What is a Serious Health Condition Under the FMLA?
Whether an employee may be entitled to leave under the Family and Medical Leave Act (FMLA) often depends on whether the employee or his or her family member has a “serious health condition.” Here’s what employers need to know about how the FMLA defines the term “serious health condition.”
A “serious health condition” is defined as an illness, injury, impairment or physical or mental condition that involves either “inpatient care” or “continuing treatment by a health care provider.” 29 C.F.R. § 825.113.
“Inpatient Care” is defined as an overnight stay in a hospital, hospice, or residential medical care facility, including any period of incapacity or any subsequent treatment in connection with the inpatient care. 29 C.F.R. § 825.114.
“Continuing treatment by a health care provider” is defined to include any of the following situations:
(1) Incapacity and treatment: Any period of incapacity of more than three consecutive, full calendar days, and any subsequent treatment or period of incapacity relating to the same condition, that also involves either: (a) treatment by a health care provider two or more times, within 30 days of the first day of incapacity, unless extenuating circumstances exist; or (b) treatment by a health care provider on at least one occasion, which results in a regimen of continuing treatment under the supervision of the health care provider.
(2) Pregnancy or prenatal care: Any period of incapacity due to pregnancy or prenatal care.
(3) Chronic conditions: Any period of incapacity or treatment for such incapacity due to a chronic serious health condition that: (a) requires periodic visits at least twice per year for treatment by a health care provider; (b) continues over an extended period of time (including recurring episodes of a single underlying condition); and (c) may cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc…).
(4) Permanent or long-term conditions: A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective (e.g., Alzheimer’s, a severe stroke, or the terminal stages of a disease). The employee or family member must be under the continuing supervision of, but need not be receiving active treatment from, a health care provider.
(5) Conditions requiring multiple treatments: Any period of absence to receive multiple treatments from a health care provider (including any related period of recovery) for: (a) restorative surgery after an accident or other injury; or (b) a condition that would likely result in a period of incapacity of more than three consecutive, full calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc…), severe arthritis (physical therapy), or kidney disease (dialysis).
Takeaway: There are multiple ways that an eligible employee or his or her family member may qualify as having a “serious health condition” under the FMLA. Employers who are covered by the FMLA need to be familiar with all of the applicable definitions.