Serious Health Conditions

Serious Health Conditions Under the FMLA
A “serious health condition” is an illness, injury, impairment, or physical or mental condition that involves either:

Inpatient care in a hospital, hospice, or residential medical-care facility; or

Continuing treatment by a health-care provider.

A condition does not qualify simply because an employee or family member is absent from work or needs medical care. The condition must meet the FMLA definition based on the individual facts, medical certification when required, and the applicable regulatory category.

• Common qualifying categories
  A serious health condition may include:
• Inpatient care, including an overnight stay in a hospital, hospice, or residential medical-care facility, followed by any period of incapacity or treatment related to that inpatient care.
• Incapacity of more than three consecutive, full calendar days combined with qualifying continuing treatment by a health-care provider.
• Pregnancy or prenatal care, including pregnancy-related incapacity, prenatal appointments, severe morning sickness, and recovery from childbirth.
• Chronic conditions that require periodic treatment visits, continue over an extended period, and may cause episodic incapacity. Examples may include chronic asthma, migraines, diabetes, epilepsy, anxiety, depression, and some other chronic physical or mental-health conditions.
• Permanent or long-term conditions for which treatment may not be effective, such as Alzheimer’s disease, terminal cancer, or the late stages of a chronic disease.
• Conditions requiring multiple treatments, including chemotherapy, radiation, dialysis, restorative surgery after an injury, or treatment that would likely result in incapacity of more than three consecutive, full calendar days if treatment were not provided.
• Substance-use-disorder treatment administered or referred by a health-care provider. Absence because of the employee’s use of alcohol or illegal drugs is not, by itself, FMLA-protected; treatment for the condition may be protected.
• Mental-health conditions that involve inpatient care or continuing treatment by a health-care provider. Examples may include anxiety disorders, depression, post-traumatic stress disorder, eating disorders, and other conditions that meet the FMLA standard.

Examples

• Conditions that may qualify, depending on the individual’s treatment, incapacity, and medical certification, include:
• Cancer and cancer treatment.
• Heart attack, heart surgery, bypass surgery, or valve surgery.
• Stroke, spinal injury, paralysis, or traumatic brain injury.
• Serious injuries from a motor-vehicle accident or workplace accident.
• Back conditions requiring surgery, extensive therapy, or periods of incapacity.
• Pneumonia or another respiratory illness requiring inpatient care or qualifying continuing treatment.
• Kidney disease, emphysema, severe arthritis, or other long-term conditions.
• Chronic asthma, chronic migraines, epilepsy, diabetes, or another chronic condition that meets the FMLA criteria.
• Pregnancy, prenatal care, childbirth, postpartum recovery, severe morning sickness, miscarriage-related medical care, or another pregnancy-related medical condition.
• Depression, anxiety, PTSD, or another mental-health condition requiring inpatient care or continuing treatment.
• Treatment for substance-use disorder when provided by or under referral from a health-care provider.

A diagnosis alone does not determine FMLA coverage. The city must evaluate the specific facts, including the type of treatment, the period of incapacity, the expected frequency and duration of leave, and the health-care provider’s certification.

Conditions that ordinarily do not qualify

• Absent complications, common conditions that ordinarily do not meet the FMLA definition of a serious health condition include:
• The common cold.
• Influenza or a routine virus.
• Earaches.
• Upset stomach.
• Minor ulcers.
• Headaches other than migraines.
• Routine dental or orthodontic treatment.
• Periodontal disease.
• Most cosmetic treatments, including most acne treatments or elective plastic surgery.
• Ordinary stress that does not involve a qualifying mental-health condition, inpatient care, or continuing treatment.
• An absence caused by the use of alcohol or illegal drugs, rather than treatment for substance-use disorder.

These examples are not absolute rules. A normally minor condition may qualify when it results in inpatient care, complications, qualifying continuing treatment, or another FMLA-covered category. For example, influenza complicated by pneumonia requiring hospitalization may qualify; a migraine may qualify when it is a chronic condition requiring periodic treatment and causing episodic incapacity.

Medical certification
A city may require medical certification to support FMLA leave for an employee’s own serious health condition or the serious health condition of a spouse, child, or parent. The employee is generally responsible for providing a complete and sufficient certification within 15 calendar days after the city requests it, unless it is not practicable despite the employee’s diligent, good-faith efforts.

The certification does not have to include a diagnosis. It should provide sufficient medical facts to show that the condition qualifies under the FMLA and that leave is needed. The city may use the U.S. Department of Labor certification forms or an equivalent form that requests only permissible information. If a certification is incomplete or insufficient, the city must identify the deficiency in writing and give the employee at least seven calendar days to cure it, unless not practicable despite the employee’s diligent, good-faith efforts.

After giving the employee an opportunity to cure deficiencies, HR, a leave administrator, a management official, or another health-care provider acting for the city may contact the employee’s health-care provider only to authenticate or clarify the certification. The employee’s direct supervisor may never contact the employee’s health-care provider. The city may not request medical information beyond what the FMLA certification form allows.

ADA and other laws
A condition that does not qualify as a serious health condition under the FMLA may still qualify as a disability under the ADA, including a temporary condition that substantially limits a major life activity. Likewise, pregnancy, childbirth, lactation, and related medical conditions may trigger obligations under the Pregnant Workers Fairness Act, Title VII, the PUMP Act, Tennessee law, workers’ compensation law, or city policy.

When an employee requests leave, reports medical restrictions, or provides a medical certification, cities should evaluate all potentially applicable rights rather than relying on FMLA eligibility alone.