FMLA: Forgetting Minutiae Lead to (legal) Actions (Part IV)

Resuming our journey through the complex maze that is the Family and Medical Leave Act, we turn now to address – through a series of questions and answers – important aspects of FMLA when employees are dealing with their own serious health conditions (when they cannot perform their essential job functions) or the serious health conditions of their spouses, parents, or children. Previously, we addressed aspects of FMLA leave (i.e., up to 12 weeks of unpaid leave during the year) for employees who are expanding their family through births, adoptions, or foster child placement.

So, employees are entitled to FMLA leave if they have a serious health condition?

Correct.

And, they can take leave when a spouse, parent, or child has a serious health condition?

Again correct. Employees can also take leave to care for their spouse, parent, or child with a serious health condition.

What about grandparents or siblings?

Generally, no. Employees are not entitled to FMLA to care for grandparents or siblings or cousins or really any other family member other than their spouse, parent, or child. However, if a grandparent acted in loco parentis (acts as a parent) to the employee before the employee was of age, then FMLA leave could be taken.

I noticed that you italicized the phrase “serious health condition” above, was there a reason for doing that?

Yes, we were trying to draw your attention to that phrase because it has a special meaning under the FMLA.

What does it mean?

It means an illness, injury, impairment, or physical or mental condition that involves (1) inpatient care, or (2) continuing treatment by a health care provider.

What is considered inpatient care?

Inpatient care means that the person receiving treatment has to stay overnight in a hospital, hospice, or residential medical care facility. It also includes periods of incapacity or subsequent treatment that’s connect to the overnight stay.

And, what do you mean by “continuing treatment by a healthcare provider”?

That phrase refers to any of the following types of ongoing treatment: incapacity and treatment, pregnancy or prenatal care, chronic conditions, permanent or long-term conditions, and conditions requiring multiple treatments.

You did that italicizing thing again with the word incapacity.

Yes, we did. That’s because the word incapacity also has a special meaning.

What is the special meaning for incapacity?

An incapacity means an inability to work, attend school, or perform other regular daily activities due to the serious health condition, treatment of the serious health condition, or recovery from the serious health condition, which lasts longer than three days.

Are there any limits on what’s included in the incapacity period?

Yes. To qualify for FMLA coverage, the incapacity must also involve:

• Treatment two or more times by a health care provider, under the supervision of a healthcare provider, or due to a referral by a health care provider, within 30 days of the first day of incapacity; or
• Treatment by a health care provider on at least one occasion, which results in a regimen of continuing treatment under the supervision of the health care provider.

So, does a period of incapacity require a visit with a health care provider?

Yes.

Who qualifies as a healthcare provider?

Health care providers include professionals who you would normally think about, like doctors of medicine or osteopathy (authorized by the State in which the doctor practices), podiatrists, dentists, optometrists, nurse practitioners, physician assistants, or clinical psychologists.

Is that all?

No. Under the FMLA, a healthcare provider can also include chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist), nurse-midwives, clinical social workers, or any healthcare provider that an employer or the employer’s group health plan’s benefits manager accepts to certifying for purposes of a benefit claim that the individual has a serious health condition.

Going back to the period of incapacity lasting more than three days, are there any additional requirements involved with that period?

There are. The first (and sometimes only) in-person treatment visit with a healthcare provider must happen within seven days of the first day of incapacity.

Can you have partial day incapacities that count towards that original three-day requirement?

No, partial days of incapacity cannot be combined to satisfy the requirement that the incapacity extend more than 3 days or 72 hours.

Can an employee receive FMLA leave if they schedule all of their routine physical exams over three days and miss three full days of work?

No. The treatment at issue does not include routine physical examinations, eye examinations, or dental examinations. The treatment protected by the FMLA is generally limited to examinations to determine if a serious health condition exists and evaluations of that condition.

You mentioned earlier that the requirement for continuing treatment by a healthcare provider includes treatment for pregnancy or prenatal care, right?

Yes, it does. However, a pregnant employee can still be entitled to FMLA leave if the employee does not receive medical treatment for the absence. For example, a pregnant employee unable to report to work because of severe morning sickness would be entitled to FMLA for that absence.

You mentioned that chronic conditions can be a qualify reason, what are those?

A chronic serious health condition is one which:

• Requires periodic visits for treatment by a health care provider, or by a nurse under direct supervision of a health care provider;
• Continues over an extended period of time (including recurring episodes of a single underlying condition); and
• May cause episodic rather than a continuing period of incapacity.

How periodic must a visit be?

It must be at least twice a year.

Are there examples of conditions that may cause episodic rather than continuing periods of incapacity?

Yes, those types of conditions may include asthma, epilepsy, diabetes, and similar types of conditions.

So, diabetes can be considered a chronic condition for which employees may use FMLA leave?

Yes, if it requires in-patient care or if it requires an employee go to the doctor at least twice a year.

Now, what about permanent or long-term conditions, must there be active treatment for all covered absences?

No. Although the individual suffering from a permanent or long-term condition must be under the continuing supervision of a health care provider, that individual is not required to receive active treatment during each covered absence.

Are there any examples of these types of conditions?

Examples of permanent or long-term conditions that fall in this category include Alzheimer’s, a severe stroke, or the terminal stages of a disease.

What types of conditions requiring multiple treatments would qualify for FMLA leave?

Either, restorative surgery after an accident or other injury; or a condition that would likely result in a period of incapacity of more than three consecutive, full calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), or kidney disease (dialysis).

As noted above, the first post in our series on FMLA summarized the steps an employer should follow when dealing with the FMLA labyrinth and addressed which employers are covered by the Act. The second post explained which employees are eligible for FMLA leave. The third post addressed FMLA leave for the birth or adoption of a child. The next post in the FMLA series will address the qualifying reasons arising from issues specific to military members and their families.

Jennifer Fowler-Hermes
jfowler-hermes@williamsparker.com
941-552-2558