Certification And Treatment
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Certification And Treatment

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A quick guide through the twists and turns of FMLA certification

A quick guide through the twists and turns of FMLA certification

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Certification And Treatment Certification And Treatment Presentation Transcript

  • Certification and Treatment: The FMLA Way A simple guide to the FMLA certification process and medical treatment standards
  • In the Beginning…FMLA certification
    • The employee is required to provide FMLA certification from an health care provider prior to FMLA leave
    • The employee is required to provide the FMLA certification for either themselves or for their family member if it’s for the family member’s leave
      • It’s due back to HR within 15 days or as soon as possible.
      • If the employee fails to provide the certification, leave can be denied until such time as the certification is provided.
      • If you get the certification, you have 5 days to respond
  • The big questions
    •   That FMLA certification has to include
      • the date the condition started,
      • the probable duration,
      • the diagnosis
      • specifically state the treatment regimen
      • if inpatient hospital stay will be required.
      • The FMLA certification needs to give an employer enough information to be able to make an assessment as to if leave is appropriate for and how long that leave is going to last.
  • If the FMLA certification doesn’t meet your standards…
    • If your not happy with the certification or can’t read it,
    • The employer can then ask the employee to see another doctor.
      • That doctor cannot be a physician who is regularly employed by the company.
      • The 2 nd and 3 rd exams are at the company’s request and cost
    • If you question the adequacy of the certification, you have the ability to request information from the health care provider directly.
  • Second Opinions
    • A Doctor employed by the company can’t give you the second opinion on FMLA leave,
    • It has to be an outside physician. You can even require a third opinion.
    • You are bound the third opinion. There’s no wiggle room.
    • You’re stuck if the third opinion is a serious health condition and leave is appropriate,
  • If your not sure the first time… recertification
    • There is a recertification process if there is a significant change in circumstances, medically or in how the leave time is used.
    • An aberration or a change in the frequency of absences is when we see a lot of abuse in intermittent and reduced leave schedule. Absences only on Fridays or Mondays which are frequently indicative of things like leave abuse and a reason to ask for recertification
    • If less treatment is required, then you can ask for recertification
  • FMLA Regulations Draw the Line Serious Medical Condition vs. Routine Visit
    • Not all treatment is created equal according to FMLA regulations.
    • Treatment will include examinations to determine whether a serious health condition exists and subsequent evaluations.
    • For example, an employee can’t get out of bed one day, then goes to the hospital on day 2, an Orthopedic Surgeon on day 3 and then a Neurosurgeon will have everything counted as treatment
  • FMLA regulations say that routine visits do not count.
    • These don’t count as treatment
      • Routine medical visits,
      • dental visits,
      • eye examinations
  • Who can sign an FMLA certification?
    • These professionals can also give treatment
    • A Doctor of medicine or osteopathy authorized to practice medicine or surgery Podiatrist,
    • Dentist,
    • Clinical Psychologist,
    • Optometrist and Chiropractors authorized to practice in the state.
    • Nurse Practitioners, Nurse Midwife, Clinical Social Workers authorized to practice under state law and performance in the scope of their practice.
    • Christian Science practitioners listed with the First Church of Christ Scientist in Boston, Massachusetts.
    • Any healthcare provider recognized by the employer or the employers’ group health plan benefits managers. In some respects you all control who can give treatment and who’s the healthcare provider.
    • Any healthcare provider listed above who practices in the country other than United States and is authorized to practice under the laws of that country.