FMLA Eligibility: Understanding What Health Reasons Qualify for Leave

Your clients likely have questions about The Family and Medical Leave Act, or FMLA, especially what qualifies and what doesn’t. FMLA allows eligible employees to take unpaid, job-protected leave for certain family and medical reasons. It’s important your clients understand what qualifies for leave under FMLA so they apply it correctly to their workplace.

Eligible employees can take leave for themselves or to care for a family member with a “serious health condition.” This means an illness, injury, impairment or physical or mental condition that involves either (1) inpatient care or (2) continuing treatment by a healthcare provider. The first is more straightforward than the second.

1. Inpatient Care

Inpatient care is defined as an overnight stay in a hospital, hospice or residential medical care facility. It also includes any period of incapacity or subsequent treatment. If an employee requires inpatient care, or is caring for a family member requiring inpatient care, they qualify for FMLA leave.

2. Continuing Treatment by a Health Care Provider

Continuing treatment has several possible requirements for eligibility. Let’s take a closer look:

Incapacity and Treatment

This includes a period of incapacity of more than three consecutive calendar days. It also includes any following treatment or period of incapacity related to the same condition.

• Incapacity is the inability to work, attend school or perform other regular daily activities due to a serious health condition.
• Treatment must be from a health care provider and requires that the first visit be in-person and must take place within seven days of the first day of incapacity. Treatment includes, but is not limited to, examinations to determine if a serious health condition exists and evaluations of the condition.

This category also requires one of the following treatment schedules:

• Two or more treatments within 30 days of the incapacity (absent extenuating circumstances). Treatment must be given by a health care provider or nurse under direct supervision of a health care provider. It can also be conducted by a provider of health care services (e.g., physical therapist) under the orders of a health care provider.
  
  Or
• Treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment.

Pregnancy or Prenatal Care

Any period of incapacity or treatment related to pregnancy or prenatal care. A visit to a health care provider is not necessary for each absence. And the absence does not have to last for more than three consecutive calendar days.

Chronic Conditions

Any period of incapacity or treatment due to a chronic serious health condition, defined as:

• A condition requiring periodic visits, at least twice a year, for treatment by a health care provider or nurse under direct supervision of a health care provider; and
• Continues over an extended period of time; and
• May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy)

A visit to a health care provider is not necessary for each absence, and the absence does not have to last for more than three consecutive calendar days.

Permanent or Long-Term Conditions

A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The individual must be under the continuing supervision of a health care provider, but does not necessarily have to be receiving active treatment.

Conditions Requiring Multiple Treatments

Any period of absence to receive multiple treatments, including any period of recovery for restorative surgery after an accident or injury. This includes conditions that would likely result in a period of incapacity of more than three consecutive days in the absence of medical intervention or treatment. Examples include cancer, severe arthritis or kidney disease.

If you or your clients have questions about FMLA, contact your representative at The Standard or visit our Paid and Family Medical Leave resource page.