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HR Policies

Policy # 88.0 Archived Version:
Family and Medical Leave

Revision date of this archived policy:
April 23, 1997

Note: This is not a current version of the policy. View current version. »

88.1 Policy
  Recognizing the occurrence(s) of family emergencies which involve either the University employee or a family member, the University provides unpaid family or medical leave of up to twelve (12) weeks in a twelve (12) month period.
  88.1.1 Any employee who has been a University employee for twelve (12) months and has worked at least one thousand two hundred fifty (1250) hours during the previous twelve (12) month period may take up to twelve (12) weeks of unpaid leave for an emergency involving the employee or a family member during any twelve (12) month period for any or all of the following reasons:
    (a) Because of the birth of a child of the employee and in order to care for such son or daughter;
    (b) Because of the placement of a child with the employee for adoption or foster care;
    (c) In order to care for the spouse, or child, or parent, of the employee, if such spouse, son, daughter, or parent has a serious health condition; or
    (d) Because of a serious health condition that makes the employee unable to perform the functions of the position of such employee.
NOTE: The twelve (12) weeks of leave under 88.1.1 is leave which is consistent with (not an additional leave) and will run concurrently with the ninety (90) days temporary disability leave that is provided for specific employees under Policy 82.1.1 or the thirty (30) working days childbearing leave that is provided for employees under Policy 82.1.18.
  88.1.2 For purposes of this policy, the following definitions shall apply:
    88.1.2.1 The term "parent" means the biological parent of an employee or an individual who stood in loco parentis to an employee when the employee was a child (minor).
    88.1.2.2 The term "serious health condition" means an illness, injury, impairment, or physical or mental condition that involves the following:
      (a) Inpatient care in a hospital, hospice, or residential medical care facility; or
      (b) Continuing treatment by a health care provider. A serious health condition involving continuing treatment by a health care provider includes any one or more of the following:
        (i) A period of incapacity (i.e., inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment thereof, or recovery therefrom) for more than three (3) consecutive calendar days, and any subsequent treatment or period of incapacity relating to the same condition, that also involves:
          (A) Treatment two or more times by a health care provider, by a nurse or physician's assistant under direct supervision of a health care provider or by a provider of health care services; or
          (B) Treatment by a health care provider on at least one (1) occasion which results in a regiment of continuing treatment under the supervision of the health care provider.
        (ii) Any period of incapacity due to pregnancy or for prenatal care.
        (iii) Any period of incapacity or treatment for such incapacity due to a chronic serious health condition. A chronic serious health condition is one which:
          (A) Requires periodic visits for treatment by a health care provider or by a nurse or physician's assistant under the direct supervision of a health care provider;
          (B) Continues over an extended period of time (including recurring episodes of a single underlying condition); and
          (C) May cause episodic rather than continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.).
        (iv) A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by a health care provider. Examples include Alzheimer's, a severe stroke, or the terminal stages of a disease.
        (v) Any period of absence to receive multiple treatments by a health care provider or by the provider of healthcare services under orders of or on referral by a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity for more than three (3) consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.) or severe arthritis (physical therapy, kidney disease (dialysis).
NOTE: A serious health condition is not intended to cover short-term conditions for which treatment and recovery are very brief; for those purposes, employees should refer to Policy 82.0: Temporary Disability Leave. For purposes of FML leave, continuing treatment includes examinations to determine if a serious health condition exists and evaluations of the condition. Treatment does NOT include routine physical examinations, eye examinations or dental examinations. A regiment of continuing treatment (see 88.1.2.2(b), above) includes a course of prescription medication (e.g., antibiotic) or therapy requiring special equipment to resolve or alleviate the health condition (e.g., oxygen). A regiment of continuing treatment that includes the taking of over-the-counter medications such as aspirin, antihistamines, or salves, or bed-rest, drinking fluids, exercise, and other similar activities that can be initiated without a visit to a health care provider is NOT, by itself, sufficient to constitute a regiment of continuing treatment for purposes of FML leave. Serious health condition means that absences are necessary on a recurring basis and for more than a few days and includes heart attacks, cancers, strokes, severe respiratory conditions, spine injuries, injuries caused by serious accidents on or off the job, etc. Generally, absences from work, or from school or the incapacity to perform other daily activities, in the case of a family member, must be for a period of more than three (3) days.
