Failure to Back up Child's Diagnoses Sinks Mom's bid for FMLA During Pandemic

                               

Fort Wayne, IN (WorkersCompensation.com)–A mere diagnosis is not enough to establish a serious health condition for purposes of the FMLA. 

That’s what an accounts receivable representative discovered in Connor v. Professional Medical Billing, No. 1:20-CV-183-HAB (N.D. Indiana 06/16/22), when she tried to claim FMLA leave to care for her daughter whose school was closed during the COVID-19 pandemic. 

The employer, a medical reimbursement management company, denied the employee’s request for paid medical leave. The representative challenged that decision in federal District Court. 

The court explained that an employee is entitled to FMLA leave if she takes the leave to care for her child with a serious health condition. A "serious health condition” under the FMLA is an illness, injury, impairment, or physical or mental condition that involves: 1) inpatient care in a hospital, hospice, or residential medical care facility; or 2) continuing treatment by a health care provider. 

Here, the court observed, the representative, failed to show that her daughter's mental and behavioral issues fell into one of these categories. 

The court remarked that “[w]hen COVID-19 hit, Plaintiff, like most parents of young children, faced the unenviable task of balancing work with childcare.” However, that didn’t obviate her obligation to establish that she was entitled to paid leave.  

The court opined that the only reference the employee made to her daughter’s condition was in an April 21, 2020, email to the company in which she claimed that her daughter, whose daycare had closed because of the pandemic, was having "serious behavior issues," and had been diagnosed with ADHD, anxiety disorder, impulsive behavior, and sleep disturbances. The court noted that employee did not provide any medical records, either to the company or to the court, to support her claim. 

The court acknowledged that the representative stated she intended to call a doctor to testify that she needed FMLA leave to care for her daughter during the pandemic. But that statement in combination with a list of diagnoses wasn’t enough to allow her to proceed. 

Further, because the employee didn’t indicate her daughter had "inpatient care in a hospital, hospice, or residential medical care facility," the court stated it was compelled to assume the claim of a serious health condition was based on the daughter's need for continuing treatment. But to establish such a need, the court observed, the employee had to show that the condition: 

  1. Requires periodic visits (defined as at least twice a year) for treatment by a health care provider, or by a nurse under direct supervision of a health care provider; 

  1. Continues over an extended period of time; and 

  1. May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.). 

A party's own statements, the court remarked cannot establish a serious health condition under the FMLA. “Instead, a party must submit evidence ‘provided by health care professionals and treating physicians’ to meet their burden,” the court wrote. 

Because the representative failed to provide evidence of a serious health condition, she could not show she was entitled to FMLA leave. The court therefore granted the company’s motion for summary judgement. 


  • AI california case management case management focus claims compensability compliance compliance corner courts covid do you know the rule exclusive remedy florida glossary check health care Healthcare iowa leadership medical medicare minnesota NCCI new jersey new york ohio opioids osha pennsylvania Safety state info technology tennessee texas violence virginia WDYT west virginia what do you think women's history month workcompcollege workers' comp 101 workers' recovery workers' compensation contact information Workplace Safety Workplace Violence


  • Read Also

    About The Author

    • WorkersCompensation.com

    Read More

    Request a Demo

    To request a free demo of one of our products, please fill in this form. Our sales team will get back to you shortly.