What Qualifies as a Serious Health Condition Under FMLA?

What Is a Serious Health Condition?

When employees request leave for their own health condition under the Family and Medical Leave Act, or FMLA, a common question is whether the condition qualifies for protection under the law.

To be eligible for FMLA leave, the condition must meet the definition of a serious health condition. Under the FMLA, this means an illness, injury, impairment, or physical or mental condition that involves either:

• Inpatient care, or
• Continuing treatment by a health care provider

Let’s take a closer look at each category.

Inpatient Care

Inpatient care includes an overnight stay in a hospital, hospice or residential medical care facility, including any period of incapacity or follow-up treatment related to that stay.

Continuing Treatment by a Health Care Provider

A serious health condition may also qualify under the continuing treatment definition. There are several categories that may meet this requirement.

Incapacity and Treatment

This category applies when an employee experiences a period of incapacity lasting more than three consecutive full calendar days and receives qualifying treatment related to the same condition.

Under the FMLA, incapacity means being unable to work, attend school or perform other regular daily activities due to a serious health condition.

To qualify, one of the following must also occur:

• Treatment two or more times within 30 days of the incapacity by a health care provider or other qualifying medical professional
• Treatment by a health care provider on at least one occasion that results in a regimen of continuing treatment

Pregnancy or Prenatal Care

Any period of incapacity or treatment related to pregnancy or prenatal care may qualify for FMLA leave.

Unlike some other categories, the employee does not need to experience more than three consecutive days of incapacity, and a visit to a heath care provider is not required for every absence.

Chronic Conditions

A chronic serious health condition may qualify when it:

• Requires treatment at least twice per year by a health care provider
• Continues over an extended period of time
• May cause episodic periods of incapacity (e.g., asthma, diabetes, epilepsy) rather than a continuous condition

Permanent or Long-Term Conditions

Some conditions may result in permanent or a long-term period of incapacity.

In these situations, the employee must be under the continuing supervision of a health care provider, but does not necessarily have to be in active treatment. Examples include Alzheimer's disease, severe stroke or the terminal stages of a disease.

Conditions Requiring Multiple Treatments

FMLA leave may also apply when an employee needs multiple treatments for a condition.

Examples include chemotherapy, radiation treatments, dialysis and physical therapy for severe arthritis.

Why It Matters for Employers

Understanding what qualifies as a serious health condition can help employers administer FMLA consistently and reduce confusion when employees request leave. Familiarity with these categories can also help employers navigate leave requests with greater confidence.

How The Standard Can Help

If you have questions or would like additional information, including how The Standard can support compliance efforts, please contact your account manager or a representative near you.