HomeMy Public PortalAboutADM-130_Family & Medical Leave Policy_Effective 01-17-2015
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 1 of
13
Approved by: Greg Lewis, City Manager
Section 1.0: Purpose
The City of Lebanon is committed to complying with the Family and Medical
Leave Act of 1993 (29 U.S.C. §2601; hereinafter, "FMLA"). The purpose of
this policy is to set forth the City's policy and procedures relating to the
administration of family and medical leave for both non-bargaining and
bargaining unit eligible employees.
Section 2.0: Scope
Section 3.0: Definitions
Child - A biological, adopted or foster child, stepchild, legal ward, or under
the federal FMLA, the child of a person having day-to-day care and financial
responsibility for the child. Child includes a person 18 years of age or older
who is incapable of self-care because of a mental or physical disability; a
medical condition which is covered under both the ADA and serious health
condition of FMLA.
Covered service member – An individual who is:
1. A current member of the Armed Forces, including a member of the
National Guard or Reserves, who is undergoing medical treatment,
recuperation, or therapy, is otherwise in outpatient status; or is
otherwise on the temporary disability retired list, for a serious injury or
illness. (Outpatient status means the status of a member of the Armed
Forces assigned to either a military medical treatment facility as an
outpatient or a unit established for the purpose of providing command
and control of members of the Armed Forces receiving medical care as
outpatients); or
2. A covered veteran who is undergoing medical treatment, recuperation
or therapy for a serious injury or illness.
Covered veteran - An individual who was a member of the Armed Forces
(including a member of the National Guard or Reserves), and was
discharged or released under conditions other than dishonorable at any time
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 2 of
13
Approved by: Greg Lewis, City Manager
during the five-year period prior to the first date the eligible employee takes
FMLA leave to care for the covered veteran.
Incapable of self care - The child requires active assistance or supervision
to provide daily self care in three or more "activities of daily living" or
"instrumental activities of daily living" including adaptive activities such as
caring appropriately for one's grooming and hygiene, bathing, dressing,
eating, or instrumental activities such as shopping, taking public
transportation, maintaining a residence, etc.
Parent - A biological parent or an individual who provides or provided day-
to-day care and financial support to the employee when the employee was a
child. This includes foster parent, adoptive parent, step-parent, and legal
guardian. Parent does not mean a parent-in-law.
Physical or mental disability - A physical or mental impairment that
substantially limits one or more major life activities of the individual.
Serious Health Condition of a family member or an employee - Illness,
injury, impairment or physical or mental condition that involves:
• Inpatient care in a hospital, hospice or residential medical care facility;
• A period of incapacity of more than three consecutive calendar days
(including any subsequent treatment or period of incapacity relating to
the same condition) that also involves: 1) treatment two or more
times by or under the orders of a health care provider; or 2) treatment
by a health care provider on at least one occasion which results in a
regimen of continuing treatment under the supervision of a health care
provider
• Any incapacity due to pregnancy or for prenatal care;
• Chronic conditions requiring periodic treatment by or under the
supervision of a health care provider which continues over an
extended period of time and may cause an episodic rather than a
continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.)
• Permanent/long-term conditions requiring supervision for which
treatment may not be effective (e.g., Alzheimer's, a severe stroke, or
the terminal stages of a disease)
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 3 of
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Approved by: Greg Lewis, City Manager
• Multiple treatments by or under the supervision of 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 of
more than three calendar days in the absence of medical intervention
or treatment, such as cancer (chemotherapy), severe arthritis
(physical therapy) or kidney disease (dialysis).
Serious injury or illness of a covered service member –
1. In the case of a current member of the Armed Forces, including a
member of the National Guard or Reserves, an injury or illness that
was incurred by the covered service member in the line of duty on
active duty in the Armed Forces or that existed before the beginning of
the member's active duty and was aggravated by service in the line of
duty on active duty in the Armed Forces and that may render the
service member medically unfit to perform the duties of the member's
office, grade, rank, or rating; and
2. In the case of a covered veteran, an injury or illness that was incurred
by the member in the line of duty on active duty in the Armed Forces
(or existed before the beginning of the member's active duty and was
aggravated by service in the line of duty on active duty in the Armed
Forces) and manifested itself before or after the member became a
veteran, and is:
• A continuation of a serious injury or illness that was incurred or
aggravated when the covered veteran was a member of the Armed
Forces and rendered the service member unable to perform the
duties of the service member's office, grade, rank, or rating; or
• 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 50 percent or greater, and such
VASRD rating is based, in whole or in part, on the condition
precipitating the need for military caregiver leave; or
• 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
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 4 of
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Approved by: Greg Lewis, City Manager
• An injury, including a psychological injury, on the basis of which the
covered veteran has been enrolled in the Department of Veterans
Affairs Program of Comprehensive Assistance for Family Caregivers.
