Family And Medical Leave Act (Fmla) Medical Certification Form Page 9
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9Employee Rights and Responsibilities
Under the Family and Medical Leave Act
Basic Leave Entitlement
Use of Leave
FMLA requires covered employers to provide up to 12 weeks of unpaid, job-
An employee does not need to use this leave entitlement in one block. Leave can be
protected leave to eligible employees for the following reasons:
taken intermittently or on a reduced leave schedule when medically necessary.
Employees must make reasonable efforts to schedule leave for planned medical
For incapacity due to pregnancy, prenatal medical care or child birth;
treatment so as not to unduly disrupt the employer’s operations. Leave due to
To care for the employee’s child after birth, or placement for adoption or foster
qualifying exigencies may also be taken on an intermittent basis.
care;
To care for the employee’s spouse, son or daughter, or parent, who has a
Substitution of Paid Leave for Unpaid Leave
serious health condition; or
Employees may choose or employers may require use of accrued paid leave while
For a serious health condition that makes the employee unable to perform the
taking FMLA leave. In order to use paid leave for FMLA leave, employees must
employee’s job.
comply with an employer’s normal paid leave policies.
Military Family Leave Entitlements
Employee Responsibilities
Eligible employees with a spouse, son, daughter, or parent on active duty or call to
Employees must provide 30 days advance notice of the need to take FMLA leave
active duty status in the National Guard or Reserves in support of a contingency
when the need is foreseeable. When 30 days notice is not possible, the employee
operation may use their 12-week leave entitlement to address certain qualifying
must provide notice as soon as practicable and generally must comply with an
exigencies. Qualifying exigencies may include attending certain military events,
employer’s normal call-in procedures.
arranging for alternative childcare, addressing certain financial and legal
Employees must provide sufficient information for the employer to determine if the
arrangements, attending certain counseling sessions, and attending post-deployment
leave may qualify for FMLA protection and the anticipated timing and duration of
reintegration briefings.
the leave. Sufficient information may include that the employee is unable to
FMLA also includes a special leave entitlement that permits eligible employees to
perform job functions, the family member is unable to perform daily activities, the
take up to 26 weeks of leave to care for a covered servicemember during a single
need for hospitalization or continuing treatment by a health care provider, or
12-month period. A covered servicemember is a current member of the Armed
circumstances supporting the need for military family leave. Employees also must
Forces, including a member of the National Guard or Reserves, who has a serious
inform the employer if the requested leave is for a reason for which FMLA leave
injury or illness incurred in the line of duty on active duty that may render the
was previously taken or certified. Employees also may be required to provide a
servicemember medically unfit to perform his or her duties for which the
certification and periodic recertification supporting the need for leave.
servicemember is undergoing medical treatment, recuperation, or therapy; or is in
outpatient status; or is on the temporary disability retired list.
Employer Responsibilities
Covered employers must inform employees requesting leave whether they are
Benefits and Protections
eligible under FMLA. If they are, the notice must specify any additional
During FMLA leave, the employer must maintain the employee’s health coverage
information required as well as the employees’ rights and responsibilities. If they
under any “group health plan” on the same terms as if the employee had continued
are not eligible, the employer must provide a reason for the ineligibility.
to work. Upon return from FMLA leave, most employees must be restored to their
Covered employers must inform employees if leave will be designated as FMLA-
original or equivalent positions with equivalent pay, benefits, and other employment
protected and the amount of leave counted against the employee’s leave entitlement.
terms.
If the employer determines that the leave is not FMLA-protected, the employer must
Use of FMLA leave cannot result in the loss of any employment benefit that accrued
notify the employee.
prior to the start of an employee’s leave.
Unlawful Acts by Employers
Eligibility Requirements
FMLA makes it unlawful for any employer to:
Employees are eligible if they have worked for a covered employer for at least one
Interfere with, restrain, or deny the exercise of any right provided under
year, for 1,250 hours over the previous 12 months, and if at least 50 employees are
FMLA;
employed by the employer within 75 miles.
Discharge or discriminate against any person for opposing any practice made
unlawful by FMLA or for involvement in any proceeding under or relating to
Definition of Serious Health Condition
FMLA.
A serious health condition is an illness, injury, impairment, or physical or mental
condition that involves either an overnight stay in a medical care facility, or
Enforcement
continuing treatment by a health care provider for a condition that either prevents
the employee from performing the functions of the employee’s job, or prevents the
An employee may file a complaint with the US Department of Labor or may bring a
private lawsuit against an employer.
qualified family member from participating in school or other daily activities.
FMLA does not affect any Federal or State law prohibiting discrimination, or
Subject to certain conditions, the continuing treatment requirement may be met by a
supersede any State or local law or collective bargaining agreement which provides
period of incapacity of more than 3 consecutive calendar days combined with at
greater family or medical leave rights.
least two visits to a health care provider or one visit and a regimen of continuing
FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered employers to
treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition.
post the text of this notice. Regulations 29 C.F.R. § 825.300(a) may require
Other conditions may meet the definition of continuing treatment.
additional disclosures
For Additional Information:
1-866-4US-WAGE (1-866-487-9243) TTY: 1-877-889-5627
U.S. Department of Labor/Employment Standards Administration/Wage and Hour Division
Please fax the completed forms to the correct processing center.
Page 9 of 9
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