Is It A Serious Health Condition Under Federal or Wisconsin FMLA?

Inpatient care (overnight stay): hospital, hospice, or residential medical care facility?

Includes:

• any period of incapacity – meaning the inability to work, attend school or perform other regular daily activities due to condition, treatment or recovery
• any subsequent treatment or incapacity in connection with inpatient care

825.113(b) and 825.114

Same as federal

103.10(1)(g)1

Continuing treatment by a healthcare provider?

Includes:

• a period of incapacity of more than three consecutive full calendar days AND

• treatment* (in-person) two or more times by a healthcare provider within 30 days of start of incapacity (first visit within 7 days) OR
• treatment* (in-person) once by a healthcare provider which results in regimen of continuing treatment**

*Treatment includes examinations to determine if a serious health condition exists and evaluations of the condition. Treatment does not include routine physical exams, eye exams, dental exams, over-the-counter medications, bed rest, drinking fluids, or exercise.

**A regimen of continuing treatment includes prescription medication or therapy requiring special equipment to resolve or alleviate the condition.

Note: Unless complications arise, the common cold, flu, allergies, ear aches, upset stomach, minor ulcers, headaches (other than migraine), routine dental or orthodontia problems, and periodontal disease are examples of conditions that do not typically meet the definition of a serious health condition.

825.115(a)(1-5) and 825.113(c)  

Includes:

• outpatient care that requires continuing treatment or supervision by a healthcare provider
• direct, continuous contact with healthcare provider subsequent to the initial outpatient contact (there is no minimum days of incapacity required)
• condition is disabling - meaning incapacitation or inability to pursue occupation because of physical or mental impairment

Note: a prescription is not considered continuing treatment.

103.10(1)(g)2

Pregnancy or prenatal care?

Includes:

• any period of incapacity (there is no minimum number of days for incapacity) 
• severe morning sickness

825.115(b) and (f)  

Includes:

• inpatient or outpatient care
• severe morning sickness

103.10(1)(g)1&2

Chronic condition?

Includes:

• condition must continue over an extended period of time
• any period of incapacity (there is no minimum number of days for incapacity)
• requirement of periodic visits for treatment by healthcare provider (at least twice/year)
• may cause episodic incapacity (ex: asthma, diabetes, epilepsy, rheumatoid arthritis, migraines)

825.115(c)(1-3) and (f)

Includes:

• inpatient or outpatient care

103.10(1)(g)1&2

Permanent or long-term condition?

Includes:

• any period of incapacity (there is no minimum amount of days for incapacity)
• requirement of continuing supervision of healthcare provider, even though may not be actively treated (ex: Alzheimer’s, severe stroke, terminal stage of disease)

825.115(d)

Includes:

• inpatient or outpatient care

103.10(1)(g)1&2

Condition requiring multiple treatments?

Includes:

• any period of incapacity (there is no minimum amount of days for incapacity)
• restorative surgery after an accident or injury
• treatment to prevent incapacity, especially with conditions that require medical intervention such as cancer, severe arthritis or kidney disease

825.115(3) and 825.113(d)

Includes:

• inpatient or outpatient care

103.10(1)(g)1&2

Substance abuse?

Includes:

• treatment by a health care provider or by a provider of health care services referred to by a health care provider 

Note: Use of a substance without treatment and absence due to abuse do not qualify.

825.119 

Includes:

• inpatient or outpatient care

103.10(1)(g)1&2

Mental illness?

Includes:

• in-patient care or continuing treatment by a healthcare provider (if all conditions of continuing treatment are met)

825.113

Includes:

• inpatient or outpatient care

103.10(1)(g)1&2

Cosmetic surgery?

Includes:

• in-patient hospitalization

Note: cosmetic treatments for acne or plastic surgery generally will not qualify unless complications develop.

825.113(d)

Includes:

• inpatient or outpatient care

103.10(1)(g)1&2