The DOL Gets Busy – New Opinion Letter, New Draft FMLA Cert Forms!

Posted on: August 13, 2019 0

By Marti Cardi, Vice President Product Compliance

August 13, 2019

 

The Department of Labor rolled out two new developments last week just in time to leave for August vacations:  First, a new opinion letter addressing whether FMLA covers time taken for specialized child educational meetings; and second, drafts of new (and improved) FMLA certification forms for public comment.

Let’s dig in!

DOL Opinion Letter FMLA2019-2-A – Meetings for Child’s Individualized Educational Program

On August 8, 2019, the DOL released Opinion Letter FMLA2019-2-A relating to whether attending a meeting to discuss a child’s Individualized Education Program (IEP) qualifies as FMLA leave. 

 

A bit of background:  The Individuals with Disabilities Education Act (IDEA) requires public schools to develop an IEP for a child who receives special education and related services with input from the child and the child’s parents, teachers, school administrators, and related services personnel. Under the IDEA, “related services” include such services as audiology services, counseling services, medical services, physical therapy, psychological services, speech-language pathology services, rehabilitation counseling services, among others. 

The individual who requested the opinion letter explained the situation as follows

You explain that your children receive pediatrician-prescribed occupational, speech, and physical therapy provided by their school district, and that four times a year their school holds CSE/IEP meetings to review their educational and medical needs, well-being, and progress. You explain that these meetings include participation by “a speech pathologist, school psychologist, occupational therapist and/or physical therapist employed or contracted by the school district to provide services to the … child under the child’s IEP,” as well as teachers and school administrators. These participants provide updates regarding your children’s progress and areas of concern; review recommendations made by your children’s doctors; review any new test results; and may make recommendations for additional therapy. You ask if your wife may use intermittent FMLA leave for the care of a child to attend these meetings.

I include these details here so it is clear that these are not your everyday parent-teacher conferences or disciplinary meetings – which would generally not be covered by FMLA.

The DOL determined that these meetings did in fact qualify for FMLA intermittent leave.  The wife’s (mother’s) attendance at these CSE/IEP meetings is “care for a family member … with a serious health condition” under 29 C.F.R. § 825.100(a).  And, care for a family member can include “mak[ing] arrangements for changes in care.”  Such FMLA coverage does not require the child’s doctor to be present nor require that the child be receiving treatment at the meetings – providing “care” is sufficient.

Pings for Employers.  Be sure to read my friend Jeff Nowak’s more detailed post on his blog, FMLA Insights. Jeff provides some excellent tips for employers that you will want to heed – including, of course, training your supervisors!

But in a nutshell:  When an employee requests leave to attend meetings relating to the care of a family member (here, a child in specialized education, but it could also be an elderly parent receiving detailed medical treatment), take time to analyze the situation carefully.  Think broadly; don’t just deny the FMLA request because the family member’s condition falls outside our usual concept of a “serious health condition” or because the meeting doesn’t seem to fit within FMLA protection. 

At Matrix our claims examiners have been alerted to this new opinion letter and its significance.  If we receive a request for time off for meetings relating to care of a family member, we will analyze the request for FMLA intermittent leave correctly and obtain appropriate documentation even when the meeting seems at first glance not to be an FMLA-qualifying event.   

 

New Draft FMLA Certification Forms – Now That’s Exciting!

Oh boy, oh boy, oh boy!  New cert forms!  And a chance to comment!  What more could an FMLA geek ask for to relieve the summer doldrums?

Seriously, this is a welcome step in FMLA-Land.  The current certification forms tend to be cumbersome and, in our experience, often don’t yield all the information the regulations entitle employers to receive.  On August 7 the DOL issued a press release explaining the goal of the new forms:

The revisions will make the forms easier to understand for employers, leave administrators, healthcare providers, and employees seeking leave. The revisions will increase compliance with the law, improve customer service, and improve the administration of the law. WHD drafted the revisions with input from the public in letters, interviews, and public meetings….

The changes will reduce the time it takes a health care provider to provide information, and help leave administrators review and communicate information to employees more directly and clearly, reducing violations.

What’s the status?  The DOL is soliciting public comments on the proposed forms by 11:59 p.m. on October 4, 2019.  The official notice was published in the Federal Register and includes directions for submitting comments. After that date, the DOL will consider the comments received and – eventually – issue new final forms.  There is no timeline for final action by the DOL and, although unlikely, they could decide not to change the forms from the current versions.  Until new forms are officially adopted, the current forms remain approved by the DOL but still optional.  With an expiration date on the current forms of August 31, 2021, the DOL has lots of time!

