R.C.S.A. § 31-51rr-41
Certification for leave taken to care for a covered servicemember (military caregiver leave) (29 CFR § 825.310)
Cite as Conn. Agencies Regs. § 31-51rr-41
leave) (29 CFR § 825.310)
(a) Required information from health care provider. When leave is taken to care for a covered servicemember with a serious injury or
illness, an employer may require an employee to obtain a certification completed by
an authorized health care provider of the covered servicemember. For purposes of leave
taken to care for a covered servicemember, any one of the following health care providers
may complete such a certification:
(1) A United States Department of Defense (DOD) health care provider;
(2) A United States Department of Veterans Affairs (VA) health care provider;
(3) A DOD TRICARE network authorized private health care provider;
(4) A DOD non-network TRICARE authorized private health care provider; or
(5) Any health care provider as defined in section 31-51rr-1(15) of the Regulations of
Connecticut State Agencies.
(b) If the authorized health care provider is unable to make certain military-related
determinations outlined below, the authorized health care provider may rely on determinations
from an authorized DOD representative, such as a DOD Recovery Care Coordinator, or
an authorized VA representative. An employer may request that the health care provider
provide the following information:
(1) The name, address, and appropriate contact information, such as telephone number,
fax number, and/or email address, of the health care provider, the type of medical
practice, the medical specialty, and whether the health care provider is one of the
following:
(A) A DOD health care provider;
(B) A VA health care provider;
(C) A DOD TRICARE network authorized private health care provider;
(D) A DOD non-network TRICARE authorized private health care provider; or
(E) A health care provider as defined in section 31-51rr-1(15) of the Regulations of Connecticut
State Agencies.
(2) Whether the covered servicemember’s injury or illness was incurred in the line of
duty on active duty or, if not, whether the covered servicemember’s injury or illness
existed before the beginning of the servicemember’s active duty and was aggravated
by service in the line of duty on active duty;
(3) The approximate date on which the serious injury or illness commenced, or was aggravated,
and its probable duration; and
(4) A statement or description of appropriate medical facts regarding the covered servicemember’s
health condition for which FMLA leave is requested. The medical facts must be sufficient
to support the need for leave.
(A) In the case of a current member of the Armed Forces, such medical facts must include
information on whether the injury or illness may render the covered servicemember
medically unfit to perform the duties of the servicemember’s office, grade, rank,
or rating and whether the member is receiving medical treatment, recuperation, or
therapy.
(B) In the case of a covered veteran, such medical facts shall include:
(i) Information on whether the veteran is receiving medical treatment, recuperation, or
therapy for an injury or illness that is the continuation of an injury or illness
that was incurred or aggravated when the covered veteran was a member of the Armed
Forces and rendered the servicemember medically unfit to perform the duties of the
servicemember’s office, grade, rank, or rating; or
(ii) Information on whether the veteran is receiving medical treatment, recuperation, or
therapy for an injury or illness that is a physical or mental condition for which
the covered veteran has received a U.S. Department of Veterans Affairs Service-Related
Disability Rating (VASRD) of fifty (50) percent or greater, and that such VASRD rating
is based, in whole or in part, on the condition precipitating the need for military
caregiver leave; or
(iii) Information on whether the veteran is receiving medical treatment, recuperation, or
therapy for an injury or illness that is a physical or mental condition that substantially
impairs the covered veteran’s ability to secure or follow a substantially gainful
occupation by reason of a disability or disabilities related to military service,
or would do so absent treatment; or
(iv) Documentation of enrollment in the Department of Veterans Affairs Program of Comprehensive
Assistance for Family Caregivers.
(5) Information sufficient to establish that the covered servicemember is in need of care,
as described in section 31-51rr-12 of the Regulations of Connecticut State Agencies,
and whether the covered servicemember will need care for a single continuous period
of time, including any time for treatment and recovery, and an estimate as to the
beginning and ending dates for this period of time;
(6) If an employee requests leave on an intermittent or reduced schedule basis for planned
medical treatment appointments for the covered servicemember, whether there is a medical
necessity for the covered servicemember to have such periodic care and an estimate
of the treatment schedule of such appointments; or
(7) If an employee requests leave on an intermittent or reduced schedule basis to care
for a covered servicemember other than for planned medical treatment, whether there
is a medical necessity for the covered servicemember to have such periodic care, which
can include assisting in the covered servicemember’s recovery, and an estimate of
the frequency and duration of the periodic care.
(c) Required information from employee and/or covered servicemember. In addition to the information that may be requested under subsection (b) of this
section, an employer may also request that such certification set forth the following
information provided by an employee and/or covered servicemember:
(1) The name and address of the employer of the employee requesting leave to care for
a covered servicemember, the name of the employee requesting such leave, and the name
of the covered servicemember for whom the employee is requesting leave to care;
(2) The relationship of the employee to the covered servicemember for whom the employee
is requesting leave to care;
(3) Whether the covered servicemember is a current member of the Armed Forces, the National
Guard or Reserves, and the covered servicemember’s military branch, rank, and current
unit assignment;
(4) Whether the covered servicemember is assigned to a military medical facility as an
outpatient or to a unit established for the purpose of providing command and control
of members of the Armed Forces receiving medical care as outpatients, such as a medical
hold or warrior transition unit, and the name of the medical treatment facility or
unit;
(5) Whether the covered servicemember is on the temporary disability retired list;
(6) Whether the covered servicemember is a veteran, the date of separation from military
service, and whether the separation was other than dishonorable. The employer may
require the employee to provide documentation issued by the military which indicates
that the covered servicemember is a veteran, the date of separation, and that the
separation is other than dishonorable. Where an employer requires such documentation,
an employee may provide a copy of the veteran’s Certificate of Release or Discharge
from Active Duty issued by the U.S. Department of Defense (DD Form 214) or other proof
of veteran status; and
(7) A description of the care to be provided to the covered servicemember and an estimate
of the leave needed to provide the care.
