Workplace Health Services Blog

HR professionals face tough challenges as they juggle their varied — and often conflicting — responsibilities. Management wants its facilities fully staffed with healthy, productive employees. But, those employees want time off for “serious health conditions.”

And, did I mention that the HR people must comply with the Family and Medical Leave Act (FMLA) and the Health Insurance Portability and Accountability Act (HIPAA) when verifying whether those health conditions are, indeed, “serious?”

Obviously, everyone involved wants injured employees to be properly treated, and given the time off necessary to properly heal. But, abuses do occur, and steps must be taken to minimize them.

When an injured employee files an FMLA claim, he or she must be examined by a certified physician. That physician then completes a form stating that the employee’s injuries meet the FMLA criteria for a serious health condition, and defining how long the employee should be off work.

But, due the confidentiality restrictions set out by HIPAA, physicians are limited in the amount of employee health information they can disclose to employers. So how do human resources managers verify these claims as they struggle to control their company’s healthcare costs?

Having an onsite primary care physician perform these examinations is obviously the most effective way to protect the employer’s interests. But, employees usually prefer having their personal doctors examine them. In this case, having a clinic nurse or nurse practitioner attend the offsite exam is a good way to ensure that the claim is legitimate.

If neither of these options are available, the healthcare provider should closely review the claim — especially those claims recommending “intermittent” leaves. The provider should also contact the examining physician, and clarify the terms of the leave.

By regularly communicating with physicians, and detailing the company’s comprehensive healthcare services, the provider may be able to influence the length of the leave. If the doctor is convinced that everything possible will be done to ensure his patient’s health at the workplace, he’ll be less inclined to recommend excessive time off.

Yes, communication is the key to controlling the costs of “serious health conditions.” Even when the regulations defining those conditions severely limit communication.

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