Tuesday, August 13, 2013

Shortterm Disability Claim Trumps FMLA Certification Request

A recent appeals court ruling indicates that an employer may wait and see if short-term disability benefits are granted or denied to the employee on leave before it sends a request for medical certification that verifies the employee’s eligibility under the Family and Medical Leave Act.

In Kinds v. Ohio Bell Telephone Company, No. 12-4048 (6th Cir., July 29, 2013), Debra Kinds, a former Ohio Bell employee, failed to convince an appellate court that her employer had interfered with her FMLA rights because it had been too late in requesting her FMLA medical certification — and then later fired her for a documented history of unexcused absences.

The 6th U.S. Circuit Court of Appeals held that under the circumstances, it was appropriate for Ohio Bell to wait until its third-party administrator’s denial of Kinds’ short-term disability insurance benefits claim before requesting that she return the requisite FMLA health care provider forms in a timely manner. The circuit court’s decision affirmed the summary judgment of the U.S. District Court for the Northern District of Ohio to dismiss the case.

“The standard for disability status under Ohio Bell’s short-term disability insurance policy is similar enough to the ‘serious health condition’ standard for FMLA leave that denial of the former at least raises a question as to the appropriateness of the latter,” the circuit court found.


Kinds, a decade-long employee of Ohio Bell, was involved in a mentally and physically abusive relationship with her live-in boyfriend that culminated in death threats and an assault. She took a nine-week period of leave and applied for short-term disability benefits with Ohio Bell’s insurance administrator, Sedgwick Claims Management Services.

Under Ohio Bell’s leave policy, the company automatically approves the first seven days of an employee’s absence as FMLA leave whenever any part of that absence is approved for disability benefits and the employee is otherwise FMLA-eligible.

Sedgwick granted a portion of Kinds’ leave period, but denied three weeks, so for the portion of leave in which she was not granted short-term disability benefits, the company’s leave policy required her to submit FMLA medical certification. Because Kinds failed to provide the requisite forms in a timely manner, Ohio Bell terminated her.

Court Analysis

Kinds’ interference claim was based solely on the alleged failure of Ohio Bell to timely request medical certification as required by FMLA. The 6th Circuit denied her claim, however, because Ohio Bell “was not required [by FMLA] to promptly exercise its right to request a medical certification when Kinds first gave notice of her need for leave.”

Ohio Bell had “reason to question the appropriateness of her leave after Sedgwick denied short-term disability benefits for the full period requested by Kinds.”

Moreover, the court determined that “there is nothing [in FMLA] indicating that the discovery of employee fraud is the only acceptable reason for an employer to request a medical certification after the five-business-day period following an employee’s notification of leave.”

The court went as far to compliment Ohio Bell by saying that “the company’s policy of deferring such requests is actually beneficial to employees because only those employees taking extended leaves for medical issues who have been denied short-term disability benefits are required to provide medical certifications.”

Interestingly, even though Kinds’ medical doctor sent a letter to Sedgwick certifying that she was providing Kinds “medical assistance” from the dates in question, the court said it was not persuaded, presumably because the letter did not indicate what condition constituted Kinds’ alleged disability.

Sedgwick did not forward a copy of the letter to Ohio Bell, however, due to the restrictions on the sharing of private health information imposed by the Health Insurance Portability and Accountability Act of 1996.

Employer Conclusion

FMLA permits an employer to request medical certification — even after the requisite five-business-day period following an employee’s notification of leave because of a serious health condition — if it suspects that the reason for an employee’s leave or its duration may not be appropriate. (See 29 C.F.R. §825.305(b).)

The circuit court’s decision can be viewed as a victory of sorts for employers in FMLA compliance matters because it affirms that an employer may defer making a request for medical certification pending claims for short-term disability benefits during the same period.