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 (1 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.

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 3 full, consecutive calendar days of incapacity as well as two visits to a healthcare professional that must have occurred within a 30 day timeframe. Such proof must be established in the certification.

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 6 hours per day instead of 8 hours, or alternatively, can work 10 hours a day on Monday-Thurs and will take off on Friday.

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, Stripe, and Twilio.