The In’s and Out’s of FMLA for Mental Health Conditions
Employees who find themselves disabled by a mental health condition often don’t have the mental or emotional capacity needed to navigate what can be a complicated and overwhelming process of applying for benefits. A good place to start is by understanding how the Family Medical Leave Act works and how it applies to your situation.
Although I’m not a lawyer or a lawmaker, I’ve learned a few things about how this process works in my 20+ years of corporate life. I’ve since left that life behind and now use the skills I’ve acquired to support the employee rather than the employer, at a time when patients are most in need of that support.
“I just need a Mental Health Day”
Ok, so you’ve probably heard someone joke about taking a “mental health day” when things get chaotic in the office? Although it can be helpful to take a day off to relieve stress and renew vitality, a “mental health day” is much different from a Medical Leave of Absence. Part of self care is knowing when to take a break. When you find that work-related stress is impacting your efficiency it may be a good time to consider a day off to recenter yourself. However, when symptoms of a mental health condition such as depression, anxiety or other conditions become disabling, that is when time off from work can be medically necessary.
What is FMLA?
It wasn’t that long ago that an employee experiencing a serious medical condition could lose their job due to absence if they are unable to work. Thankfully, this is no longer the case.
Enacted in 1993, The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of job-protected leave per year. It also requires that their group health benefits be maintained during that time and they are entitled to return to their same job or one that is nearly identical in terms of pay, benefits and working conditions.
Do I qualify for a Medical Leave of Absence?
Well, that depends. First, your employer must be covered by FMLA. Small employers with fewer than 50 employees in a 75 mile radius may not be subject to the Family Medical Leave Act but some choose to observe similar benefits anyway or may be subject to other state laws regarding medical leave. Either way, it’s important to find out if your employer is covered. You can find this information easily in your company's employee handbook, benefits policy or ask someone in the Human Relations department.
Assuming your employer is required to provide FMLA benefits, now you need to confirm that you are eligible to receive them. Federal law establishes the requirements for eligibility and your employer is expected to track the information necessary to determine if you meet those requirements. You must have worked for the organization for at least 12 months or worked 1250 hours within that same time period. This means that if you just started a new job you may not be covered under FMLA. That doesn’t necessarily mean there aren’t other company benefits that could apply to your situation so don’t give up.
Is my condition serious enough to request leave?
In addition to your employment qualifications, you also need to have a valid reason to request medical leave. As in the example of taking a “mental health day”, practicing self-care is not a medical necessity (although we think it should be). An employee must be able to demonstrate that their own serious medical condition forces them to miss work for medical treatment or renders them unable to perform one or more essential functions of their job for at least three (3) consecutive calendar days. The fine print also requires that the employee see a medical professional within seven (7) days so it’s important to seek care for your condition or risk short-changing your FMLA benefits.
How do I request Medical Leave?
Here’s a general timeline:
The employee notifies the employer that they require a medical leave of absence for a serious health condition. If the leave of absence is in any way foreseeable such as a pregnancy, you’re required to provide 30 days notice but most mental health incapacitations don’t come with a “save the date” so employees should notify their employer as soon as possible, even if they have already incurred medical-related absences.
The employer confirms FMLA eligibility within 5 business days. This means that if they are not covered by FMLA or you do not meet the employment qualifications, they need to notify you so you can plan accordingly. This is a good time to ask about other company benefits that could be applicable.
The employee provides documentation to support their FMLA claim within fifteen (15) calendar days. This almost always includes documentation from a medical professional but may also include some company-specific forms.
The employer makes a decision to approve or deny the claim within 5 business days from receiving all of the requested documentation.
Why does the process seem so complicated?
It’s common for employers or 3rd party claims handlers to come back and ask for additional information after you submit your initial round of documents. Don’t fret, this isn’t personal or some kind of stalling technique. They need the information to be detailed enough to make a decision either way. If the medical provider is too vague with the paperwork it could cause the process to be dragged out or your claim denied. You should always take the extra time to review the documentation that is submitted to your employer and make sure that every question is answered and that the answers fully reflect your disabling condition.
Retaliation against an employee who requests FMLA is illegal and employers can get in a lot of trouble both legally and financially if that is proven. Since FMLA is unpaid, most employers will err on the side of caution when deciding to accept or deny a claim and they would be stupid to take any actions that can be considered retaliation.
WAIT, FMLA is unpaid???
Technically, yes. The Federal law protects your job but it does not ensure you are paid during that time. Fortunately, most companies have benefits to off-set any lost wages while you are tending to your health. The most common of these is Short-Term Disability. If your employer carries an insurance policy for (STD) and you qualify under the terms of that particular policy, you may be entitled to some or all of your pay while you are disabled. These policies vary from company to company so you will need to inquire about the policy coverage or better yet, your employer should be kind enough to provide that information to you up front.
Additionally, some States have enacted their own laws regarding medical leave that either extend the coverage past 12 weeks, require medical leave to be paid (up to a point) or possibly both. If you live in any of these States it may be worth your time to do a little research.
California, Colorado, Connecticut, Delaware, Massachusetts, Maryland, New Jersey, New York, Oregon, Rhode Island, Washington and the District of Columbia
If you are feeling overwhelmed by all of this, know that there are resources out there to help you through the process. A Disability Compliance Specialist such as myself, can gather medical information about your symptoms, treatment and limitations to complete the documentation and wrap everything up into a nice, neat little package you can hand over to your employer. Working with a professional means that your request will include the necessary details to properly document your disability the first time, making it less likely that your employer will need more information or deny your request altogether.
To learn more about legal protections for persons with mental health disabilities or to speak with a Compliance Specialist, visit www.modyfi.com
REFERENCES
US Department of Labor, Wage and Hour Division, Fact Sheet #280: Mental Health Conditions and the FMLA, (May 2022) https://www.dol.gov/agencies/whd/fact-sheets/28o-mental-health
NCSL, National Conference of State Legislatures. State Family and Medical Leave Laws (2022)
https://www.ncsl.org/research/labor-and-employment/state-family-and-medical-leave-laws.aspx
29 CFR, Part 825, Subpart A, (100, 104, 110-113, 123). Coverage Under the Family and Medical Leave Act
https://www.ecfr.gov/current/title-29/subtitle-B/chapter-V/subchapter-C/part-825/subpart-A
29 CFR, Part 825, Subpart B, (200, 209-210, 214-215, 220). Employee Leave Entitlements Under the Family and Medical Leave Act
https://www.ecfr.gov/current/title-29/subtitle-B/chapter-V/subchapter-C/part-825/subpart-B
29 CFR, Part 825, Subpart C, (301-304, 306-307, 313). Employee and Employer Rights and Obligations Under the Act
https://www.ecfr.gov/current/title-29/subtitle-B/chapter-V/subchapter-C/part-825/subpart-C
29 CFR, Part 825, Subpart G, (701-702). Effect of Other Laws, Employer Practices, and Collective Bargaining Agreements on Employee Rights Under FMLA
https://www.ecfr.gov/current/title-29/subtitle-B/chapter-V/subchapter-C/part-825/subpart-G
