Presentation on theme: "Managing the FMLA Certification and Re-Certification Process James H. Gilliam BrownWinick 666 Grand Avenue, Suite 2000 Des Moines, IA 50309-2510 Telephone:"— Presentation transcript:
Managing the FMLA Certification and Re-Certification Process James H. Gilliam BrownWinick 666 Grand Avenue, Suite 2000 Des Moines, IA 50309-2510 Telephone: 515-242-2446 Facsimile: 515-323-8546 E-mail: firstname.lastname@example.org
Family and Medical Leave Act Authorizes employees to take up to 12 workweeks of leave within a 12 month period for qualifying reason.
FMLA Qualifying Reasons Employee’s own serious health condition (SHC) Child care within one year of birth or foster care/adoption placement Care of spouse/parent/child with SHC
FMLA Qualifying Reasons (cont.) 12 weeks for qualifying military exigency of spouse/child/parent on active duty 26 weeks for care of spouse/child/parent/ next of kin for illness/injury in line of duty
FMLA Leave May Be Taken: Continuously Intermittently Reduced Work Schedule
Medical Certification Required for: Existence of SHC Type and Duration of Absence Needed Medical Necessity of Care for Covered Family Member
Tip No. 1 Examine medical certifications for completeness and sufficiency.
Incomplete Defined “A certification is considered incomplete [if] one or more of the applicable entries have not been completed.”
Insufficient Defined “A certification is considered insufficient if the … information provided is vague, ambiguous or non-responsive.”
Required Certification Content - 1 Name and contact information of health care provider and type of medical practice/ specialization.
Required Certification Content - 2 Approximate date SHC commenced and probable duration.
Required Certification Content - 3 Medical facts sufficient to support the need for leave.
Examples of “Sufficient” Medical Facts Symptoms Diagnosis Hospitalizations Doctor Visits Medication Prescribed Referrals for Evaluation Regimen of Continuing Treatment
Required Certification Content – 4 (Patient is Employee) Inability to Perform Essential Function(s) Nature of Work Restrictions Duration of Inability
Required Certification Content – 5 (Patient is Covered Family Member) Family Member is in Need of Care Estimate of Frequency/Duration of Leave Required to Provide Care
Required Certification Content – 6 (Intermittent/Reduced Schedule for Planned Treatment for Employee or Family Member) Medical Necessity for Intermittent/Reduced Schedule Estimate of Dates/Duration for Treatments/Periods of Recovery
Required Certification Content - 7 (Unforeseeable Intermittent/Reduced Schedule for Employee’s SHC) Medical Necessity for Intermittent/Reduced Schedule Estimate of Frequency/Duration of Episodes of Incapacity
Required Certification Content - 8 (Intermittent/Reduced Schedule for Family Member) Statement that Leave is Medically Necessary to Care for Family Member Frequency/Duration of Leave
If Incomplete or Insufficient Advise Employee in Writing State What Information is Necessary Advise Employee of 7 Day Deadline to Cure Advise Employee of Consequences
Consequences May Include: Denial of FMLA Denial of Approved Leave Discipline for Denial of Leave
Tip No. 2 Clarify or Authenticate the Medical Certification
Clarification Defined “Contacting the health care provider to understand the handwriting … or to understand the meaning of a response.”
Authentication Defined “Requesting verification that the information … was completed and/or authorized by the health care provider that signed the document.”
Limited Contact Permitted HR Professional Leave Administrator Other Management Official Never the Employee’s Direct Supervisor
Tip No. 3 Request Second/Third Opinions of Medical Necessity
Second Opinion Reason to Doubt Validity of Certification Leave Granted on Provisional Basis May Not use Health Care Provider Under Employer Control
Third Opinion Only if Employer-Designated Provider Disagrees Jointly Designated Third Opinion Binding
Employer May Require a New Certification When the Need for Leave Lasts Beyond the Leave Year
Example: Amy exhausted FMLA leave in 2012 due to recurring migraines. She will re-qualify for FMLA in January, 2013. Even though her health care provider certified the condition as “permanent,” the employer may require a new certification when Amy re-qualifies for FMLA in January, 2013.