    88.1.2.3 The term "child" means a biological, adopted, or foster son or daughter, a stepson or stepdaughter, a legal ward, or a son or daughter of a person standing in loco parentis, who is:
      (a) Under eighteen (18) years of age, or
      (b) Eighteen (18) years of age or older and incapable of selfcare because of a mental or physical disability.
    88.1.2.4 The term "spouse" means a husband or wife, as the case may be.
    88.1.2.5 The term "health care provider" means a doctor of medicine or osteopathy who is authorized to practice medicine or surgery (as appropriate) by the State in which the doctor practices, podiatrist, dentist, clinical psychologist, optometrist, chiropractor, nurse practitioner, nurse-midwife, Christian Science practitioners and clinical social workers, or other persons determined by the United States Secretary of Labor to be capable of providing health care services. The federal law places restrictions on specific purposes under which chiropractors and Christian Science practitioners may be health care providers; an employee shall check with an official of Human Resource Services for an interpretation before relying that these persons are health care providers.
NOTE: A higher standard for Family and Medical leave is held for an employee to be absent for the employee's serious medical condition than for an employee to be absent to care for a child, spouse, or parent. An employee shall be granted Family and Medical leave because the employee has a serious medical condition and because the employee cannot perform the functions of the position; an employee shall be granted Family and Medical leave because a spouse, child or parent has a serious medical condition and because the employee is needed to care for the family member.
  88.1.3 Leave taken for childbirth or placement (adoption or foster care) may not be taken intermittently or on a reduced schedule. This leave may be taken only within twelve (12) months of the date of the birth or placement of the child.
    88.1.3.1 A pregnant employee may take leave intermittently for prenatal examinations or for her own condition, such as for periods of severe morning sickness.
NOTE: Under Policy 85.0: Special Leaves and in accordance with Kentucky law, an employee may take up to six (6) weeks of unpaid leave for the adoption of a child under the age of seven (7). This policy expands the six (6) weeks leave to twelve (12) weeks in one Family and Medical leave twelve (12) month period; however, there is no limit to the number of six (6) weeks periods which may be granted for the adoption of additional children under the age of seven (7) under Policy 85.0.
  88.1.4 Leave taken to care for a spouse, child, or parent or for the serious health condition of the employee may be taken intermittently or on a reduced schedule when medically necessary. Taking leave on an intermittent or reduced schedule under this paragraph shall not result in a reduction in the total amount of leave to which an employee is entitled under Section 88.1.
    88.1.4.1 For example, one who takes intermittent leave under this Policy, who normally works a five-day week and who takes one day of leave under this policy will use one-fifth of one week of leave available under this Policy. With this intermittent schedule, the employee could take one day (one fifth of a week) for up to fifty two (52) weeks (or one year) to get the full twelve (12) weeks of Family and Medical leave.
    88.1.4.2 Under a reduced schedule for Family and Medical leave, if a full-time employee who regularly works five days a week must take off one half of the workweek, one half week (or two and one half days) of leave under this Policy is used each week. Thus it could take the employee up to twenty four (24) weeks to use the entire entitlement of Family and Medical leave.
    88.1.4.3 For employees who work less than full time, leave entitlement under this Policy is calculated on a pro rata (or proportional basis). If an employee's work schedule varies from week to week, the average weekly hours worked during the twelve (12) weeks prior to the start of the leave under this Policy will be used to calculate the employee's normal work schedule.
      88.1.4.3.1 A less than full-time employee is entitled to twelve (12) weeks of the less than full-time employee's regular work week. For example, one who normally works thirty (30) hours per week in entitled to twelve (12) thirty (30) hour weeks of Family and Medical leave.
      88.1.4.3.2 A less than full-time employee who takes intermittent leave is entitled to the equivalency of twelve (12) weeks of that employee's less than full time schedule. For example, if an employee who normally works a schedule of thirty (30) hours per week is able to work only a twenty (20) hour week on a reduced work schedule, the ten (10) hours of leave would equal one third (.33) of a week of leave under this Policy. This employee could take up to thirty six (36) weeks to use the entire entitlement.
NOTE: An exempt employee's taking Family and Medical leave by the hour is not a violation of the employee's exempt status under the Fair Labor Standards Act.
