Who can take FMLA leave? We covered this in previous PODCASTS but let’s review…
In order to be eligible to take leave under the FMLA, an employee must:
- work for a covered employer;
- have worked 1,250 hours during the 12 months prior to the start of leave; ( special hours of service rules apply to airline flight crew members )
- work at a location where the employer has 50 or more employees within 75 miles; and
- have worked for the employer for 12 months. The 12 months of employment are not required to be consecutive in order for the employee to qualify for FMLA leave. In general, only employment within seven years is counted unless the break in service is (1) due to an employee’s fulfillment of military obligations, or (2) governed by a collective bargaining agreement or other written agreement.
Hours of Service Requirement
(Q) Does the time I take off for vacation, sick leave or PTO count toward the 1,250 hours?
The 1,250 hours include only those hours actually worked for the employer. Paid leave and unpaid leave, including FMLA leave, are not included. ( Special hours of service rules apply to airline flight crew members. )
Unpaid leave
(Q) Is my employer required to pay me when I take FMLA leave?
The FMLA only requires unpaid leave. However, the law permits an employee to elect, or the employer to require the employee, to use accrued paid vacation leave, paid sick or family leave for some or all of the FMLA leave period. An employee must follow the employer’s normal leave rules in order to substitute paid leave. When paid leave is used for an FMLA-covered reason, the leave is FMLA-protected.
Qualifying conditions
(Q) When can an eligible employee use FMLA leave?
A covered employer must grant an eligible employee up to a total of 12 workweeks of unpaid, job-protected leave in a 12 month period for one or more of the following reasons:
- for the birth of a son or daughter, and to bond with the newborn child;
- for the placement with the employee of a child for adoption or foster care, and to bond with that child;
- to care for an immediate family member (spouse, child, or parent – but not a parent “in-law”) with a serious health condition;
- to take medical leave when the employee is unable to work because of a serious health condition; or
- for qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter, or parent is on covered active duty or call to covered active duty status as a member of the National Guard, Reserves, or Regular Armed Forces.
The FMLA also allows eligible employees to take up to 26 workweeks of unpaid, job-protected leave in a “single 12-month period” to care for a covered servicemember with a serious injury or illness.
Birth and bonding
(Q) Are there any restrictions on when an employee can take leave for the birth or adoption of a child?
Leave to bond with a newborn child or for a newly placed adopted or foster child must conclude within 12 months after the birth or placement. The use of intermittent FMLA leave for these purposes is subject to the employer’s approval. If the newly born or newly placed child has a serious health condition, the employee has the right to take FMLA leave to care for the child intermittently, if medically necessary and such leave is not subject to the 12-month limitation.
(Q) When can a parent take leave for a newborn?
Mothers and fathers have the same right to take FMLA leave to bond with a newborn child. A mother can also take FMLA leave for prenatal care, incapacity related to pregnancy, and for her own serious health condition following the birth of a child. A father can also use FMLA leave to care for his spouse who is incapacitated due to pregnancy or child birth.
How do I learn the status of a medical authorization request, bill, or claim for reimbursement?
Injured Workers, Providers, and Employing Agencies can check on the status of bills and reimbursements on the OWCP Web Bill Processing Portal. To speak with a Customer Service Representative regarding a bill or reimbursement, you may call 844-493-1966, toll free. This number is available Monday – Friday, 8am – 8pm, EST.
How do I do find out what conditions OWCP has accepted on my claim?
While your initial acceptance letter includes this information, claims are often updated to include other conditions. This information is also available on the OWCP Web Bill Processing Portal. You can log in by clicking FECA/Claimant. From there you will enter your case number, date of birth, and date of injury. Once logged in, you can click on the "Eligibility and Accepted Conditions" link to access a list of accepted conditions. You can help your provider by giving her/him the list of accepted conditions for your claim and by telling your provider how to access this information online.
I think that other diagnoses need to be added as accepted conditions on my claim. What should I do?
If you believe that additional or different conditions warrant acceptance on your claim, please provide OWCP with medical documentation supporting the claim's expansion for review by the claims examiner. As is the case with anything sent to OWCP, this medical documentation must include the claim/case number on every page and may be mailed to U.S. Department of Labor, OWCP/DFEC, PO Box 8300, London, KY 40742-8300 or uploaded to the case electronically via ECOMP.
What form do I submit to get reimbursed for traveling to and from my medical appointments?
