time Off with pay before the benefits had accrued.  He had published an addendum to his Handbook stating that if a staff member left the practice, the extra benefits taken would be subtracted out of their final paycheck. He never discussed or distributed that addendum to the staff members. 

A staff member recently left the practice, having used all of her Paid Time Off for 2022.  The extra money that she was paid was subtracted out of her last paycheck. She made a terrible scene in the office in front of patients.  It was not pretty.

Don’t let this happen to you!  First, I recommend that you make it clear that PTO will only be paid if it was accrued. Second, if you allow any exception to this rule, make sure that your staff member understands that it must be paid back!!