  88.1.5 An eligible employee is entitled to take a total of twelve (12) weeks of leave under this policy during a twelve (12) month period; the twelve (12) month period begins on the first day of the first approved Family and Medical leave.
    88.1.5.1 For example, an employee who becomes eligible for Family and Medical leave on September 1, 1994 does not have an established Family and Medical leave twelve (12) month period until the employee requests this leave for a particular purpose.
    88.1.5.2 Pursuant to an appropriate first request, the above employee goes on a Family and Medical leave on January 15, 1995. This employee's Family and Medical leave twelve (12) month period runs from January 15, 1995 to January 14, 1996. On January 15, 1996, or any date thereafter, the employee is eligible for a second twelve (12) weeks of Family and Medical leave, provided that the employee has worked one thousand two hundred fifty (1250) hours during the previous twelve (12) months
  88.1.6 An employee taking leave under Sections 88.1.1 (a), (b), or (c) of this policy shall first take any paid leave available under the provisions and limitations of Policy 82.0: Temporary Disability Leave (Section 82.1.15 or 82.1.16 or 82.1.18), shall then exhaust any paid vacation leave available under the provisions of Policy 80.0: Vacation Leave, and then shall be in a leave without pay status for the balance of the twelve (12) week leave period.
  88.1.7 An employee taking leave under Section 88.1.1 (d) of this policy shall first take any paid leave available under the provisions and limitations of Policy 82.0: Temporary Disability Leave, shall then exhaust any accrued vacation leave under Policy 80.0: Vacation Leave, and then shall be in a leave without pay status for the balance of the approved Family and Medical leave.
    88.1.7.1 Under Sections 88.1.6 and 88.1.7 above, any paid or unpaid leaves provided for under Policy 80.0: Vacation Leave and Policy 82.0: Temporary Disability Leave (TDL) shall run concurrently with FML leave. For example, if an employee qualifies for six (6) weeks of FML leave because of the employee's own serious health condition, that leave would be with pay to the extent that the employee had accrued vacation leave and to the extent that the employee had accrued temporary disability leave and to the extent that the TDL was applicable to the employee's sickness/injury. All of the six (6) weeks period would also run concurrently with six (6) weeks of the employee's ninety (90) day temporary disability entitlement, as provided by Policy 82.1.1.
    88.1.7.2 Similarly, workers compensation shall be designated as FML leave (to the extent that it qualifies as FML leave) and shall run concurrently with the FML leave.
  88.1.8 In the case of child birth or placement (adoption or foster care), the employee shall, whenever foreseeable based on birth or placement, give the supervisor thirty (30) days notice, before the leave is to begin, of the employee's intention to take such leave. If the birth or placement requires leave to begin in less than thirty (30) days, the employee shall provide the supervisor with such notice as is practicable.
  88.1.9 When leave under Section 88.1.1 (c) or (d) of this Policy is taken for planned medical treatment, the employee shall act in accordance with the following:
    88.1.9.1 The employee shall make a reasonable effort to schedule the treatment so as not to disrupt unduly the operations of the University department in which the employee works, subject to the approval of the health care provider of the child, spouse, or parent of the employee, as appropriate; and
    88.1.9.2 The employee shall provide the department with no less than thirty (30) days notice, before the date the leave is to begin, of the employee's intention to take leave under Sections 88.1.1 (a) or (b) except that if the date of the treatment requires leave to begin in less than thirty (30) days, the employee shall provide such notice as is practicable.
  88.1.10 In any case in which husband and wife are both employees of the University, the combined (total) number of workweeks of leave entitlement under this policy is twelve (12) weeks during any twelve (12) month period if such leave is taken under Sections 88.1.1 (a) or (b) or for the care of a sick parent under Section 88.1.1 (c).
88.2 Delegation
  88.2.1 The responsibility for approving leave taken under the policy is delegated jointly to the department head and Human Resource Services officials. The department head shall be responsible for reporting complete and accurate records of leave taken under this Policy.
  88.2.2 A department head is authorized to promulgate departmental policies and procedures concerning family and medical leave. These policies and procedures shall be approved by a Human Resource Services official.
88.3 Procedure
  88.3.1 An employee seeking leave shall submit a written request for leave in accordance with the department's usual and customary procedures for such submission.
    88.3.1.1 An employee shall give the department thirty (30) days advanced notice of the need to take leave under Family and Medical leave when it is foreseeable for the birth or placement of a child for adoption or foster care, or for planned medical treatment.
    88.3.1.2 When advanced notice is not practicable (e.g., premature birth), notice shall be given as soon as practicable, ordinarily within one (1) or two (2) work days of the emergency need for the leave.