What are the changes?  The changes are summarized by the DOL as:

  • Fewer questions requiring written responses; replaced by statements that can be verified by simply
    checking a box [These are the best changes, in our humble opinion.  They should result in fewer
    inconsistencies within the form and less confusion regarding the frequency and duration for intermittent
    leave.]
  • Reorganization of medical certification forms to more quickly determine if a medical condition is a
    serious health condition as defined by the FMLA
  • Clarifications to reduce the demand on health care providers for follow-up information
  • More information on the notification forms to better communicate specific information about leave
    conditions to employees
  • Changes to the qualifying exigency certification form to provide clarity to employees about what
    information is required
  • Changes to the military caregiver leave forms to improve consistency and ease of use
  • Layout and style changes to reduce blank space and improve readability

Here are the revised forms, with links for your viewing pleasure:

  • WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition
  • WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition
  • WH-381 Notice of Eligibility of Rights & Responsibilities
  • WH-382 Designation Notice
  • WH-384 Certification of Qualifying Exigency for Military Family Leave
  • WH-385 Certification for Serious Injury or Illness of Covered Servicemember—for Military Family Leave
  • WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave

What is Matrix Doing?  Several years ago, we at Matrix designed our own certification forms for FMLA leave necessitated by the employee’s or a family member’s serious health condition.  Like the newly proposed DOL revisions, we adopted a simpler means of identifying the type of serious health condition involved with a check-the-box format and reconfigured the questions about leave parameters, including frequency and duration of episodes for intermittent leave.  As the DOL is now hoping, these resulted in significantly clearer provider responses and much less need for follow-up and clarification.

We will review the DOL’s proposed forms and submit comments by the deadline.  If you would like to share with us your own thoughts on the draft forms, please do so!  Once the forms are finalized we will evaluate whether they have gone far enough to simplify leave management and consider using the DOL forms going forward. 

MATRIX CAN HELP!

At Matrix Absence Management, we administer FMLA leaves for employers day in, day out, every day.  Our claims examiners are experts in reviewing FMLA certification forms to ensure we have received all the information the employer is entitled to and that it is clear and makes sense.  Want to harness that expertise? Contact us at ping@matrixcos.com or through your Account Manager.

FMLA 2nd and 3rd Opinion Process: A powerful tool to manage intermittent FMLA

Posted on: July 29, 2019 0

By Gail I. Cohen, Director, Employment Law & Compliance

July 29, 2019

Readers of DMEC @Work Magazine know I have been writing a series of articles on recommended best practices using the 2nd and 3rd opinion process to manage intermittent FMLA leave.  Readers of this blog who have not read my articles (tsk tsk…as if!), well you are in luck because today’s blog post will be a Cliff Notes™ version summarizing the key takeaways from each of those articles!

 

January 2019 Issue: When Can an Employer Request a 2nd Opinion and Why Would I Want to Spend Money to Get One?

An employer can only request the employee attend a 2nd opinion before approving FMLA leave for the employee’s or family member’s “serious health condition,” in connection with a new leave request, or initial certification at the start of a leave year.

Strategic use of the 2nd opinion process is a good investment for employers. The advantages we have seen include the “grapevine effect” in the workplace, organically increasing employee awareness that you are managing leave usage. This increased awareness can often result in reduced frequency and duration of employee leaves.

 

March 2019 Issue: What Does it Mean to Have “Reason to Doubt the Validity” of an Employee’s Certification?

The FMLA for an employer “who has reason to doubt the validity of a medical certification may require the employee to obtain a second opinion at the employer’s expense.” (29 C.F.R. §825.307(b)) Like so many things about the FMLA, there is no definition of what would provide employers with that “reason to doubt.”  At Matrix, we spend a lot of time thinking about things like this! Some of the (perhaps obvious?) circumstances we have identified that warrant an employer to consider pursuing a 2nd opinion include:

  • clearly excessive leave parameters in the employee’s certification for the condition;
  • leave certified by a healthcare provider that does not seem appropriate for the condition
    (e.g., an ophthalmologist certifying depression); and
  • a healthcare provider certifying leave for an employee who is a relative or close friend.

