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FMLA Denied by employer even though it meets the federal requirements!


Guest JDouglas

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Guest JDouglas

I have just a few quick questions about FMLA. This will be the 2nd time I have needed to use FMLA this year and this will be probably the 2nd time it will be denied. The first time was earlier this year when I was out sick with a sinus infection. I missed approx 4 days of work and was on antibiotics for 10 days. When I was given my fmla paperwork to have the doctor fill out I was told that my approval rested on what the doctor had to say. Well I don’t have a “family doctor” I normally go to urgent care clinics. Well I took in the paperwork and dropped it off and the doctor filled it out, but when he did, he only put the date I was seen (by him) on the paperwork (not the 4 days I missed because of it). He did put down that I was on 10 days of meds but because he didn’t put the full 4 days that I missed on there my HR dept saw that and denied my fmla request. Since it was denied, those days I missed were counted against me and have adversely affected my dependability rating with my company. That means that until these days fall off at the end of a rolling 12 month period I can not apply for any promotions or raises.

That was back in Feb of this year. I am currently at home sick due to another sinus infection. This time it was a lot worse, I have missed approx 2 weeks of work. I have been on 4 types of meds. This time I thought I was being smart and I had the doctor write me a note for work, the note he wrote was just for 6 days though. After those few days I had to go back to the doctor because the antibiotic he put me on was not working. So he then prescribed 10 more days of meds. I went in to my work and got my fmla paperwork for the doctor and took it in to the office and dropped it off for them to fill out. Now my question is this, if they only put the 2 dates on there that I was seen by the doctor (versus putting all the time I missed work) and my HR dept denies my fmla request, what can I do? If it is denied this will bring my dependability rating down so low that I may lose my job.

How serious does the government take these complaints? Would my best bet be to talk to an attorney?

Thanks

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A sinus infection is generally not a "serious health

condition" but under the circumstances you describe

(incapacity of 3 or more days along with a doctor's

visit and prescription) you probably qualified.

The DOL does investigate the complaints, and

for the most part does a pretty good job.

You may want to get on their website and pull

information backing your claim...then turn it

over to HR and argue for both periods to be

FMLA time. If they don't budge, file an administrative

complaint. It is not a difficult process and

can probably be handled without

an attorney...unless you are fired.

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Guest JDouglas

Im not worried about the "sinus infection" falling under the Fmla guidelines because I know that it does qualify. My question is, just because the doctor only puts on the fml paperwork the dates he actually saw me in his office does that give them the right to deny my fml leave all together? (because he didnt see me 3 days in a row) Thats what they told me last time.

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The employer has an absolute right to receive sufficient information, including medical verification, to make a determination about the validity of your FMLA claim.

I would agree with mal, the first time may not have been FMLA based on the information you gave us. However, this time is establishing a chronic problem, and it sounds like you have seen the doctor multiple times and can document ongoing medical treatment. The employer (if wise) may even be able to retro assign FMLA to your previous absence based on the new information.

I'd approach your HR for help, not confrontation. You're sick, you're worried about your job, you know how hard it is on the company, etc. Do they need you to get any more, or clearer, information from your doctor? (This is one of the major advantages of having a long time personal physician. They are engaged in your good health, whereas the "doc-in-the-box" urgent care mds may be more focused on one or two time treatment, not management of your chronic condition). How can you help them get the information they need to cover their bases? Do they have a doctor that they would recommend or prefer you to see?

In HR and claims we see the seediest side of people. It may only be 1% of the people, but it takes 95% of our effort to deal with it. It is refreshing to be able to truly help a fellow employee who is caught in difficult situation, but who is obviously trying to do the right thing without pulling anything over on anyone. If your employment record is otherwise spotless, this should be a breeze. Ask for help and you'll get it. But if you're borderline, understand their skepticism, help them get the info they need, appreciate the challenges they have, and then grow up or move on.

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The doctor does not have to see you 3 days in a row.

If you see a doctor on Monday and he tells you

to take a prescription and stay off work until Thursday,

that is likely FMLA qualifying. The key may be to

get a letter from the doctor certifying that you were

unable to work for the periods in question.

Also, don't be so sure that a sinus infection qualifies

you for leave. The regs specifically mention the flu

and colds as non-qualifying events.

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  • 3 years later...
Guest Chris3251

I don't know that a sinus infection qualifies, but as jsb said, the 2nd time indicates a chronic problem which might be covered under FMLA. The dr. has to actually state on the paperwork the dates that you were out sick as well as a release to return. The days you are off will not be covered if he/she only puts down the dates that you saw him. Personally I wouldn't rely on urgent care drs for a recurring problem because as jsb also said, they're more set up to just handle the one time visit, not long term care. I would personally recommend getting a family practitioner or perhaps even a specialist if these sinus infections are continuing problems. They're better equipped to handle these problems on an ongoing basis and they have a much better understanding of FMLA requirements as well as the paperwork involved.

As a supervisor I've seen too many instances of employees getting incomplete paperwork or information only supporting dates seen by a dr. even though their condition qualifies. And if your benefits dept. doesn't have all the required information within 15 days they can turn down your claim which means even if it's something that should be covered it could end up counting against you towards your employers attendance policy.

And if this is something that could potentially be an ongoing problem, you'll want to not only get approved for the initial time off, but look into intermittent approval for time off that may be needed for dr's appointments, etc. For example in my case, I was approved for my daughters initial hospitalization which was one FMLA approval. Then I had to file a 2nd request for intermittent FMLA which in my case I'm covered @ 2 days per week to take my daughter in for tests, appts, or if she's just too sick to leave her home alone.

I hope this helps and I wish you luck.

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