    88.3.1.3 An employee shall follow standard department notice for an absence in the case of an emergency need for this leave.
  88.3.2 The request shall be supported by a written medical certification issued by the health care provider of the employee or of the child, spouse, or parent of the employee, as appropriate. Such a certificate shall be provided in a timely manner, e.g., usually fifteen (15) calendar days. Such a certificate from the health care provider shall state the following:
    (a) The date on which the serious health condition commenced;
    (b) The probable duration of the condition;
    (c.1) For purposes of leave under Section 88.1.1(c), a statement that the eligible employee is needed to care for the child, spouse, or parent and an estimate of the amount of time that such employee is needed to care for the child, spouse, or parent; and
    (c.2) For purposes of leave under Section 88.1.1 (d), a statement that the employee is unable to perform the essential functions of the position at the University;
    (d) In the case of certification for intermittent leave, for leave on a reduced leave schedule, or for planned medical treatment, the dates on which such treatment is expected to be given and the duration of such treatment;
    (e) In the case of certification for intermittent leave, or for leave on a reduced leave schedule, under Section 88.1.1(d), a statement of the medical necessity for the intermittent leave or for leave on a reduced leave schedule and the expected duration of the intermittent leave or reduced leave schedule; and
    (f) In the case of certification for intermittent leave or for leave on a reduced leave schedule, under Section 88.1.1(c), a statement that the employee's intermittent leave or leave on a reduced schedule (a) is necessary for the care of the child, parent, or spouse who has a serious health condition or (b) will assist in their recovery, and a statement as to the expected duration and schedule of the intermittent leave or reduced leave schedule.
  88.3.3 It is the responsibility of the department to designate leave as FML leave and to notify the employee that the leave will count toward the employee's twelve (12) week leave entitlement. The department must notify the employee within two (2) working days of the employee's request for leave that a leave is paid or unpaid and that the leave is an FML qualifying leave. Notice from the department shall be sent at least once each six (6) month period. The department shall mail the notice to the employee if the leave has already begun. The department shall update the written notice within two (2) working days if the content of the notice changes or the type of leave (paid/unpaid) changes.
    88.3.3.1 This designation as FML leave made by the department shall be based only on information received from the employee or the employee's spokesperson (e.g., if the employee is incapacitated, the employee's spouse, adult child, parent, doctor, etc.).
    88.3.3.2 The department's notice to the employee that the leave has been designated as FML leave may be oral or in writing. If the notice is oral, it shall be confirmed in writing no later than the following payday, unless the payday is less that one week after the oral notice, in which case the notice must be no later than the subsequent payday. The written notice may be in any form, including a notation on the employee's pay stub.
NOTE: An employee shall satisfy the requirements of 88.3.1 (written request for Family and Medical leave) and 88.3.2 (accompanying doctor's statement) by submitting a completed Form 88.4.
    88.3.3.3 If the department does not initially have sufficient information to make a determination that the leave is an FML qualifying leave, the notice must be given to the employee within two (2) working days of the time the department determines the leave qualifies as FML leave.
    88.3.3.4 If the department learns that the leave is for a FML purpose after the leave has begun, (perhaps the employee gives notice for the need for extension of a paid leave) the portion of the leave which qualifies as FML leave may be retroactively counted as FML leave.
    88.3.3.5 Leave may not be designated as FML leave after the employee has returned to work, with two exceptions, as follows:
      88.3.3.5.1 If an employee was absent for a FML qualifying event and the department did not learn the reason for the absence until the employee's return, the department may within two (2) working days of the employee's return to work designate the leave retroactively with appropriate notice to the employee. If the leave taken for a FML purpose has not been designated as such and the employee desires such designation, the employee should notify the department within two (2) working days that the leave was for a FML purpose. In the absence of timely notice, an employee may not usually assert subsequent FML protections. Upon appeal to a dean or director or community college president, and with proper written medical information, leave may be subsequently designated, at the employee's request.
