Botched Leave

Okay, the dept let the employee go out 07/26 for an elective surgical procedure - breast augmentation. I know nothing about it, and no one in the dept will fess up to who said she could go. The initial doctor's note said she needed three weeks. She comes back to work yesterday, and a shift manager lets her work based on the original note's return time frame. After three hours she says she still hurts, so they let her off. Calls today says she's back off work. I call doc who faxes note saying she can't return until further notice, expected time frame through 08/22. My question...do elective surgeries qualify under FMLA?

Comments

  • 17 Comments sorted by Votes Date Added
  • I'm not sure if the surgery qualifies or not but I do know that if there are medical problems after the surgery (which it sounds like there may be?) they do qualify.

    Had the exact same surgery, with complications happen here and our attorney advised us that the complications were covered under FMLA. Employee didn't come close to using 12 weeks so not sure if we would have counted the time off for the surgery under FMLA or not.
  • Nope, no complications. Doc just said she needed a little more time off. She's a blackjack dealer and they stand and reach all day. I'm sure it wasn't comfortable.
  • A blackjack dealer with large breasts, real or otherwise, ought to be an asset to your organization. I would encourage you to allow her ample (no pun intended) opportunity to recover and come back to work.
  • I do not think the time off for the surgery or normal recovery is covered under FMLA. While she recovers, if she can't lean and deal easily, perhaps you could reassign her to another area, maybe the nipple slots, I mean nickel slots. Something less strenuous.



    "Life is a tragedy when seen in close-up, but a comedy in long-shot."
    Charlie Chaplin




  • TN HR: This post is the most sexist remark I think I have read on this forum, you and Don should be ashamed. How un-professional, can you be? Hey, I'm back and just could not stand to see your & Don's post about large breast and nickel slots go by!

    PORK
  • We had an employee who elected to have the stomach stapling surgery. I contacted our attorney and was informed that it would be covered under FMLA as the employee spent a night in the hospital even though it was an elective procedure. It wasn't my call to determine whether or not the procedure qualified, if the doctor completed the certification that it is an FMLA qualifying event, then FMLA should be allowed.
  • [font size="1" color="#FF0000"]LAST EDITED ON 08-18-05 AT 04:42AM (CST)[/font][br][br]I disagree with your conclusion. The lady who had the stapling had a serious medical condition and surgery was indicated, possibly required, as a last resort. That's totally different from a boob job.

    (edit) And, Mushroom, it is indeed the employer's responsibility to determine whether or not to qualify an event as FMLA. The doctor only completes the paperwork that allows you to make that determination. Doctors do not administer FMLA, employers do.




    "Life is a tragedy when seen in close-up, but a comedy in long-shot."
    Charlie Chaplin




  • The Regs state that voluntary or cosmetic treatments not considered medically necessary are excluded from the difinition of a Serious Health Condition, UNLESS inpatient hospital care is required OR complications develop......

    So I interpret this condition as FMLA qualifying.

    I spoke with Wage & Hour regarding who determines FMLA eligibility--the doctor or the employer. The answer I received was that if the doctor completes the medical cert form, it is pretty much FMLA. I do not see how the employer can determine someone's condition is or is not a "serious health condition" by reading a few words on the Med Cert. Therefore, how can our knowledge of the condition be greater than the doctor's that would make us qualified to decide who has a serious health condition and who does not. (Let's forget about those doctor's who sign anything to cover themselves or the employees whom we know are faking it). If someone can shed new light on this debate, I would surely welcome it! I still don't know how to approach this. Thanks!
  • [font size="1" color="#FF0000"]LAST EDITED ON 08-18-05 AT 04:56PM (CST)[/font][br][br]VS: It is the company policy on FMLA that determines the conditions under which the employer will call the shot as to whether a case is FMLA or not. It is the physician's certification that gives the employer the feelings that "yes this case is FMLA qualifing under the company FMLA POLICY". It is the history of granting FMLA under the company policy that gives the employer the weight to defend one's decisions. The physician is only another component part of the equation from which you the HR will come to the conclusion that it is covered or it is not covered and write the conclusion letter to the employee which provides the details to the specific case. The physician has nothing to do with the company decision except to provide you with the evidence/documentation on which you the employer representative makes the decision.

    The wage and hour folks are usually pretty good with helping we employers with issues in wage and hour, but their input into an FMLA issue is wrongly considered, unless they are reading from your policy and procedures manual. But, I would hope that you can read your own words better than they can.

