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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Friday, November 23, 2007
    Family Medical Leave Act: Good and Bad

    So, the Family Medical Leave Act. Let us speak of it. FMLA was enacted in 1993 with the purpose of giving workers more freedom to take care of kids and/or aging parents, as well as chronic health issues affecting employees themselves. Restrictions do apply; the Act is only available to companies of 50 or more employees, and before a worker qualifies for FMLA coverage he or she has to have been employed at the company for at least 12 months and have worked at least 1250 hours during that time. The coverage allows for up to 12 weeks of unpaid leave per year.

    The only relatives of employees who qualify for coverage are parents or children of workers - I had one patient who wanted to take time to care for her aging grandfather but this was not covered under the Act. Mostly, though, patients want this time for their own health issues. I have several patients who have applied for FMLA coverage. If someone needs time to recuperate from surgery or has ongoing appointments for physical therapy, chemo or radiation treatments, obviously this makes a lot of sense. Where things get trickier is if someone has a chronic disease and is taking time off at irregular intervals (red flags here would be something like fibromyalgia or chronic fatigue syndrome). Employers hate this sort of thing because it makes it very difficult to schedule workers if someone takes unplanned or intermittent leave.

    The potential for abuse here is clear: according to the article, one investigator found an employee who was using FMLA leave to start a landscaping business; the Pennsylvania Turnpike Commission refers to FMLA requests around holidays and weekends as "get out of jail free cards." I tend not to register patients for FMLA myself until I am very familiar with their medical issues, and employers are starting to request second and third opinions in some cases before approving coverage.

    Some employers use outside benefits providers to handle FMLA; this makes it easier for them because having a third party handle the paperwork and monitor requests removes the friction between employer and employee. If employees don't qualify they can't blame the employer for putting a spoke in their wheel.

    The Department of Labor is planning to revise the Act, but what form those revisions will take remains to be seen. Of note, though, when the department requested comments on the law in 2006 they were surprised by the sheer volume they received: more than 15,000 responses from unions, workers, companies and law firms. Clearly this is a hot button topic for everyone concerned.




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