FMLA Leave 101: What Qualifies as a Serious Health Condition?

Managing leave under the Family and Medical Leave Act (FMLA) has its challenges. Employers need to ensure that all HR staff and all managers who deal with employee leave requests are well-versed in the finer details of FMLA-related leave. They should understand who is eligible for leave, how much they’re eligible for, how you track FMLA absences, and how intermittent FMLA leave is managed.

One of the first steps when administering any individual case of FMLA leave is ensuring eligibility. There are several key criteria that must be met in order for an employee to be eligible to take FMLA leave:

• The employee must work at a location that qualifies for FMLA. In order for an employer to be subject to FMLA requirements, a private employer must have at least 50 employees. And the employee must work at a location in which the employer has at least 50 employees within a 75-mile radius.
• The employee has to have worked for that employer for at least 12 months.
• The employee has to have worked at least 1,250 hours for the employer during the preceding 12 months.
• The leave must be for one of the following[i]:
  • Birth of a child or placement of a foster child or adopted child
  • Caring for an immediate family member with a serious health condition
  • The employee’s own serious health condition

  If all criteria are met, the employer must grant up to 12 weeks of unpaid, job-protected leave to the employee.

  What Constitutes a Serious Health Condition?

  As noted above, one of the main reasons an employee may be eligible to take FMLA leave is for his or her own or an immediate family member’s serious health condition. But you may be wondering what constitutes a “serious health condition”? Thankfully for us, the regulations are actually fairly clear on this point.

  According to the Department of Labor website:

  • Any period of incapacity or treatment connected with inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility; or
  • A period of incapacity requiring absence of more than 3 calendar days from work, school, or other regular daily activities that also involves continuing treatment by (or under the supervision of) a healthcare provider; or
  • Any period of incapacity due to pregnancy or for prenatal care; or
  • Any period of incapacity (or treatment therefore) due to a chronic serious health condition (e.g., asthma, diabetes, epilepsy); or
  • A period of incapacity that is permanent or long-term due to a condition for which treatment may not be effective (e.g., Alzheimer’s, stroke, terminal diseases); or
  • Any absences to receive multiple treatments (including any period of recovery therefrom) by, or on referral by, a healthcare provider for a condition that likely would result in incapacity of more than 3 consecutive days if left untreated (e.g., chemotherapy, physical therapy, dialysis).”[ii]

  As you can see, the requirements for having a serious health condition are actually rather straightforward.

  It is up to the employer whether it chooses to require medical certification at the beginning of an FMLA leave for a serious health condition. If the employer chooses to do so, there are rules around the medical certification as well.

  During an FMLA leave of absence, the employee retains all work benefits, and at the end of the leave period the employee must be allowed to return to his or her original job or to an equivalent position in the organization.

  [i] For simplicity, this article is not discussing the military leave components of the FMLA, and instead is focusing on the family/medical components.