Legal Question in Medical Leave in Oregon

Denied FMLA leave under ''serious health condition'' definition.

My husband and I are seeking alternative/complimentary

treatment for infertility, however, certification by provider was filled in wrong but was already turned in, a second application was filled out and turned in along with a letter from provider stating my(patient)information was put on my husbands leave app. instead of mine the letter also asked to reconsider the application for leave, I spoke to the HR manager at my husbands work and she said it was pointless to have us reapply because they would not recosider the denial. A section of the certification asked whether it is necessary for the employee to be absent from work to care for spouse, the provider assumed since I was the employee they marked no on that entire section because I was not needing leave to care for anyone I was the patient,I am not the employee but my husband. The denial letter stated the reason for the denial was because the provider stated he was not needed to accompany me, after several weeks I had called and now they are saying that we do not meet the ''serious health condition'' criteria was the reason for denial, I know they have not looked at the correct application,my practitioner reccomended such treatment under defintion we do meet the guidelines.


Asked on 6/16/04, 1:52 pm

1 Answer from Attorneys

Craig Crispin Crispin Employment Lawyers

Re: Denied FMLA leave under ''serious health condition'' definition.

Leave may be taken for a �serious health condition.� What constitutes a �serious health condition� is one of the more frequently misunderstood aspects of the FMLA. The concept of �serious health condition� was meant to be construed broadly. Department of Labor Regulations define the phrase as an illness, injury, impairment or physical or mental condition that involves inpatient care, a period of incapacity combined with treatment by a health care provider, pregnancy or prenatal care, chronic conditions, long-term incapacitating conditions, and conditions requiring multiple treatments. 29 C.F.R. � 825.114(a).

More specifically, inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including any period of incapacity (inability to work, attend school or perform other regular daily activities), or any later treatment in connection with the inpatient care. 29 C.F.R. � 825.114(a)(1).

Incapacity plus treatment means a period of incapacity of more than three consecutive days, including any later treatment or period of incapacity relating to the same condition, that also involves: (1) treatment two or more times by a health care provider, by a nurse or physician�s assistant, or a physical therapist; or (2) 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. 29 C.F.R. � 825.114(a)(2)(i).

Pregnancy or prenatal care includes any period of incapacity due to the pregnancy or prenatal care, such as time off from work for doctors� visits. 29 C.F.R. � 825.114(a)(2)(ii). A chronic health condition means a condition which requires periodic visits for treatment by a health care provider, which continues over an extended period of time (including recurring episodes of a single underlying condition), and may cause episodes of incapacity (inability to work, attend school or perform other regular daily activities) rather than continuing incapacity. 29 C.F.R. � 825.114(a)(2)(iii).

Conditions requiring multiple treatments includes any period of absence to receive multiple treatments (including any period of recovery from the treatments) by a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity (inability to work, attend school or perform other regular daily activities) of more than three consecutive calendar days in the absence of medical intervention or treatment. 29 C.F.R. � 825.114(a)(2)(v).

On the other hand, by way of example, routine physical, eye or dental examinations; treatments for acne or plastic surgery; common ailments such as a cold or the flu, ear aches, upset stomach, minor ulcers, headaches (other than migraines); and treatment for routine dental or orthodontic problems or periodontal disease generally do not qualify as serious health conditions. 29 C.F.R. � 114(b),(c).

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Answered on 6/16/04, 2:18 pm


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