Spouse - A husband or wife as defined or recognized under state law for
purposes of marriage in the state where the employee resides.
Section 4.0: Policy Detail
Under the Family and Medical Leave Act ("FMLA"), eligible City employees
may take an unpaid leave of absence and be restored to the same or an
equivalent position upon their return to work for any of the following
reasons:
(1) The birth of the employee's child and to care for the newborn child (leave
must be taken within twelve (12) months of the birth of the child);
(2) The placement of a child with the employee for adoption or foster care,
and in order to care for the newly placed child (leave must be taken within
twelve (12) months of the adoption or placement of the child);
(3) The serious health condition of a spouse, parent, minor child, or adult
child when the adult child is incapable of self-care and the employee is
needed for such care ("covered family members");
(4) The employee's own serious health condition that renders the employee
unable to perform his or her job;
(5) A "qualifying exigency" (as defined in the Department of Labor
Regulations and as amended by the National Defense Authorization Act for
Fiscal Year 2010);
(6) The employee is a spouse, son, daughter, parent, or next of kin of a
"covered service member" (as defined in the Department of Labor
Regulations and as amended by the National Defense Authorization Act for
Fiscal Year 2010) who has a serious injury or illness (which was incurred or
was aggravated while on active duty) and the employee is needed to care
for such person.
Eligibility Requirements
To be eligible for FMLA leave, an employee must satisfy both of the following
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 5 of
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Approved by: Greg Lewis, City Manager
conditions:
• The employee must have worked for the City for at least twelve (12)
months (which need not be consecutive), and must have performed at
least 1,250 hours of work in twelve (12) months prior to the FMLA
qualifying event (these hours must be actual hours worked, not to
include holidays, sick vacation personal and unpaid leave); and
• At the time leave is requested, the employee must either: (a) work at
a site where the City employs fifty (50) or more employees or (b) work
at a worksite where the City employs less than fifty (50) employs if
fifty (50) or more employees are employed within a seventy-five (75)
mile radius of the worksite.
Amount of Leave Available
If an eligible employee takes FMLA leave for a reason stated in paragraphs
(1)-(5), above, the employee is entitled to up to twelve (12) workweeks of
unpaid leave during a twelve (12) month period. That twelve (12) month
period is defined as a "rolling" twelve (12) month period measured backward
from the date an employee begins an FMLA leave. In other words, the
number of weeks the employee has available upon the beginning of a FMLA
leave will be twelve (12) weeks less the number of FMLA leave weeks taken
in the twelve (12) month period prior to the beginning of the current FMLA
leave (the "Available Leave Weeks"). If an employee takes FMLA leave for
the reason stated in paragraph (6), above, the employee may take up to 26
weeks of unpaid FMLA leave within a single 12-month period. This 12-month
period begins on the first day of leave.
An employee who takes FMLA leave for a reason stated in paragraph (6),
above, will be limited to a combined total of 26 workweeks of leave for any
FMLA-qualifying reason during the single 12-month period. The leave
entitlement described in paragraph (6) above is to be applied on a per-
covered-service member, per injury basis such that an eligible employee
may be entitled to take more than one period of 26 workweeks of leave if
the leave is to care for different covered service members or to care for the
same service member with a subsequent serious illness of injury, except
that no more than 26 workweeks of leave may be taken within any single
12-month period.
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 6 of
13
Approved by: Greg Lewis, City Manager
Spouses employed by the City are jointly entitled to a combined total of 12
weeks of family leave for the birth or placement of a child for adoption or
foster care, to care for a parent who has a serious health condition, or for a
"qualifying exigency." Spouses employed by the City are jointly entitled to
26 weeks for leave to care for a "covered service member."