      88.3.3.5.2 If the department knows the reason for the leave but has not been able to confirm that the leave qualifies under FML, or where the department has requested medical certification which has yet been received or where the parties are in the process of obtaining a third medical opinion (see 88.3.3), the department should make a preliminary designation and so notify the employee, at the time the leave begins or as soon as the reason for the leave becomes known. Upon receipt of the requisite information from the employee or of the medical certification, the preliminary designation becomes final. If the medical certification fails to confirm a FML qualifying event, the department shall withdraw the designation with written notice to the employee.
      88.3.3.5.3 The department should send to the employee a written notice detailing the specific expectations and obligations of the employee and explaining the consequences of a failure to meet these obligations. The written notice to the employee should include the following, as appropriate:
        (a) The leave will be counted against the employee's annual FML leave entitlement;
        (b) Any requirement/request that the employee furnish medical certification of a serious health condition, and the consequences of failure to do so;
        (c) The requirement that the employee substitute paid leave(s);
        (d) The requirement that the employee make any premium payments to the Employee Benefits Office to maintain such benefits, the arrangements by which the payments could be made, and consequences of failure to make such payments;
        (e) Any requirement for the employee to present a fitness-for-duty certification to be restored to employment in the department upon return;
        (f) If the employee is a "key" employee and potential consequences that restoration to an equivalent job may be denied;
        (g) The employee's right to restoration to the same or an equivalent position upon return from FML leave; and
        (h) The employee's potential liability to pay health insurance premiums which were paid by the University during the employee's unpaid FML leave, if the employee fails to return to work after taking FML leave.
  88.3.4 In any case the department head has reason to doubt the validity of the certification provided in Section 88.3.1 for leave under Section 88.1.1.(c) or (d), the department head may require, at the expense of the department, that the employee obtain the opinion of a second health care provider, designated or approved by the department head. (The department head may consult with the Director of the Wellness Program in designating a physician. This second health care provider may not be an employee of the University.)
    88.3.4.1 In any case where a second opinion is obtained and the second opinion differs from the first opinion, then the department head may require, at the department's expense, an opinion of a third medical care provider, designated and approved jointly by the employee and the department head.
    88.3.4.2 In any case where a third opinion is sought, the third opinion shall be considered to be final and binding on both the employee and the department.
  88.3.5 An employee who takes leave under this Policy shall be entitled, upon return from such leave, (a) to be restored by the department to the position of employment held by the employee when the leave commenced or (b) to be restored to an equivalent position with equivalent employment benefits, pay, and other terms and conditions of employment.
    88.3.5.1 If the employee is unable to perform an essential function of the position because of a physical or mental condition, including the continuation of a serious health condition, the employee has no right to restoration to another University position under this Policy; however, the University's obligation to the employee shall then be determined by the Americans with Disabilities Act.
    88.3.5.2 An equivalent position is one that is virtually identical to the employee's former position in terms of pay, benefits, and working conditions, including privileges, prerequisites, and status. It must involve the same or substantially similar duties and responsibilities which must entail substantially equivalent skill, effort, responsibility, and authority.
    88.3.5.3 With approval of dean, director or community college president, the position of an employee taking leave under this Policy may be filled by a temporary employee during the period of approved leave.
    88.3.5.4 The position of an employee taking leave under this Policy may be filled by a regular employee only with approval of a Human Resource Services official.
  88.3.6 If an employee requests intermittent leave or leave on a reduced leave schedule, under 88.1.1 (c) or (d), that is foreseeable based on planned medical treatment, the employing department may require such employee to transfer temporarily to an available alternative position for which the employee is qualified and that has equivalent pay and benefits and better accommodates recurring periods of leave than the regular position of the employee.
  88.3.7 Upon recommendation of a dean, director or president of a community college, the President or the appropriate chancellor or vice president may deny restoration of employment to any employee who is in the highest paid ten percent (10%) of all salaried employees if the following circumstances exists:
    88.3.7.1 This action is necessary to prevent substantial and grievous economic injury to the University;
    88.3.7.2 The President or appropriate chancellor or vice president notifies the employee of the University's intent to deny restoration, and the reasons supporting the denial; and