(d) The United States Department of Labor has developed optional forms (WH–385, WH–385–V)
for employees’ use in obtaining certification that meets FMLA’s certification requirements.
(The employer may use the form referenced in Appendix A). These optional forms reflect
certification requirements so as to permit the employee to furnish appropriate information
to support his or her request for leave to care for a covered servicemember with a
serious injury or illness. WH–385, WH–385–V, or another form containing the same basic
information, may be used by the employer; however, no information may be required
beyond that specified in this section. In all instances the information on the certification
must relate only to the serious injury or illness for which the current need for leave
exists. An employer may seek authentication and/ or clarification of the certification
under section 31-51rr-38 of the Regulations of Connecticut State Agencies. Second
and third opinions under section 31-51rr-38 of the Regulations of Connecticut State
Agencies are not permitted for leave to care for a covered servicemember when the
certification has been completed by one of the types of health care providers identified
in section 31-51rr-41(a)(1) to 31-51rr-41(a)(4), inclusive, of the Regulations of
Connecticut State Agencies. However, second and third opinions under section 31-51rr-38
of the Regulations of Connecticut State Agencies are permitted when the certification
has been completed by a health care provider as defined in section 31-51rr-1(15) of
the Regulations of Connecticut State Agencies that is not one of the types identified
in section 31-51rr-41(a)(1)–(4) of the Regulations of Connecticut State Agencies.
Additionally, recertifications under section 31-51rr-39 of the Regulations of Connecticut
State Agencies are not permitted for leave to care for a covered servicemember. An
employer may require an employee to provide confirmation of covered family relationship
to the seriously injured or ill servicemember pursuant to section 31-51rr-10(c) of
the Regulations of Connecticut State Agencies.
(e) An employer requiring an employee to submit a certification for leave to care for
a covered servicemember shall accept as sufficient certification, in lieu of the Department’s
optional certification forms (WH–385) or an employer’s own certification form, invitational
travel orders (ITOs) or invitational travel authorizations (ITAs) issued to any family
member to join an injured or ill servicemember at his or her bedside. An ITO or ITA
is sufficient certification for the duration of time specified in the ITO or ITA.
During that time period, an eligible employee may take leave to care for the covered
servicemember in a continuous block of time or on an intermittent basis. An eligible
employee who provides an ITO or ITA to support his or her request for leave may not
be required to provide any additional or separate certification that leave taken on
an intermittent basis during the period of time specified in the ITO or ITA is medically
necessary. An ITO or ITA is sufficient certification for an employee entitled to take
FMLA leave to care for a covered servicemember regardless of whether the employee
is named in the order or authorization.
(1) If an employee will need leave to care for a covered servicemember beyond the expiration
date specified in an ITO or ITA, an employer may request that the employee have one
of the authorized health care providers listed under section 31-51rr-41(a) of the
Regulations of Connecticut State Agencies complete the United State Department of
Labor optional certification form (WH–385) or an employer’s own form, as requisite
certification for the remainder of the employee’s necessary leave period.
(2) An employer may seek authentication and clarification of the ITO or ITA under section
31-51rr-38 of the Regulations of Connecticut State Agencies. An employer may not utilize
the second or third opinion process outlined in section 31-51rr-38 of the Regulations
of Connecticut State Agencies or the recertification process under section 31-51rr-39
of the Regulations of Connecticut State Agencies during the period of time in which
leave is supported by an ITO or ITA.
(3) An employer may require an employee to provide confirmation of covered family relationship
to the seriously injured or ill servicemember pursuant to section 31-51rr-10(c) of
the Regulations of Connecticut State Agencies when an employee supports his or her
request for FMLA leave with a copy of an ITO or ITA.
(f) An employer requiring an employee to submit a certification for leave to care for
a covered servicemember must accept as sufficient certification of the servicemember’s
serious injury or illness documentation indicating the servicemember’s enrollment
in the Department of Veterans Affairs Program of Comprehensive Assistance for Family
Caregivers. Such documentation is sufficient certification of the servicemember’s
serious injury or illness to support the employee’s request for military caregiver
leave regardless of whether the employee is the named caregiver in the enrollment
documentation.
(1) An employer may seek authentication and clarification of the documentation indicating
the servicemember’s enrollment in the Department of Veterans Affairs Program of Comprehensive
Assistance for Family Caregivers under section 31-51rr-38 of the Regulations of Connecticut
State Agencies. An employer may not utilize the second or third opinion process outlined
in section 31-51rr-38 of the Regulations of Connecticut State Agencies or the recertification
process under section 31-51rr-39 of the Regulations of Connecticut State Agencies
when the servicemember’s serious injury or illness is shown by documentation of enrollment
in this program.
(2) An employer may require an employee to provide confirmation of covered family relationship
to the seriously injured or ill servicemember pursuant to section 31-51rr-10(c) of
the Regulations of Connecticut State Agencies when an employee supports his or her
request for FMLA leave with a copy of such enrollment documentation. An employer may
also require an employee to provide documentation, such as a veteran’s Form DD–214,
showing that the discharge was other than dishonorable and the date of the veteran’s
discharge.
(g) Where medical certification is requested by an employer, an employee may not be held
liable for administrative delays in the issuance of military documents, despite the
employee’s diligent, good-faith efforts to obtain such documents. In all instances
in which certification is requested, it is the employee’s responsibility to provide
the employer with complete and sufficient certification and failure to do so may result
in the denial of FMLA leave.