The Family and Medical Leave Act (FMLA) entitles eligible employees of covered employers to take unpaid, job-protected leave for specified medical and family reasons while maintaining group healthcare coverage. Two of the most common events triggering FMLA leave are if the employee or a covered family member suffers from a serious health condition. But what qualifies as a serious health condition under the FMLA?
Many employers struggle with whether an employee or their family member has a serious health condition when making an FMLA leave request. In short, a serious health condition is an illness, injury, impairment, and physical or mental condition involving continuing treatment or inpatient care by a healthcare provider. This brief definition likely does not answer all your questions. To offer more clarity on what qualifies as an FMLA serious health condition, here are some examples:
Inpatient Care
A health condition requiring an overnight stay in a hospital, residential medical care facility, or hospice meets the definition of a serious health condition, including any period of subsequent treatment or incapacity connected with the overnight stay.
Pregnancy and Prenatal Care
Any period of incapacity due to pregnancy, such as morning sickness or bed rest before giving birth, is a serious health condition. FMLA leave may also be taken for prenatal care even if it does not result in incapacitation.
Incapacity With Continuing Treatment
An FMLA serious health condition includes a period of incapacity of more than three consecutive full-calendar days, plus any continuing treatment or period of incapacity relating to the same condition. Continuing treatment means either two or more visits to a healthcare provider within 30 days of the first day of incapacity (with the first treatment occurring within seven days) or at least one treatment with a healthcare provider within seven days of the first day of inability followed by a regimen of care such as antibiotics or physical therapy.
Chronic Health Conditions
FMLA leave may be taken for a period of incapacity due to a chronic health condition such as migraine headaches, epilepsy, diabetes, and asthma. This type of serious health condition requires care by a healthcare provider at least twice a year and must recur over an extended period. Chronic conditions can cause a continuing inability to work or merely episodes of incapacity.
Long-Term or Permanent Conditions
If an employee is being supervised by a health care provider for a condition rendering them incapacitated for a long time or permanently, they have an FMLA serious health condition. These serious health conditions include Alzheimer’s disease and terminal illnesses such as cancer.
Conditions Requiring Multiple Treatments
Time off for multiple medical treatments qualifies as a serious health condition if it is for restorative surgery following an accident or other injury. Additionally, a condition that would likely require an absence of more than three consecutive full-calendar days if not treated qualifies (e.g., severe arthritis, kidney disease, and cancer requiring chemotherapy).
Elective Surgery
Not all elective surgery qualifies as a serious health condition. However, if elective surgery results in an overnight stay in a hospital, an employee’s FMLA leave request would meet the definition of a serious health condition under the inpatient care criteria.
Conditions such as the common cold, the flu, earaches, upset stomach, minor ulcers, headaches (other than migraine), routine dental or orthodontia problems, and periodontal disease typically do not meet the definition of serious health condition unless complications arise resulting in inpatient care or continuing treatment.
Remember, employers can be exposed to extensive liability for FMLA interference or denial if they do not respond in a timely manner to an employee’s FMLA leave request. If there is a possibility that the medical condition of an employee or covered family member is an FMLA serious health condition, employers should provide the proper notification and certification forms to the employee to determine whether a serious health condition exists. Model notification and certification forms can be found on the U.S. Department of Labor’s website https://www.dol.gov/agencies/whd/fmla/forms).
Learn more about how WorkForce Software can help keep your organization compliant.