    88.3.7.3 In any case in which the leave under this Policy is commenced, the employee elects not to return to employment with the University after receiving such notice.
  88.3.8 During Family Medical leave, the status of an employee’s benefits is as follows:
    88.3.8.1 During any period that an employee takes leave under this Policy, the University shall continue the employee's health plan for the duration of the leave at the same level and conditions of coverage as if the employee had been in employment continuously for the duration of the leave.
      88.3.8.1.1 During any period of leave approved under this Policy, the University shall continue to contribute the employer's credit portion toward the employee's health insurance plan.
    88.3.8.2 During any period of leave approved under this Policy, the University shall continue to cover the cost of the employee's basic life insurance. (See Policy 91.1.1.)
    88.3.8.3 During any period of paid leave approved under this policy or during a period of six (6) months or less of unpaid leave approved under this policy, the University shall continue to cover the cost of the employee's enrollment in the long term disability plan.
    88.3.8.4 During any period of leave approved under this Policy, the employee shall make arrangements with the Employee Benefits Office to pay the cost of other benefits for which the employee would ordinarily be responsible during any period of unpaid leave. (See Policy 91.3.3, 92.3.3, and 93.3.2.1.)
      88.3.8.4.1 The Employee Benefits Office shall terminate any benefits for which the employee has not made appropriate payment after such payment is past due for thirty (30) days.
      88.3.8.4.2 The Employee Benefits Office shall mail to the employee notice that the coverage will cease at least fifteen (15) days before coverage is ceased. The Employee Benefits Office letter will advise the employee that the coverage will cease retroactively on a specific date which is the date the premium was due.
  88.3.9 During any period of leave approved under this Policy, the employee's original date of employment (service date) shall be retained. (See Policy 110.0, Original Employment Date.)
NOTE: While an employee may continue to accrue vacation and temporary disability leave if the employee remains in a pay status, an employee taking leave under this Policy shall not accrue vacation and temporary disability leave while in a no pay status.
  88.3.10 If a department head has any reasonable doubt of the continued validity of an approved Family and Medical leave, and if the Family and Medical leave continues for over (6) six weeks, a department head may require reports from the employee on the employee's status and intent to return to work.
    88.3.10.1 Such re-certification may be required at the end of six (6) weeks and again at the end of nine (9) weeks.
    88.3.10.2 At the time an employee gives notice of intent not to return to work, the University's obligation to provide any benefits under 88.3.5 ceases.
  88.3.11 The employee shall be obligated to repay to the University any health insurance premium which the University paid for the employee, if the employee fails to return to University employment after an approved period of leave under this Section, and if the employee fails to return to work for a reason other than the following:
    88.3.11.1 The continuation, recurrence or onset of a serious health condition that entitled the employee to leave under Sections 88.1.1 (c) or (d), or
    88.3.11.2 Other circumstances beyond the control of the employee.
  88.3.12 If the employee fails to return to work, at the end of an approved Family and Medical leave, because of the continuation, recurrence, or onset of the serious health condition (See above 88.3.4.2 a.), a department head may require supporting evidence as follows:
    88.3.12.1 A certification issued by the health care provider of the child, spouse, or parent of the employee, as appropriate, in the case of an employee unable to return to work because of a condition specified in Section 88.1.1(c), or
    88.3.12.2 A certificate issued by the health care provider of the eligible employee, in the case of an employee unable to return to work because of a condition specified in Section 88.1.1(d).
    88.3.12.3 A certification for a leave due to serious health condition of an employee is sufficient if the certification states that a serious health condition prevented the employee from being able to perform the functions of the position of the employee on the date that the leave of the employee expired.
    88.3.12.4 A certification for a leave due to a serious health condition of a family member (Section 88.3.4.3.1) shall be sufficient if the certification states that the employee is needed to care for the child, spouse, or parent who has a serious health condition on the date that the leave of the employee expired.
  88.3.13 When an employee is due to return to work from a Family and Medical leave, a department head may require presentation of a certificate that the employee is able to resume work.
    88.3.13.1 Certification from an employee's health care provider that an employee is able to resume work shall be in accordance with the department's customary and uniformly applied procedures.
    88.3.13.2 A certification shall be required in departments where there are specific physical requirements in a job description.
88.4 Forms
  88.4.1 Request for Family and Medical Leave and Certification of Physician or Practitioner Form