 

May 2019 Issue: Use of Onsite Medical Personnel in Evaluating Whether to Pursue a 2nd or 3rd Opinion

Many employers have onsite medical personnel, or doctors with whom they have a relationship, who can be consulted in connection with the decision whether or not to seek a 2nd opinion. These personnel are prohibited by FMLA regulations from actually performing the 2nd opinion exam, but it does not mean they cannot otherwise be helpful. For example, when you read the employee’s certification and you identify that the frequency and/or duration of estimated leave seems excessive, a medical provider can add heft to that decision by reviewing it as well to confirm (or contradict!) your impression.

 

July 2019 Issue: What Does it Mean to Act in Good Faith in the 2nd/3rd Opinion Process?

Once the 2nd opinion results are received, if the results differ from the employee’s certification, the employer has a choice to either:

  1. accept the employee’s certification and manage the leave to those parameters; or
  2. send the employee to a 3rd opinion, again at employer expense.

If the employer elects to require a 3rd opinion, the regulations require the employer and employee to “act in good faith” in the selection of the 3rd opinion provider; but again, they don’t tell you what that means! We think a process that meets this standard includes the employer proposing 2-3 providers whose specialty is appropriate for the employee’s condition and whose offices are located in the employee’s general vicinity.  Like the 2nd opinion provider, the 3rd opinion provider can’t be someone the employer has previously consulted.

The employee is then given the option of selecting one of the employer’s suggested doctors, or identifying one or more of his own choice – with the same criteria that the employee’s doctor be in an appropriate specialty and with whom he has not previously consulted.

 

More to Come!

There are two more articles in my series that will be published in September and December: In the September issue, I will discuss best practices for what an employer should do about any absences the employee reports while the 2nd/3rd opinion process is pending.  My final column will give guidance to employers on other issues unanswered by the regulations, such as how long the employer can rely on 3rd opinion results.

 

Read the Full Articles.  You can read my column articles here at DMEC.org.  If your organization isn’t already a DMEC member, here’s another reason to join!

 

MATRIX CAN HELP!

At Matrix Absence Management, we administer FMLA leaves for employers day in, day out, every day and have seen firsthand how thoughtful, strategic use of the 2nd/3rd opinion process can lead to beneficial results.  Want to harness that expertise? Contact us at ping@matrix.com or through your Account Manager.

 

Falsified FMLA Certifications? Employer Doesn’t Have to be Inspector Clouseau to Support Honest Belief Defense!

Posted on: April 2, 2019 0

By Gail Cohen, Director Employment Law & Compliance

April 2, 2019

 

Marion Egler was employed as a Reservations Agent for American Airlines.  From 2006 through 2013, she applied and was approved for, FMLA on thirty-four separate occasions.  In November and December 2014, Egler submitted four certification forms for continuous blocks of time that appeared to have been “whited out and/or written over.”  The FMLA regulations allow an employer to authenticate a certification form, by providing a copy to the provider and asking for verification that the information supplied was completed or authorized by the provider who signed it.  As a result of the apparent alteration of those forms, American sought authentication of the certifications and was advised by the doctor that it was not completed or signed by that provider or anyone else in his office.

Egler was confronted with these discrepancies and denied knowing anything about the forms being altered. Egler wrote a statement (she later claimed under duress) in which she indicated she understood her leave was being questioned and that while she understood the forms appeared to have been altered, she indicated she’d be following up with her doctor’s office because “she [couldn’t] speculate.” She was placed on a paid suspension and invited to submit any additional information to clarify the discrepancies.  When she did not do so, American fired her for altering FMLA forms, a violation of the company’s Code of Conduct.

Egler appealed her termination using the company’s process to do so, claiming she was “not guilty,” and had not been given the resources and time to defend herself. She submitted two additional letters purporting to come from the provider’s office. He reiterated that neither he nor anyone else in his office completed this documentation. As a result, the company upheld the decision to terminate her employment on appeal.  Egler sued American alleging, among other things, FMLA interference and retaliation.

The court quickly disposed of her FMLA interference claim because American granted her all the leave she had requested and moved on to the retaliation claim.  In evaluating that claim, the court elaborated that it is Egler’s burden to undermine American’s “honest belief,” meaning, presenting evidence that American did not honestly believe she had broken its conduct rules by submitting altered FMLA certifications.  While Egler herself “emphatically denied [she] alter[ed] the forms,” and challenged whether American had shown that she had done so, that is not the standard.  It is not the role of the court to decide that the reason given for the employer’s decision was “wise, fair or even correct;” it is Egler’s burden, as the plaintiff, to demonstrate that the reason for American’s decision was false, dishonest or more likely the result of retaliation. Her own self-assessment was not enough.

