Key Takeaways

  • A certification of health care provider is essential for verifying employee medical leave under or beyond FMLA.
  • FMLA provides up to 12 weeks of unpaid leave for eligible employees under specific conditions.
  • Certification forms involve the employer, employee, and health care provider.
  • Additional leave and documentation may apply to military caregiver situations.
  • Certifications must be specific, timely, and can require second opinions or updates.
  • In other contexts, "healthcare provider certification" can refer to professional or immigration-related qualifications, like BLS or USCIS credentials.

Certification of Health Care Provider

The purpose of certification of health care provider is to certify those employees on medical leave who otherwise do not qualify for or have exhausted all time off under the Family and Medical Leave Act (FMLA). The certification will include information needed in order to determine how long and what type of leave the employee is seeking.

FMLA is a federal law that promises certain qualified employees up to 12 working weeks of unpaid leave on an annual basis without fear of losing the job. FMLA also compels employers maintain health insurance for eligible employees while out on leave. FMLA was enacted in 1933 as a way to offer qualified employees up to 12 weeks of excused absence from their jobs without risk of losing the job. Since FMLA can be rather tricky, it is often a challenge for HR professionals. Employers that maintain the requirements must conform with FMLA; however, not all companies maintain such requirements and therefore are exempt from the FMLA rules. Such minimum requirements include the following: the employer must have at least 50 people working for the company for a minimum of 20 workweeks out of the year—either the current or prior year. All state, federal, and local employers must also conform with the rule. However, smaller employers are not required to abide by the law. As previously noted, FMLA applies to qualified employees. The employee must work for a covered employer for at least 12 months (one year), and at least 1,250 hours during the year, before applying for leave under FMLA. In addition, the employee’s job must take place at a location where at least 50 other employees work, or within 75 miles of a location where 50 or more employees work for the same company.

In addition to the above criteria, one of the following must be met:

  • The employee must not be an elected official at the local, state, or federal level.
  • The employee can’t work due to a serious medical condition.
  • The employee must care for an immediate family member that has a significant medical problem.
  • The employee gives birth.
  • The employee fosters or adopts a child.
  • A qualifying emergency arises due to the employee’s spouse, child, or parent being on active duty or being called to active duty for the National Guard or Reserve.

Broader Definitions of Healthcare Provider Certification

While the certification of health care provider under FMLA is specific to verifying an employee’s serious health condition, the term “healthcare provider certification” can also refer to broader legal or professional requirements:

  • USCIS Health Care Worker Certification: Required for certain non-U.S. citizens to work legally as health care providers in the United States. These certifications verify education, licensure, and English proficiency for occupations like nurses, physical therapists, and speech-language pathologists.
  • Basic Life Support (BLS) Certification: Required for many health professionals such as nurses and EMTs, this credential verifies competency in life-saving procedures. The American Red Cross and American Heart Association provide these certifications.
  • State-Level Provider Certifications: Some states require health care provider certificates for institutions or individuals to offer specific services or participate in managed care programs. For instance, Florida mandates a certificate with a $1,000 non-refundable application fee for commercial health care providers.

Each of these uses of “healthcare provider certification” reflects different regulatory or professional requirements but shares the common goal of ensuring qualified, safe, and authorized care.

Certification Form: Broken Down

  • Section 1. The first section is to be filled out by the employer.
  • Section 2. The second section is to be filled out by the employee.
  • Section 3. The third section is to be filled out by the health care provider.

Employees can take up to 26 weeks of unpaid FMLA leave in a given 12-month period to care for family members who suffer a severe injury or illness while on active duty. The definition of “serious” injury can be hard to prove as the law states that the condition must involve more than three full, consecutive calendar days of incapacity as well as two visits to a health care professional that must have occurred within a 30-day timeframe. Such proof must be established in the certification.

Certification Renewal and Updates

Medical certifications under FMLA are not always one-time documents. Employers may require updated certifications in the following cases:

  • Extended or Intermittent Leave: If an employee is on extended or intermittent FMLA leave, the employer may request a new certification every 30 days under certain conditions.
  • Change in Condition: If the seriousness of the medical condition changes significantly, an updated certification may be requested.
  • Return-to-Work Certifications: Employers may request a fitness-for-duty certification before an employee returns from medical leave, provided the requirement is communicated in advance and applies uniformly.

Employees must comply with requests for recertification or face potential denial of ongoing leave protection.

Other Considerations

  • Employees are not required to visit with a doctor that the employer chooses; the employee can choose whichever doctor he or she sees fit.
  • The employer is required to obtain a medical certification for every FMLA leave request that is due to a serious health condition.
  • The employer must deny the leave request if the employee fails to submit the certification on time.
  • The employer must ensure that the certification is properly filled out
  • The employer must ask for a second opinion if there is any suspicion as to the validity of the medical certification.
  • Once the certification is approved, the employer must inquire each time the employee requests more leave.
  • The employer must keep track of the employee’s absences in the event that he or she is taking advantage of the FMLA policy in effect.
  • Employers want to ensure that employees are not taking intermittent leave throughout the year as this raises suspicion that the employee is not being truthful. However, the employee may be suffering from an ongoing condition that needs treatment on an as-needed basis.
  • Employers should not accept certifications that are broad as to the reason for the FMLA leave request.
  • Employers should be mindful that some employees wish to seek a reduced schedule for FMLA leave meaning that the employee can work six hours per day instead of eight hours, or alternatively, can work 10 hours a day Monday-Thurs and will take off Friday.

Consequences of Incomplete or Inaccurate Certification

Failing to provide a complete and accurate health care provider certification can result in denied leave and potential disciplinary action:

  • Denial of FMLA Leave: If the certification is late, vague, or missing required details, employers are within their rights to deny leave.
  • Disciplinary Measures: Employees who falsify or misrepresent information on certifications may face consequences under company policy.
  • Impact on Job Protection: Without proper documentation, employees risk forfeiting FMLA’s job protection provisions.

Employers must give employees a minimum of seven calendar days to fix incomplete certifications. If the employee fails to do so, the leave can be denied.

Frequently Asked Questions

1. What is a healthcare provider certification? 

It is a document or credential that verifies a health care provider’s qualifications. In the FMLA context, it certifies a medical condition; in other contexts, it may validate professional or immigration credentials.

2. Who fills out the FMLA health care provider certification?

The employer, employee, and the treating health care provider each complete separate sections of the form.

3. Can an employer request a second opinion on a certification?

Yes. If there is doubt about the validity, the employer can request a second (and even third) medical opinion at the company’s expense.

4. Are certifications needed for intermittent leave?

Yes. The certification must specify that intermittent or reduced-schedule leave is medically necessary and outline the expected frequency and duration.

5. Can a healthcare provider certification affect immigration or employment eligibility?

Yes. For foreign nationals seeking to work in U.S. health care, certifications through USCIS-approved entities are often mandatory to prove education, licensure, and language proficiency.

If you need help learning more about the certification of health care provider as well as the associated FMLA rules and your rights under the law, you can post your legal need on UpCounsel’s marketplace. UpCounsel accepts only the top 5 percent of lawyers to its site. Lawyers on UpCounsel come from law schools such as Harvard Law and Yale Law and average 14 years of legal experience, including work with or on behalf of companies like Google, Menlo Ventures, and Airbnb.