(a)
Required
information from health care provider. When leave is taken to care for a
covered servicemember with a serious injury or illness, an employer may require
an employee to obtain a certification completed by an authorized health care
provider of the covered servicemember. For purposes of leave taken to care for
a covered servicemember, any one of the following health care providers may
complete such a certification:
(1) A United
States Department of Defense (DOD) health care provider;
(2) A United States Department of Veterans
Affairs (VA) health care provider;
(3) A DOD TRICARE network authorized private
health care provider;
(4) A DOD
non-network TRICARE authorized private health care provider; or
(5) Any health care provider as defined in
section 31-51rr-1(15) of
the Regulations of Connecticut State Agencies.
(b) If the authorized health care provider is
unable to make certain military-related determinations outlined below, the
authorized health care provider may rely on determinations from an authorized
DOD representative, such as a DOD Recovery Care Coordinator, or an authorized
VA representative. An employer may request that the health care provider
provide the following information:
(1) The
name, address, and appropriate contact information, such as telephone number,
fax number, and/or email address, of the health care provider, the type of
medical practice, the medical specialty, and whether the health care provider
is one of the following:
(A) A DOD health
care provider;
(B) A VA health care
provider;
(C) A DOD TRICARE network
authorized private health care provider;
(D) A DOD non-network TRICARE authorized
private health care provider; or
(E) A health care provider as defined in
section 31-51rr-1(15) of
the Regulations of Connecticut State Agencies.
(2) Whether the covered servicemember's
injury or illness was incurred in the line of duty on active duty or, if not,
whether the covered servicemember's injury or illness existed before the
beginning of the servicemember's active duty and was aggravated by service in
the line of duty on active duty;
(3) The approximate date on which the serious
injury or illness commenced, or was aggravated, and its probable duration;
and
(4) A statement or description
of appropriate medical facts regarding the covered servicemember's health
condition for which FMLA leave is requested. The medical facts must be
sufficient to support the need for leave.
(A)
In the case of a current member of the Armed Forces, such medical facts must
include information on whether the injury or illness may render the covered
servicemember medically unfit to perform the duties of the servicemember's
office, grade, rank, or rating and whether the member is receiving medical
treatment, recuperation, or therapy.
(B) In the case of a covered veteran, such
medical facts shall include:
(i) Information
on whether the veteran is receiving medical treatment, recuperation, or therapy
for an injury or illness that is the continuation of an injury or illness that
was incurred or aggravated when the covered veteran was a member of the Armed
Forces and rendered the servicemember medically unfit to perform the duties of
the servicemember's office, grade, rank, or rating; or
(ii) Information on whether the veteran is
receiving medical treatment, recuperation, or therapy for an injury or illness
that is a physical or mental condition for which the covered veteran has
received a U.S. Department of Veterans Affairs Service-Related Disability
Rating (VASRD) of fifty (50) percent or greater, and that such VASRD rating is
based, in whole or in part, on the condition precipitating the need for
military caregiver leave; or
(iii)
Information on whether the veteran is receiving medical treatment,
recuperation, or therapy for an injury or illness that is a physical or mental
condition that substantially impairs the covered veteran's ability to secure or
follow a substantially gainful occupation by reason of a disability or
disabilities related to military service, or would do so absent treatment;
or
(iv) Documentation of enrollment
in the Department of Veterans Affairs Program of Comprehensive Assistance for
Family Caregivers.
(5) Information sufficient to establish that
the covered servicemember is in need of care, as described in section
31-51rr-12 of the Regulations of
Connecticut State Agencies, and whether the covered servicemember will need
care for a single continuous period of time, including any time for treatment
and recovery, and an estimate as to the beginning and ending dates for this
period of time;
(6) If an employee
requests leave on an intermittent or reduced schedule basis for planned medical
treatment appointments for the covered servicemember, whether there is a
medical necessity for the covered servicemember to have such periodic care and
an estimate of the treatment schedule of such appointments; or
(7) If an employee requests leave on an
intermittent or reduced schedule basis to care for a covered servicemember
other than for planned medical treatment, whether there is a medical necessity
for the covered servicemember to have such periodic care, which can include
assisting in the covered servicemember's recovery, and an estimate of the
frequency and duration of the periodic care.
(c)
Required information from employee
and/or covered servicemember. In addition to the information that may be
requested under subsection (b) of this section, an employer may also request
that such certification set forth the following information provided by an
employee and/or covered servicemember:
(1)
The name and address of the employer of the employee requesting leave to care
for a covered servicemember, the name of the employee requesting such leave,
and the name of the covered servicemember for whom the employee is requesting
leave to care;
(2) The relationship
of the employee to the covered servicemember for whom the employee is
requesting leave to care;
(3)
Whether the covered servicemember is a current member of the Armed Forces, the
National Guard or Reserves, and the covered servicemember's military branch,
rank, and current unit assignment;
(4) Whether the covered servicemember is
assigned to a military medical facility as an outpatient or to a unit
established for the purpose of providing command and control of members of the
Armed Forces receiving medical care as outpatients, such as a medical hold or
warrior transition unit, and the name of the medical treatment facility or
unit;
(5) Whether the covered
servicemember is on the temporary disability retired list;
(6) Whether the covered servicemember is a
veteran, the date of separation from military service, and whether the
separation was other than dishonorable. The employer may require the employee
to provide documentation issued by the military which indicates that the
covered servicemember is a veteran, the date of separation, and that the
separation is other than dishonorable. Where an employer requires such
documentation, an employee may provide a copy of the veteran's Certificate of
Release or Discharge from Active Duty issued by the U.S. Department of Defense
(DD Form 214) or other proof of veteran status; and
(7) A description of the care to be provided
to the covered servicemember and an estimate of the leave needed to provide the
care.