Tracking FMLA Leave
When an eligible employee has a FMLA qualifying event, the employee may
request FMLA leave or the City may designate any resulting period of
absence as FMLA leave. For example, if an eligible employee suffers a work
related injury that qualifies as a serious health condition, the City has the
right to designate any time away from work as FMLA leave. In such
circumstances, the City will provide the employee with the same notifications
as though the employee had specifically requested FMLA leave. The City
reserves the right to designate periods of absence as FMLA leave retroactive
to the first day of absence.
In order to assure that employees receive their FMLA rights, employees are
required to contact the City's Benefits Coordinator whenever they miss three
consecutive days of work. For example, if an employee is absent from work
on a Friday and the following Monday and Tuesday (where all are scheduled
work days) due to his or her own illness or to care for his or her minor child,
the employee must contact the Benefits Coordinator no later than
Wednesday.
Intermittent and Reduced Schedule Leave
Under some circumstances, employees may take FMLA leaves of absences
intermittently (in separate blocks of time due to a single FMLA qualifying
reason) or on a reduced leave schedule (reducing the usual number of hours
an employee works per workweek or workday). Medical certification will be
required to show that an intermittent or a reduced schedule leave is a
medical necessity for leaves under paragraphs (3), (4), and (6), above.
Other documentation or certification may be required to show that such an
intermittent or a reduced schedule leave is necessary in the case of a leave
of a "qualified exigency" under paragraph (5), above.
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 7 of
13
Approved by: Greg Lewis, City Manager
If FMLA leave is for birth and care, or placement for adoption or foster care,
as described in paragraphs (1) and (2), above, use of intermittent leave is
subject to City approval.
When an employee takes intermittent or reduced schedule leave, time spent
working will not be counted against the employee's FMLA entitlement.
Employees taking intermittent or reduced schedule leave will be paid for the
time they work, and the leave time away from work will be unpaid unless
the employee qualifies for workers' compensation, short-term disability, or
other benefits. If an employee is a salaried employee, the City will prorate
the employee's salary, if he or she is not using other compensation benefits,
based on the amount of time actually worked.
While an employee is on intermittent or reduced schedule FMLA leave, the
City may temporarily transfer the employee to an available alternate position
that better accommodates the employee's recurring leave and that has
equivalent pay and benefits.
Employees who take intermittent leave for a planned medical treatment
have an obligation to make a reasonable effort to schedule the treatment so
as not to disrupt unduly the City's operations.
Benefit Continuation During Leave
The City will maintain workers' compensation, group health insurance
coverage and other employment benefits (as described in City policy or
applicable collective bargaining agreement) for an employee while on FMLA
leave whenever such insurance was provided to the employee before the
leave was taken and on the same terms as if the employee had continued
work. Employees are required to pay their regular portion of insurance
premiums during periods of FMLA absence. Employees should contact the
Benefits Coordinator for an explanation of your benefit continuation and
payment options. Where possible, the City will continue to deduct the
employee's portion of health insurance premiums from employee
compensation. If the employee is not receiving compensation from the City,
the employee will need to arrange with the Benefits Coordinator to make
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 8 of
13
Approved by: Greg Lewis, City Manager
timely payments. Health and other benefit coverage may be canceled if a
premium payment is more than (thirty) 30 days late.
Benefits that are accumulated based upon hours worked shall not
accumulate during the period of FMLA leave, except as provided in applicable
collective bargaining agreements or Personnel Policy.
Where permitted by law, the City may recover premiums it paid to maintain
health insurance coverage for an employee who fails to return to work from
FMLA leave.
FMLA is a period of unpaid leave. FMLA leave shall run concurrent with
workers' compensation, short/long term disability, and employee paid time
off. While on FMLA, employees receiving an insurance benefit (workers'
compensation or disability) shall use accrued paid time off to increase total
compensation to 100 percent of the employee's base wages.
Absence due to employee illness or illness of covered family member:
employee shall use accrued sick leave until exhausted, then at the discretion
of the employee and, in the order designated in writing to the Benefits
Coordinator, accrued personal leave and vacation leave until exhausted; any
remaining FMLA time will be unpaid. If an employee on FMLA is not eligible
for an insurance benefit, he or she shall concurrently use accrued paid time
off, as outlined in the manner above.
