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FMLA Denial Iowa

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  • FMLA Denial Iowa

    I recently applied for FMLA leave due to my mental health condition. It was turned in on time but denied due to my being unable to see a provider within 7 days of my first absence. I advised my first appointment had been scheduled for 01/30/13 and that was the earliest I could get in. I had even made an appointment with another provider office but the earliest they were able to get me in was 02/01/13. I made these calls on 01/23/13 which was 2 days after my first absence and the day I printed off my FMLA paper work. The appointment that I had been able to make for the 30th was canceled due to weather and the next available appointment with this office was for my med management visit which was done on 02/06/13. However there were several issues with this providers office(they would not schedule me another appointment with an actual therapist until I paid 219.00-I later found out thru my insurance they were in violation of their PPO contract and should not have been trying to charge me at all until they submitted a claim and received and EOB back in response. I notified the office of this however they still refused to schedule me an appointment. This is a whole different issue I am sure but it ties in to all the problems I have had with this FMLA request) and I was forced to find a different provider office to see a therapist. I was able to get into another office however the soonest they could get me in was 02/13/13. This provider office did fill out my paperwork but due to when I was able to first see them my company is using that as reason to deny my claim. I have been on FMLA(intermittent absence and one consecutive time absence) in the past with my employer and have not had any problems with the claim and they were approved. My company also has only given me 5 business days to appeal this denial. They denied my claim on 02/19/13 (I called my HR department on 02/20/13 and was not given the determination of my claim at that time even though I was checking the status of the claim) and the mailed the notice to me. The denial notice was not received until 02/21/13 and the last day I can submit an appeal is 02/25/13. I have written my own appeal stating all the reasons why I was unable to be seen any earlier than I was but I have been advised by an HR rep that most likely I will need to provide documented proof that I was unable to get in any earlier than what I have stated. What kind of recourse, if any, do I have to try and protect my job?

  • #2
    Unfortunately, if you weren't actually under the care of a doctor, the time doesn't qualify as FMLA. Your own subjective belief that you should not be working is not enough, even if at some later point a doctor agrees that you should be off work. Your FMLA might pick up starting 2/13, but the time that you were off previous to that would not. The time you were off which was not FMLA, is subject to the regular employment policies. A billing issue with a doctor who would have seen you a few days sooner would not change any of this. If you were in such desperate straights that you could not work at all, I can't imagine why you would wait weeks before seeing someone. Surely you have a family doctor who could at least provide some treatment or get you in with someone sooner. Even the hospital would have been a better option for your own sake.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.