Complete the OWCP-957A "Medical Travel Refund Request – Mileage" if you are only claiming mileage reimbursement. Complete the OWCP-957B “Medical Travel Refund Request – Expenses” if you are claiming reimbursement for other travel expenses in addition to or instead of mileage. These forms are available on the OWCP Medical Bill Processing Portal or the FECA Forms page. Write your OWCP claim number on the top right side of the form.
How do I get reimbursed for out of pocket expenses I've paid for authorized treatments, pharmacy expenses/medications, medical appliances, or medical supplies for a work-related injury?
Reimbursement for pharmacy expenses/medications, medical appliances and supplies, and medical, surgical, and dental services can be claimed using Form OWCP-915 "Claimant Medical Reimbursement Form". This form is available on the OWCP Web Bill Processing Portal. Click on Resources – "Forms and References" link. Put each date of service on a separate line. If you are requesting reimbursement for a co-pay, write "Co-Pay" in the "Description of Charge" field. Use a separate form for each provider you paid. Don't mix prescriptions and office visits on the same form.
A reimbursement claim for medical services, surgical services, medical appliances, or medical supplies must be accompanied by a copy of the OWCP-1500/HCFA-1500 "Health Insurance Claim Form" showing individual charges and signed by the medical Provider.
A reimbursement claim for pharmacy expenses/medications must be accompanied by a copy of the Universal Claim Form or other pharmacy statement showing the name of the drug, NDC code, quantity provided, cost, prescribing physician, and date the prescription was filled.
All reimbursement requests must be accompanied by proof of payment – a cash receipt, cancelled check, or credit card receipt.
ECOMP or Mail the completed OWCP-915 and related documentation to:
U.S. Department of Labor
OWCP/DFEC
PO Box 8300
London, KY 40742-8300
ECOMP the completed OWCP-957A and B forms to ECOMP with a cover sheet with a brief explanation of what you are submitting to your claims examiner:
Lastly I had a patient who was on temporary total disability that had moved to another state and the claims examiner tried to cut-off his benefits due to a light duty offer being proposed due to a 2nd opinion doctor sending him back to light duty. The post master from his original postal duty station made a bonified light duty job offer that was in his original home state rather than 50 miles from where he actually lives now. This is a common problem and it is not a proper modified duty assignment per DFEC Procedure Manual 2-0814 which says that
YOU SHOULD NOT BE SENT GREATER THAN 50 MILES FROM HOME FOR MODIFIED DUTY
DFEC Procedure Manual- 2-0814, Job Offers and Return to Work
9. Temporary Assignments. c (2) (f)
(f) The light duty assignment should be in the location where the employee currently resides. If this is not practical, the EA may provide light duty at the employee's former duty station if that station is within the claimant's commuting area. Reemployment at any other location may only be considered where the distance between the location of the light duty assignment and the location where the employee currently resides is no greater than 50 miles and the employee is physically capable of performing the commute entailed. Special travel arrangements through vocational rehabilitation will not be pursued for temporary assignments.
So remember that DFEC procedure rule it is very commonly misused to punish people incorrectly.
A couple of announcements for the doctors and attorneys who follow this podcast;
OWCP will host a provider training session, “New Provider Orientation” on Wednesday, April 17, 2024, from 4:00 pm – 5:00 pm ET. Please click this link for further information.
OWCP will host a provider training session, “Portal Refresher” on Friday, April 19, 2024, from 1:00 pm – 2:00 pm ET. Please click this link for further information.
Well that does it for this episode of Federal Workers Comp Coffee break Podcast. I want to thank you for listening and want to remind you to share this podcast with other federal workers you think would benefit from this information. Also be kind enough to leave a review on the platform you found this podcast so others will also find this information. Also
if you need an approved medical provider for your DOL -OWCP Or Longshore case in Florida you can find me in Tampa and Pensacola. To make a consultation with Dr. Taylor to discuss your case or if you know someone if Florida who is recently injured you can call the clinic at
813-877-6900 or go to our website at https://fedcompconsultants.com/ & https://mrtherapycenter.com/ Also if you are in another state and you want me to assist you with claim questions or assistance for your doctor you can email me at fedcompconsultants@protonmail.com or send me a message on the website at fedcompconsultants.com
I need to warm up this coffee and get going. As usual I want to thank all of you who put on that uniform, that badge, deliver that mail, take care of our veterans and make this government run… a big thank you. I do this for free just for you…We could not do this without all of the work all of you out there do…so a big thank you. And remember if you
have an injured federal claim and you need assistance….I am here to help!.
See you next time.
Off to get my coffee!