Absences due to arrival of new child in the home as result of birth, adoption
or foster care placement: employee shall use, at their discretion and, in the
order designated in writing to the Benefits Coordinator, accrued personal
leave and vacation leave until exhausted; any remaining FMLA time will be
unpaid.
The substitution of paid leave time for unpaid leave time does not extend the
FMLA leave period.
Section 5.0: Procedures
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
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Approved by: Greg Lewis, City Manager
Notifying the City of the Need for Family or Medical Leave
Generally, an application for leave must be completed for all leave taken
under this policy. The need to take non-emergency leave should generally be
requested from the Benefits Coordinator at least 30 days, or as soon as
practicable, in advance of the need. If an employee's need for leave is
foreseeable, such as for the birth of a child or planned medical treatment,
you must give (thirty) 30 days' prior written notice. In cases of planned
medical treatment, please make efforts to schedule the treatment so as to
avoid disrupting the City's operations.
In cases of emergency, verbal notice should be given as soon as possible (or
by your representative if you are incapacitated), and the application form
should be completed as soon as practicable. Failure to provide adequate
notice may, in the case of foreseeable leave, result in a delay or denial of
the leave. It is the employee's responsibility to notify their Department Head
and the Benefits Coordinator of absences that may be covered by FMLA.
Employees must provide sufficient information regarding the reason for an
absence for the City to know that protection may exist under this policy.
Failure to provide this information within two working days of an employee's
return to work will result in forfeiture of rights under this policy. The means
the absence may then be counted against the employee's record for
purposes of discipline for attendance, etc.
Medical Certification Process
Employees requesting or who have been designated as using FMLA leave for
their own serious health condition, a covered family member's serious health
condition, or for the serious injury or illness of a covered service member,
are required to have a medical certification form completed by a health care
provider. It is an employee's responsibility to provide a complete and
sufficient certification. Employees should obtain a medical certification form
from the Benefits Coordinator for the health care provider to complete. If
possible, employees should provide the medical certification before the
leave begins. If that is not possible, employees must provide the medical
certification within fifteen (15) days of requesting or being designated as
using FMLA leave. If an employee does not provide the required medical
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
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Approved by: Greg Lewis, City Manager
certification in a timely manner, the employee's leave may be delayed. If an
employee does not provide the certification at all, the City will not be able to
determine eligibility for FMLA leave and leave will be denied. The City
reserves the right to authenticate or clarify any medical certification if
necessary.
In the case of an employee's own serious health condition or that of a family
member's serious health condition, the City, at its expense, may require an
examination by a second health care provider designated by the City. If the
second health care provider's opinion conflicts with the original medical
certification, the City, at its expense, may require a third health care
provider agreed upon by the employee and the City to conduct an
examination and provide a final and binding opinion.
The City may also require subsequent medical recertification. Failure to
provide requested re-certifications within fifteen (15) days of a request may
result in delay of further leave.
Certifications for a Qualifying Exigency
Employees who request a leave for a "qualifying exigency" arising from an
immediate family member's call to active duty or impending call or order to
active duty will be required to provide a copy of the family member's active
duty orders or other documentation issued by the military indicating the
member is on active duty or has been called to active duty status in support
of a contingency operation. Other documentation certifying the exigency
necessitating the leave will also be required.
Confirmation of Familial Relationship
Employees requesting a leave of absence based on a familial relationship
(e.g., leaves of absence under paragraphs (3), (5) and (6)) may be required
to provide reasonable documentation or statement of family relationship.
This documentation may take many forms, including but not limited to a
child's birth certificate, a court document, etc.
Reporting While On Leave
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 11 of
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Approved by: Greg Lewis, City Manager
If an employee takes leave because of his or her own serious health
condition, to care for a covered family member with a serious health
condition, to care for a covered service member with a serious illness or
injury, or for a qualifying exigency, the employee must contact the office of
the Benefits Coordinator on a regular basis to provide updates about the
status of the need for leave (e.g. the medical condition of the employee or
the individual for whom the employee is caring, or other circumstances
necessitating leave) and the employee's intention to return to work. In
addition, the employee must give notice as soon as practicable (within two
(2) business days if feasible) if the dates of leave change or are extended if
they initially were unknown.
