Employer Guidelines for Determining a Serious Health Condition

A serious health condition exists if the employee, or the employee's child, spouse, or parent has an illness, injury, impairment, or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider. Use the following guidelines to determine whether an absence can be attributed to a serious health condition. 

INPATIENT CARE (check one)

______ 1A. overnight stay in a hospital, hospice, or residential medical care facility

______ 1B. any period of incapacity or subsequent treatment in connection with an overnight stay in the type of facility listed above

______ 1A. incapacity lasting more than 3 consecutive calendar days and that involves: (to check this, you must first check one of the following)

 ______ a. Two or more treatments by or under the supervision, orders, or referral of a health care provider

or

______ b. One treatment by a health care provider followed by a regimen of continuing treatment under the supervision of the health care provider (e.g., prescription medications or therapy with specialized equipment but not over-the-counter medications or salves, bed- rest, fluid intake or exercise). NOTE: Absent complications, this generally would not include the common cold, the flu, ear aches, upset stomach, minor ulcers, headaches other than migraine, routine dental or orthodontia problems, and periodontal disease.

______ 1B. any period of incapacity or subsequent treatment relating to the above condition

______ a. requires periodic visits for treatment by or under the direct supervision of a health care provider

and

______ b. continues over an extended period (including recurring episodes)

and

______ c. may be episodic (e.g. asthma, diabetes, epilepsy)

______ 4. permanent or long term incapacity for which treatment may be ineffective and which requires the supervision of, but not necessarily treatment by, a health care provider (e.g. Alzheimer's, severe stroke, terminal stages of disease)

______ a. restorative surgery after an accident or injury

or

______ b. a condition that is likely to result in incapacity of more than 3 consecutive calendar days without medical intervention or treatment (e.g. cancer, severe arthritis, kidney disease)

______ 5B. any period of recovery relating to the above treatments.

• conditions not involving inpatient care or continuing treatment;
• unless complications develop, the common cold, flu, ear aches, upset stomach, minor ulcers, headaches other than migraines, routine dental or orthodontia problems, or periodontal disease;
• unless inpatient care is required or complications develop, cosmetic treatments (examples: treatments for acne or plastic surgery );
• absences because of an employee's use of a substance, rather than for treatment. (FMLA leave in connection with substance abuse may only be taken for treatment of substance abuse by a health care provider or by a provider of health care services on referral by a health care provider.)

What about a potentially serious condition? The FMLA recognizes that some nonserious conditions have the potential to become serious; absences are FMLA protected if they are for the purpose of receiving multiple treatments for a condition that, if untreated, is likely to result in incapacity of more than three consecutive calendar days.