Current through Register Vol. 63, No. 9, September 1, 2024
(1) A claimant applying for Paid Family and
Medical Leave Insurance (PFMLI) benefits for their own serious health condition
or to care for a family member with a serious health condition must provide one
of the following forms of verification:
(a)
The Paid Leave Oregon Verification of a Serious Health Condition
Form;
(b) The Oregon and Federal
Family and Medical Leave Health Care Provider Certification issued by the
Oregon Bureau of Labor and Industries (BOLI);
(c) The Family and Medical Leave Act (FMLA)
certification of health care provider for a serious health condition form
issued by the U.S. Department of Labor;
(d) A FMLA certification for a serious health
condition form issued by an employer;
(e) A document issued by a health care
provider; or
(f) Another document
approved by the department for this purpose.
(2) The forms of verification listed in
section (1) of this rule must include:
(a) The
health care provider's:
(A) First and last
name;
(B) Type of medical
practice/specialization;
(C)
Contact information, such as mailing address and telephone number;
and
(D) Handwritten or electronic
signature. If issued before the start of leave, the verification document must
be signed by the health care provider within 60 calendar days before the
claimant's leave start date;
(b) The patient's first and last
name;
(c) The claimant's first and
last name, when different from the patient identified in section (2)(b) of this
rule;
(d) The approximate date on
which the serious health condition commenced or when the serious health
condition created the need for leave;
(e) A reasonable estimate of the duration of
the condition or recovery period for the patient;
(f) A reasonable estimate of the frequency
and duration of intermittent leave and estimated treatment schedule, if
applicable; and
(g) Other
information as requested by the department to determine eligibility for the
PFMLI benefits; including:
(A) For medical
leave, information sufficient to establish that the claimant has a serious
health condition, including but not limited to a diagnosis; or
(B) For family leave, information sufficient
to establish that the claimant's family member has a serious health condition,
including but not limited to a diagnosis.
(3) If any of the documents listed in section
(1) of this rule do not include the full name of the patient or the claimant,
when different from the patient identified in section (2)(b) of this rule, or
do not show the family relationship of the claimant and the patient, the
claimant must submit at least one of the following documents to meet the
verification requirements described in this rule:
(a) A legal marriage certificate;
(b) A certified Declaration of Domestic
Partnership;
(c) A legal birth
certificate; or
(d) One or more
documents issued by an independent and verifiable third party that establishes
marriage, domestic partnership, or a significant family relationship between
claimant and patient. The document must be issued within six months before the
claimant's start of leave.
Publications: Contact the Oregon Employment Department for
information about how to obtain a copy of the publication referred to or
incorporated by reference in this rule.
Statutory/Other Authority: ORS
657B.340 & ORS
657B.090
Statutes/Other Implemented: ORS
657B.090