    PORK
  • Pork,
    Thanks for your clarification as well. Your explanation defines my approach. My interpretation was just too literal and I could not see the trees for the forest!
  • An FMLA absence is one that has inpatient care plus treatment or incapacity of three days plus treatment by a health care provider. I have not ever seen anything in the regs that says elective procedures do not count. As HR professionals it is our job to determine if the absence meets the definition of FMLA not if a procedure is necessary or not -- I agree that if the physician says the employee must be out of work then the employee must be out of work -- if in doubt pay for a second opinion. As for your dealer, I would start the FMLA clock from when you can do the notice and let the other leave stand as approved leave -- when your manager complains about the extended absence show him/her your policy that FMLA requests go thru HR and that when they don't they can't be backdated -- also remember this when another employee wants time off without counting it toward FMLA
  • 29 CFR 825.114 (c), "Conditions for which cosmetic treatments are administered, such as most treatments for acne or plastic surgery, are not 'serious health conditions' unless inpatient hospital care is required or unless complications develop." "Restorative plastic surgery after an injury or removal of cancerous growths are serious health conditions provided all the other conditions of this regulation are met."

    It's absurd that the Wage & Hour telephone answerer implied that 'once the doctor fills out the form you PRETTY MUCH have to allow it'. What the hell kind of answer is that. Useless, that's what kind. What you have there is a Thursday morning interpretation from a clerk with two cups of coffee and three cigarettes under her belt.

    The medical certification is often required of a doctor. The employer makes the final determination. This does not imply that the employer is involving itself in medical analysis or the reading of symptoms and diagnoses. Simply that the employer is responsible for administering the program.

    An example, one of many, of a situation where a completed medical certification and recommendation is absolutely turned down follows: Employee presents medical certification with everything checked off appropriately, much more information than the employer is entitled to or asks for, recommends the employee be allowed intermittent, monthly, two to four days leave due to wife's ongoing medical condition and certifies that the time frame for that condition is years and years.

    Fine, however, upon review and scrutiny and several interviews with employee it is found that the need for the employee to attend his wife is secondary to the fact that she has some sort of monthly female outburst and NEEDS HIM AT HOME TO BABYSIT THE FOUR CHILDREN UNDER SIX YEARS OF AGE. Not qualified, rejected, denied. There are all sorts of situations in which we should and do deny FMLA when we have medical certifications.



    "Life is a tragedy when seen in close-up, but a comedy in long-shot."
    Charlie Chaplin




  • Livindon South,
    Thanks for your response. That's how I deal with FMLA, so it's nice to have confirmation of the interpretation. "I Can See Clearly Now, the Fog is Gone"!!!
  • I know I'm in the minority and I know HIPAA has changed the way we think about PHI . . . but -- my opinion is that the employer IS entitled to know what the serious health condition is. If not, why does the DOL's Certification of Health Care Provider clearly ask for that information? It says, "4. Describe the medical facts which support your certification, including a brief statement as to how the medical facts meet the criteria of one of these categories . . ." When I get a certification that says simply, "EE needs to be off" I don't accept it. That's not enough information.
  • FMLA preceeded HIPAA and you will not find anywhere in the FMLA where there is a suggestion that the employer is entitled to a DIAGNOSIS. The sections you cite are misinterpreted. Asking for medical facts and how those facts support the certification does not equate to asking for a diagnosis or PMI. If you have not read the entire act, I suggest you do that.



    "Life is a tragedy when seen in close-up, but a comedy in long-shot."
    Charlie Chaplin




  • Did some research and found that we had accepted elective surgeries in the past. Some were not cosmetic, but elective just the same. Decided we couldn't differentiate, so for consistency sake, had the doc fill out the documentation and backtracked the FMLA to her first day missed.
  • Thanks for the suggestion, Livindon, but I've read the act too many times to count. In fact only in the last few years have I stopped reading it with virtually each new request for leave!

    I'm comfortable with my process because our employment law attorney agrees with it and because I have never had any issues -- no lawsuits, no complaints. That includes my time administering the Act for Teamsters Local XXXX.

    How, pray tell, have I misinterpreted the DOL form? What is not clear about "describe the medical facts . . . how (do) the medical facts meet the criteria . . ."? A doctor's note saying the employee needs to be off work is not a medical fact. Don, earlier you correctly stated, "it is indeed the employer's responsibility to determine whether or not to qualify an event as FMLA." If I make a determination just because the doctor says so haven't I abdicated my responsibility? I'm not afraid to have knowledge of an ee's medical condition. I trust myself to keep it confidential.

    For elective stuff, even though I don't have to, I allow it, but insist on scheduling the leave at an optimal time for the department.
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