Re-Certification Rules A:30 Day Rule Employer may not require re-certification more frequently than every 30 days and only in connection with an absence (unless B or C apply).
B: More Than 30 Days If the certification indicates the minimum duration of the SHC is more than 30 days, Employer must wait until minimum duration expires before requiring re- certification.
Example: Suzy breaks a leg in a freak wallpapering accident at home. Her doctor certifies she must stay off her feet for 40 days, necessitating FMLA. Employer may not request re-certification during the first 40 days.
B – (continued) An Employer may require a re-certification every six months regardless of period in original certification.
Example: Amy’s recurring migraines are certified as “permanent.” The Employer may require re-certification after six months.
C – Less Than 30 Days An Employer may require re-certification in less than 30 days if the Employee requests an extension of leave.
Example: Tom has a certified FMLA absence of 7 days to take his wife to physical therapy after her operation. On the 6 th day he informs Employer she needs an additional week of PT. Employer may require re-certification.
C – (continued) An Employer may require re-certification when the circumstances described by previous certification have changed significantly.
Examples of Significant Change of Circumstances Duration of Absence Frequency of Absences Nature of Illness Severity of Illness Nature/Severity of Complications
Example: Amy’s migraine-certification states she needs to leave for 1-2 days upon an episode. Her last two migraines lasted 4 days each. Employer may require re-certification even within a 30 day period.
Example: Amy’s last 4 migraines all occurred on a Friday prior to a three-day holiday weekend. Employer may require re-certification.
C – (continued) If the Employer receives information that casts doubt on the stated reason for the absence or the continued validity of the certification.
Example: Bob is on a 4 week FMLA leave following knee surgery. During week 3, Employer sees pictures of Bob water- skiing on his Facebook page. Employer may require re-certification.
Re-Certification Requirements 15 Days to Respond After Employer Request Same Obligations to Cooperate Employer May Provide Health Care Provider With Absence Pattern and Ask If Pattern is Consistent With SHC
Tip No. 6 Require Reports on Status and Intent to Return to Work
Policy Must Be Non-Discriminatory and Take All Relevant Facts Into Account
Notice of Intent Not to Return Must Be Unequivocal
Tip No. 7 Require a Fitness-for-Duty Certification
Certification Requirements Able to Return to Work Able to Perform Essential Elements Must Notify Employee Upon Designation Provide List of Essential Elements
Intermittent Reduced Schedule Fitness-for-Duty Certification Cannot Be Required for Each Absence Unless Reasonable Safety Concerns Exist (30- Day Limit)
Tip No. 8 Transfer Employee During Foreseeable Intermittent/Reduced Schedule Leave
Same Pay/Benefits Harassment Not Permitted Return to Prior Position
Tip No. 9 Require Employee to Schedule Intermittent Foreseeable Treatment at Convenient Times
Only Requires Employee Attempts Subject to Approval of Provider
Website: www.brownwinick.comwww.brownwinick.com Toll Free Phone Number: 1-888-282-3515 OFFICE LOCATIONS: 666 Grand Avenue, Suite 2000 Des Moines, Iowa 50309-2510 Telephone: (515) 242-2400 Facsimile: (515) 283-0231 616 Franklin Place Pella, Iowa 50219 Telephone: (641) 628-4513 Facsimile: (641) 628-8494 DISCLAIMER: No oral or written statement made by BrownWinick attorneys should be interpreted by the recipient as suggesting a need to obtain legal counsel from BrownWinick or any other firm, nor as suggesting a need to take legal action. Do not attempt to solve individual problems upon the basis of general information provided by any BrownWinick attorney, as slight changes in fact situations may cause a material change in legal result.