 

 

 

 

 

 

 

 

 

 

 

 

REQUEST FOR FAMILY AND MEDICAL LEAVE

and

CERTIFICATION OF PHYSICIAN OR PRACTITIONER FORM

 

 

SECTION A. This section, consisting of twelve (12) questions, is to be completed by the employee who is requesting Family and Medical Leave in accordance with Policy 88.0 (A.R. II 1.1-12).

 

1. Employee's full name:  

 

2. Employee's social security number:  -  -  

 

3. Department in which employee is regularly employed:  

 

4. Employee is seeking Family and Medical Leave (FML) for which of the

following reasons:

 

  Birth of a child and to care for that child

 

  Placement of child with employee for adoption or foster care

 

  Care of spouse, child or parent of employee

 

  A serious health condition prevents employee from being able to perform

functions of position.

 

5. Patient's name (if other than employee):  

 

6. Patient's relationship to employee (if not employee):  

 

7. Date on which requested FML is to commence:  

 

8. Date on which FML would probably end:  

 

9. Number of days FML will be taken with pay  ; without pay  

 

10. Number of days of temporary disability leave which will be used  

 

11. Number of days of vacation leave which will be used  

 

12. If FML is to be taken for care of a family member, state below the care which the employee will provide, an estimate of the time period which this care will be provided, and, if FML is requested on intermittent basis or on a reduced leave schedule, a requested schedule:

 

 

 

 

 

 

 

Employee's signature:   Date:  

 

Page 1 of 2 page form

 

FORM 88.1.4

 

 

Page 2 of 2 page form

FORM 88.4.1

 

SECTION B This section is to be completed by physician or practitioner.