American went to her doctor, just as the FMLA allowed it to do, and had substantiated that the forms were not authentic. Armed with this information, and a good faith investigation that allowed Egler to be heard, American acted on its honest belief she violated its rules and prevailed on summary judgment.

You can read more here: Egler v American Airlines, E.D. North Carolina (February 21, 2019)  

 

PINGS FOR EMPLOYERS – What American Did Right

  • They had a written policy addressing falsification or fraud in the FMLA process
  • They allowed employee to take the leave, then reinstated her and dealt with
    the fraud issue separately.
  • They didn’t deal with the fraud issue until their investigation was complete. In
    connection with their investigation, they used the tools the FMLA affords employers
    like seeking authentication of medical information and/or certification forms that
    appear to be altered.

 

If you just can’t get enough of FMLA certifications (and let’s face it, at least it’s not Paid Family Leave!) you might want to check out the 2019 DMEC FMLA/ADA Employer Compliance Conference, May 6-9, in Portland, OR. On May 8 our very own Gail Cohen and fellow legal eagle and blogger extraordinaire  Jeff Nowak will present Medical Certifications: How to Maximize one of the FMLA’s Most Important Tools. Don’t miss it!


Matrix can help!  At Matrix Absence Management, we administer FMLA, state leaves, the ADA, and related company policies for employers every day, day in and day out.  If you would like more information contact us at ping@matrix.com or through your Account Manager.

DOL to Employers: If it’s FMLA, it’s FMLA. If it’s not, it’s not.

Posted on: March 18, 2019 0

By Marti Cardi, Vice President Product Compliance Gail Cohen, Director Employment Law & Compliance

March 18, 2019

 

There is joy in my blessed li’l FMLA heart.  The US Department of Labor has issued a much-needed Opinion Letter addressing whether an employer or employee can elect not to apply the FMLA to a leave for an FMLA-qualifying event.  Spoiler alert:  The answer is NO.

This has never seemed like a gray area to me.  We blogged about this over 3 years ago.  (See prior blog posts here  and here.) As I said back then, “No, no, no!  The employee does NOT get to choose!”  The regulations are clear, and the DOL FMLA Branch Chief has spoken publicly on this issue. Yet many employers still think employees have the right to choose whether to use FMLA for a qualifying absence.

In the new Opinion Letter FMLA2019-1-A, the DOL addressed this specific question:  Can an employer delay application of FMLA to a leave that is clearly FMLA-qualifying and allow the employee to first use paid sick leave or other leave?

But the DOL went further. As stated in the Opinion Letter:

  • Once an eligible employee communicates a need to take leave for an FMLA-qualifying reason,
    neither the employee nor the employer may decline FMLA protection for that leave.
  • Accordingly, when an employer determines that leave is for an FMLA-qualifying reason, the qualifying
    leave is FMLA-protected and counts toward the employee’s FMLA leave entitlement.
  • Once the employer has enough information to make this determination, the employer must,
    absent extenuating circumstances, provide notice of the designation within five business days.
  • And so, the employer may not delay designating the leave as FMLA-qualifying even if the
    employee would prefer that the employer delay the designation.

When does this arise? Take a look at my friend Jeff Nowak’s blog FMLA Insights for a humorous example (and some additional guidance).  Here is another scenario. Your employee announces she is pregnant.  She also tells you that her husband needs surgery and she wants to take a week off to care for him during the operation and recovery.  But, she doesn’t want to use her FMLA time for that, preferring to reserve it for bonding following the birth of the child.  She’ll use her accrued sick leave and PTO instead:

EMPLOYEE: I am pregnant and want to take FMLA for bonding time after my baby is born.  I also need a week off to care for my husband following his surgery next month.  I want to use my sick leave for the time to care for my husband and save all of my FMLA for bonding.   Remember, care of my husband is an allowed use for sick leave under our policy.

YOU (the employer):  OK.

YOU (6 weeks later): Hey, you said you only needed a week off and you’ve been gone 2 weeks.  You are out of sick leave and PTO.  You’re fired.

EMPLOYEE: But you can’t fire me! My husband needed more time for recovery and care.  The time off was for an FMLA reason and I have job protection.