No Work While On Leave
The taking of substitute employment (including self-employment) while on
FMLA leave or any other authorized leave may lead to disciplinary action, up
to and including discharge.
Returning To Work
If an employee wishes to return to work prior to the scheduled expiration of
a FMLA leave, he or she must notify the City as soon as possible but no later
than two working days prior to the desired return date. Permission to return
to work will not be granted if a return has not been authorized by a health
care provider.
At the end of an authorized FMLA leave, the employee will be reinstated to
his or her original position. If the position is not vacant, you will be placed in
an equivalent employment position with equivalent pay, benefits, and other
terms and conditions of employment. However, certain highly compensated
employees or "key employees" may be denied restoration to their prior or
equivalent position if keeping the job open for the employee would result in
substantial economic injury to the City. Key employees are those employees
who are among the highest paid ten percent of employees within 75
miles of the worksite.
The law provides that an employee has no greater rights upon a return from
leave that the employee would have if the employee had continued to work.
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
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Approved by: Greg Lewis, City Manager
Therefore, you may be affected by a layoff, termination or other job change
if the action would have occurred had you remained actively at work.
Return to Work Certification
A return-to-work certification will be required in order for an employee to
return from a medical leave for his/her own serious health condition. Failure
to provide the certification will result in a delay in the return to work. An
employee with an adequate return-to-work certification from his or her
provider shall be reinstated to paid status, but may be required to submit to
further examination before returning to active duty.
Failure to Return to Work at Expiration of FMLA
An employee who fails to return to work immediately after the expiration of
the leave period may be considered to have voluntarily terminated his/her
employment.
Coordination with Maternity Leave
In accordance with New Hampshire law, the City provides female employees
with a leave of absence for the period of temporary physical disability
resulting from pregnancy, childbirth, and related medical conditions. If an
employee is also eligible for FMLA leave, the employee's FMLA leave and
Maternity Leave will run concurrently.
For purposes of coordinating FMLA and maternity leaves, maternity disability
leave will be treated in the same manner as the FMLA leave of absence
described in paragraph (4) above. Maternity disability leave begins when an
employee is medically determined to be disabled and ends when medically
determined to be able to return to work. If a maternity disability leave is for
the number of available FMLA leave weeks or less, the employee may take
additional FMLA leave pursuant to paragraph (1) or (2) after the end of the
disability period, not to exceed the number of remaining available leave
weeks and will be reinstated in accordance with this FMLA policy. If a
maternity disability leave exceeds the number of available FMLA leave
weeks, then reinstatement will be governed by the maternity leave policy.
City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
FAMILY AND MEDICAL LEAVE POLICY
Policy Number Effective Date Last Revision Page No.
ADM-130
Previous 2015-01-A 01/17/2015 01/16/2015 Page 13 of
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Approved by: Greg Lewis, City Manager
Coordination with Other City Policies; Reference To FMLA And
Federal Regulations
In the event of any conflicts between this policy and other City policies, the
provisions of this policy will govern. In the event of any conflicts between
this policy and an applicable collective bargaining agreement, the collective
bargaining agreement will govern. The FMLA and the FMLA regulations
issued by the U.S. Department of Labor contain many limitations and
qualifications that are not stated in this policy. The City reserves the right to
apply the terms of the FMLA and the FMLA federal regulations.
If you do not qualify for the types of leave described in this policy, the City
may approve a leave of absence, depending on your circumstances, and in
accordance with City policy or applicable collective bargaining agreement.
Except where mandated by law, we cannot guarantee that benefits will
continue or that your position will remain open in your absence.
This policy provides an introduction to the rights and provisions of the
federal FMLA. Questions you may have about this law should be directed to
the Benefits Coordinator.
No Retaliation/Discipline
No employee shall be subject to any form of workplace retaliation for
requesting information about, applying for or utilizing FMLA leave. However,
employees applying for or utilizing FMLA leave remain covered by all of the
City's disciplinary policies applicable to other active and on leave employees.
Section 6.0: References (Charter/Code/State Statues)
Section 7.0: Policy & Procedure Revision History
Section Revisions Date
Original Adoption
Amendment
Amendment
Amendment