 

1. Employee's name:  

 

2. Patient's name (if not employee):  

 

3. Date on which condition commenced or was diagnosed:  

 

4. Probable duration of condition:  

 

5. Is inpatient hospitalization required? Yes   No  

 

6. Dates hospitalization will be required: From   to  

 

7. If patient is employee, is employee able to perform work of any kind? Yes   No  

 

8. (If answer to # 7 is NO, skip this question.) Is employee able to perform the functions of employee's position? (Please answer this question after reviewing statement from UK concerning the essential functions of the employee's position, or if no statement provided, after discussion with the employee.) Yes   No  

 

9. Indicate general regimen of treatment (Indicate schedule of visits or treatment necessary; referral(s) to other provider of health services)

 

 

 

 

 

The following questions (#10 through #13) are to be answered only if the certificate related to the care for an employee's seriously-ill family member:

 

10. Is inpatient hospitalization of the family member required?

Yes   No  

 

11. Does (or will) the patient require assistance for basic medical, hygiene, nutritional needs, safety or transportation?

Yes   No  

 

12. After review of the employee's signed statement (See Section A, opposite page.), is the employee's presence necessary or would it be beneficial for the care of the patient? (The answer to this question may include psychological comfort and will probably involve your expressing a professional opinion.) Yes   No  

 

13. Estimate the period of time needed or the period of time the employee's presence would be beneficial:

 

 

 

 

     

Name, physician or practitioner Signature Date

(please print)

Type of practice (field of specialization, if any)  

 

 

 

 

 

April 20, 1995

 

 

 

MEMORANDUM

 

 

TO: Charles T. Wethington, Jr.

 

FROM: T. Lynn Williamson

 

RE: Family and Medical Leave

 

As you are aware, the United States Congress legislated the Family and Medical Leave Act (FMLA) to be effective August 5, 1993. The University adopted a parallel policy (Human Resources Policy and Procedure Number 88.0: Family and Medical Leave) which was effective on August 5, 1993. More recently, Congress has revised the original legislation, and Final Regulations for FMLA were published in February, 1995 and to be effective in April, 1995. Accordingly, I have revised the University's Policy (Policy 88.0) to parallel the new federal regulations.
Most of the changes to the University policy have been made where it is necessary for compliance with the federal regulations. Significant sections of the federal regulations and the revisions to the UK Policy are as follows:
  1) An expanded, and hopefully clarified, definition of a serious health condition (see Section 88.1.2.2 and NOTE on second page of Policy);
  2) A clarification of the relationship between FML leave and University's other paid leave, including (and in particular) when an employee is on workers compensation (see Sections 88.1.7.1 and 88.1.7.2);
  3) A clarification of the fact that an employee may request FML leave, but it is the responsibility of the employer (the University) to DESIGNATE leave as FML leave (see Sections 88.3.3, 88.3.3.1 and 88.3.3.2);
  4) A major change which gives an employer (the University) ONLY two days after an employee requests FML leave to respond to the employee (see Sections 88.3.3.3, 88.3.3.4, 88.3.3.5, 88.3.3.5.1, and 88.3.3.5.2);
  5) A second major change which requires WRITTEN notice to the employee when FML leave is granted, and the eight items which the written notice must contain (see Sections 88.3.3.5.3 a, b, c, d, e, f, g, and h);
  6) An attempt to define the relationship between FML leave and the Americans with Disabilities Act (ADA) (see Section 88.3.5.1); and
  7) An attempt to define an equivalent position (see Section 88.3.5.2).
Further, I have taken this opportunity to revise this Policy to reflect the reorganization of Human Resources and to delete all references to the sector personnel offices.
Upon your approval of these revisions, I will proceed with publication of this revised Policy and will insure that it is on line with UKCC's "View."

 

 

 

cc George DeBin
  Bob Lawson
  Bill Webb

Encl. (1)

1055(19-20)

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