YOU: You said you didn’t want to use FMLA.

EMPLOYEE: Yes, but I wouldn’t have chosen that if I had known I wouldn’t have job protection during my leave!

What a mess.  I wonder who wins in front of a jury?

It’s OK to allow employees more time through company policies.  The Opinion Letter makes clear that an employer cannot designate time as FMLA in excess of the 12 (or 26) weeks, whether before OR after FMLA leave. If you want to be more generous, provide it through a company policy but don’t call it FMLA.  In fact, the FMLA regulations state that “[a]n employer must observe any employment benefit program or plan that provides greater family or medical leave rights to employees than the rights established by the FMLA.”  29 C.F.R § 825.700.

But what about “substitution?”  Sometimes there is confusion due to the provision in the FMLA regulations that an employee may “substitute” other leave for FMLA leave.  But the regulations – and now the Opinion Letter – make it clear that paid leave provided by the employer will run concurrently with the unpaid FMLA leave.  29 C.F.R § 825.207(a).  As the DOL says in the Opinion Letter:

[P]roviding such additional leave outside the FMLA cannot expand the FMLA’s 12-week (or 26-week) entitlement under the FMLA. . . . Therefore, if an employee substitutes paid leave for unpaid FMLA leave the employee’s paid leave counts toward his or her 12-week (or 26-week) FMLA entitlement and does not expand that entitlement.

So here’s the deal, in my words:

  • The FMLA is a law that provides 12 (or 26) weeks of job-protected leave of absence for 5 qualifying leave
    reasons (key word: law).
  • Neither the employer nor the employee can change the law or choose not to follow it.
  • It’s the law.

Pings for Employers

  • Don’t allow an employee to decline FMLA coverage and protections for a leave you know, or have reason
    to believe, is for an FMLA-qualifying event.
  • Always provide the employee with the FMLA Notice of Rights and Responsibilities and Eligibility Notice
    within 5 days of the employee’s leave request. If you are not clear whether the leave is requested for an FMLA
    reason, be safe and provide the employee with the notices and the certification form.
    Failure to do so
    could be considered interference with the employee’s FMLA rights.
  • Don’t chafe about this rule if it is news to you: It’s actually to your benefit!  The rule gives you, the employer,
    some control over how much time your employees can take off and when. You get to choose whether and
    under what circumstances employees can take more company leave following FMLA leave by designing your
    policies accordingly
    .
  • If you live in states covered by the federal Ninth Circuit Court of Appeals, you may already be aware of the
    opinion in Escriba v. Foster Poultry Farms, Inc., 743 F.3d 1236 (9th Cir. 2014). In that case the court held that
    an employee may use non-FMLA leave for an FMLA-qualifying reason and decline to use FMLA leave in order
    to preserve FMLA leave for future use.  A few lower courts in other states have followed the Escriba decision.
    In the Opinion Letter the DOL explicitly rejects the Ninth Circuit’s holding.  This causes a conundrum for
    employers within those states – whether to follow the court’s ruling or the FMLA regulations and now this
    Opinion Letter.

I strongly support the DOL’s interpretation as the only logical result from the FMLA statute and regulations, and have always maintained that the Escriba decision is flat out wrong. (But then, they didn’t ask me!) For more discussion see our prior blog posts linked above. But, you should check with your own employment counsel for advice regarding the specific fact situation you are dealing with.

 

Matrix can help!  At Matrix Absence Management, we administer FMLA, state leaves, the ADA, and related company policies for employers every day, day in and day out.  If you would like more information contact us at ping@matrix.com or through your Account Manager.

Spice up your compliance with 50 Shades of FMLA!

Posted on: March 4, 2019 0

Are you struggling to manage FMLA gray areas such as intermittent leave or suspicious leave requests from employees?

The 2019 DMEC FMLA/ADA Employer Compliance Conference, May 6-9, in Portland, OR, is the place to find answers and solutions that help you minimize risk in your organization and ensure you’re on the path towards ongoing compliance.

Our very own Marti Cardi, together with Jeff Nowak, will help you “color in” those gray areas of FMLA compliance. Read their recent blog post to get a peek under the covers of their general session, 50 Shades of FMLA: Dealing with Those Gray Areas.

This session is just one of many that will prepare you to confidently tackle your organization’s FMLA/ADA challenges. Check out the list of sessions and speakers online.

Early registration ends on Mar. 7. Don’t miss the chance to save $200! Secure your spot today.