(d) The United
States Department of Labor has developed optional forms (WH-385, WH-385-V) for
employees' use in obtaining certification that meets FMLA's certification
requirements. (The employer may use the form referenced in Appendix A). These
optional forms reflect certification requirements so as to permit the employee
to furnish appropriate information to support his or her request for leave to
care for a covered servicemember with a serious injury or illness. WH-385,
WH-385-V, or another form containing the same basic information, may be used by
the employer; however, no information may be required beyond that specified in
this section. In all instances the information on the certification must relate
only to the serious injury or illness for which the current need for leave
exists. An employer may seek authentication and/ or clarification of the
certification under section
31-51rr-38 of the Regulations of
Connecticut State Agencies. Second and third opinions under section
31-51rr-38 of the Regulations of
Connecticut State Agencies are not permitted for leave to care for a covered
servicemember when the certification has been completed by one of the types of
health care providers identified in section
31-51rr-41(a)(1)
to 31-51rr-41(a)(4),
inclusive, of the Regulations of Connecticut State Agencies. However, second
and third opinions under section
31-51rr-38 of the Regulations of
Connecticut State Agencies are permitted when the certification has been
completed by a health care provider as defined in section
31-51rr-1(15) of
the Regulations of Connecticut State Agencies that is not one of the types
identified in section
31-51rr-41(a)(1)
-(4) of the Regulations of Connecticut State Agencies. Additionally,
recertifications under section
31-51rr-39 of the Regulations of
Connecticut State Agencies are not permitted for leave to care for a covered
servicemember. An employer may require an employee to provide confirmation of
covered family relationship to the seriously injured or ill servicemember
pursuant to section
31-51rr-10(c) of
the Regulations of Connecticut State Agencies.
(e) An employer requiring an employee to
submit a certification for leave to care for a covered servicemember shall
accept as sufficient certification, in lieu of the Department's optional
certification forms (WH-385) or an employer's own certification form,
invitational travel orders (ITOs) or invitational travel authorizations (ITAs)
issued to any family member to join an injured or ill servicemember at his or
her bedside. An ITO or ITA is sufficient certification for the duration of time
specified in the ITO or ITA. During that time period, an eligible employee may
take leave to care for the covered servicemember in a continuous block of time
or on an intermittent basis. An eligible employee who provides an ITO or ITA to
support his or her request for leave may not be required to provide any
additional or separate certification that leave taken on an intermittent basis
during the period of time specified in the ITO or ITA is medically necessary.
An ITO or ITA is sufficient certification for an employee entitled to take FMLA
leave to care for a covered servicemember regardless of whether the employee is
named in the order or authorization.
(1) If
an employee will need leave to care for a covered servicemember beyond the
expiration date specified in an ITO or ITA, an employer may request that the
employee have one of the authorized health care providers listed under section
31-51rr-41(a) of
the Regulations of Connecticut State Agencies complete the United State
Department of Labor optional certification form (WH-385) or an employer's own
form, as requisite certification for the remainder of the employee's necessary
leave period.
(2) An employer may
seek authentication and clarification of the ITO or ITA under section
31-51rr-38 of the Regulations of
Connecticut State Agencies. An employer may not utilize the second or third
opinion process outlined in section
31-51rr-38 of the Regulations of
Connecticut State Agencies or the recertification process under section
31-51rr-39 of the Regulations of
Connecticut State Agencies during the period of time in which leave is
supported by an ITO or ITA.
(3) An
employer may require an employee to provide confirmation of covered family
relationship to the seriously injured or ill servicemember pursuant to section
31-51rr-10(c) of
the Regulations of Connecticut State Agencies when an employee supports his or
her request for FMLA leave with a copy of an ITO or ITA.
(f) An employer requiring an employee to
submit a certification for leave to care for a covered servicemember must
accept as sufficient certification of the servicemember's serious injury or
illness documentation indicating the servicemember's enrollment in the
Department of Veterans Affairs Program of Comprehensive Assistance for Family
Caregivers. Such documentation is sufficient certification of the
servicemember's serious injury or illness to support the employee's request for
military caregiver leave regardless of whether the employee is the named
caregiver in the enrollment documentation.
(1)
An employer may seek authentication and clarification of the documentation
indicating the servicemember's enrollment in the Department of Veterans Affairs
Program of Comprehensive Assistance for Family Caregivers under section
31-51rr-38 of the Regulations of
Connecticut State Agencies. An employer may not utilize the second or third
opinion process outlined in section
31-51rr-38 of the Regulations of
Connecticut State Agencies or the recertification process under section
31-51rr-39 of the Regulations of
Connecticut State Agencies when the servicemember's serious injury or illness
is shown by documentation of enrollment in this program.
(2) An employer may require an employee to
provide confirmation of covered family relationship to the seriously injured or
ill servicemember pursuant to section
31-51rr-10(c) of
the Regulations of Connecticut State Agencies when an employee supports his or
her request for FMLA leave with a copy of such enrollment documentation. An
employer may also require an employee to provide documentation, such as a
veteran's Form DD-214, showing that the discharge was other than dishonorable
and the date of the veteran's discharge.
(g) Where medical certification is requested
by an employer, an employee may not be held liable for administrative delays in
the issuance of military documents, despite the employee's diligent, good-faith
efforts to obtain such documents. In all instances in which certification is
requested, it is the employee's responsibility to provide the employer with
complete and sufficient certification and failure to do so may result in the
denial of FMLA leave.
