Employee Family Medical Leave (FMLA) is for an eligible employee to care for their own Illness, Injury, Maternity or Paternity Leave or to care for a family member who has a serious health condition. This leave provides an eligible employee 12 weeks of leave in a 12-month rolling calendar period.

*In this document, “Department Representative” can be the Employee’s Supervisor, Department Manager or HR Representative. The designated person is unique to each Department’s internal FMLA process.

Step 1: Employee requests LOA and HCP forms

  • Employee must complete the Request for Leave of Absence (Form 1001) and submit this form to his manager.
  • Employee must have the Health Care Provider (HCP) (Form 1002) completed by the certifying Health Care provider and submit this form to manager. In special circumstances, the HCP form can be delivered directly to EOHW.

Step 2: Eligibility Requirements

"Department Representative" determines if the employee is eligible for FMLA and completes Form 1003 - a Notice of Eligibility and Rights & Responsibilities (see Step 5). To be considered eligible, employees must have worked 1 year in the previous 7 years (need not be continuous) and 1,250 hours in the last 12 months.

Eligible family members include:

  • Spouse
  • Registered same-sex partner
  • Parent
  • Son
  • Daughter

Step 3: Access the FMLA Submission Tool

The FMLA Submission Tool is a resource that provides information about the FMLA process, easy to follow visual aids & FMLA forms. It is also a tool to upload FMLA related documents to send to EOHW.

Step 4: "Department Representative" obtains the following paperwork from the staff member and review for completeness

Obtain the following paperwork:

Review for completeness:

  1. Confirm the duration of the requested leave.
  2. Allow the staff member at least 15 days from the date of application and the employee's request to submit a Health Care Provider Certification (Form 1002) unless it is not practicable under the particular circumstances to do so despite the employee's diligent, good faith efforts.
  3. If the information is insufficient, provide an additional 7 calendar days to cure any deficiency. If the employee does not correct it within the cure period, leave can be denied.
  4. Recertification from health-care provider may be requested every 6 months when associated with an absence (or missed scheduled work time) allowing at least 15 days from the date of the request for recertification. . A recertification can also be required at any time if an extension to a leave is requested, circumstances described in the last certification have changed (such as a pattern of absences around an employee's scheduled days off), or the employer receives information casting doubt on the employee's stated reason for an absence or the continuing validity of the last certification (such as an employee observed engaging in activities that are inconsistent with a need for time off due to the certified condition). Again, allow at least 15 days from the date of the request for recertification.

Step 4a: Employee Goes Directly to EOHW for Confidentiality Reasons

If the employee chooses to submit the Health Care Certification (Form 1002) directly to EOHW instead of the department, the employee must submit the Request for Leave of Absence (Form 1001) to the department, who will determine eligibility based on hours worked and time with Duke.

The department will provide the staff member the Notice of Eligibility and Rights & Responsibilities (Form 1003) within 5 business days of when the employee submitted the FMLA.

If the employee does or does not meet the requirements for FMLA, the "Department Representative" will provide the Notice of Eligibility and Rights & Responsibilities (Form 1003) to the employee within 5 business days of when the employee submitted the FMLA paperwork.

Eligible

If the employee is eligible based on time and hours worked, then EOHW reviews the HCP form for FMLA eligibility.

Not Eligible

If the staff member is deemed not eligible, then the "Department Representative" will indicate not eligible on the Notice of Eligibility and Rights and Responsibility (Form 1003) and notify EOHW. A person is ineligible if he/she did not work 1250 hours in last 12 months and/or has not worked at Duke for 1 cumulative year in the last 7 years.

Step 5: Notice of Eligibility and Rights & Responsibility

If the employee does or does not meet the requirements for FMLA, the "Department Representative" will provide the Notice of Eligibility and Rights & Responsibilities (Form 1003) to the employee within 5 business days of when the employee submitted the FMLA paperwork.

Eligible

If the employee is eligible then the "Department Representative" forwards a copy of the following forms to EOHW.

  1. Request for Leave of Absence (Form 1001) with the supervisor's name/phone number and their signature.
  2. Certification of Health Care Provider (Form 1002). Please include employee's Duke Unique ID.
  3. Notice of Eligibility and Rights & Responsibilities (Form 1003). Please include supervisor's signature.

Please use the FMLA Submission Tool to send information.

This is the preferred method for submitters (Department Representatives) to send FMLA requests to EOHW for review and approval determination. Please note that this doesn't change your internal process, it is simply a portal to submit cases.

Please note that in order to expedite & streamline the FMLA process, please send all three completed forms, at the same time. Forms can be uploaded to the FMLA submission tool portal or faxed to 919-660-0231 or 919-681-0555. Please include the employee's name in the subject line. Please note that any document received after 3:30 pm will not be reviewed until the next business day.

You can email your questions to eohwfmla@dm.duke.edu.

Not Eligible

If the staff member is deemed not eligible based on the requirements below, then the "Department Representative" will provide a Notice of Eligibility and Rights & Responsibilities (Form 1003) indicating the reasons the employee is not eligible. (1250 hours not worked in last 12 months and/or the employee has not worked at Duke for 1 cumulative year in the last 7 years.)

Step 6: Employee Occupational Health and Wellness will determine if absence is an FMLA qualifying event and provide an EOHW Determination Form

Paper work involved: EOHW Determination Form (Form 1004) - 1-2 day turnaround

EOHW will review the medical request for FMLA and provide an EOHW Determination Form (Form 1004) to the department and the employee via email within 1-2 days. The form will indicate whether the medical request is a qualifying event or not. In addition, the form will provide clarity around when FMLA should be approved; i.e., medical appointments, frequency and duration.

Qualifying Events Include:

  • Overnight Inpatient Facility
  • Absence Plus Treatment
  • Pregnancy and/or prenatal visits
  • Chronic Conditions Requiring Treatments
  • Permanent/Long-term Conditions Requiring Supervision
  • Multiple Treatments (Non-Chronic)

If clarification of the FMLA Healthcare Provider Certification (Form 1002) is needed, EOHW will notify the department, instructing the supervisor to provide the employee with the Designation Notice (Form 95), indicating that certification is pending.

Step 7: Employee Occupational Health and Wellness will determine how FMLA will be Taken - Consecutive or intermittently or both

The way in which FMLA is taken will depend on medical guidance provided by the staff member's health provider and, if necessary, confirmed by Employee Occupational Health and Wellness.

Consecutive Leave (Full-time for a consecutive 12 week period):

Eligible staff members may take up to 12 weeks (the staff member's normal work week) or 480 hours of unpaid FMLA in a rolling 12-month period. Eligible FMLA hours are prorated based on a regular work schedule.

Intermittent Leave:

Leave taken in separate blocks of time due to a single qualifying reason.

Step 8: Designation Notice (Form 95)

(Department must provide to employee within 5 days of the completed Health Care Provider certification request being submitted)

Once EOHW provides the EOHW Determination Form (Form 1004), the "Department Representative" and the employee should discuss the results of the EOHW Determination form (Form 1004). The "Department Representative" must provide the employee with a Designation Notice (Form 95) indicating the appropriate outcome.

Step 9: Payroll Notification

The department payroll representative notifies Corporate Payroll by filling out HR Payroll Leave of Absence Form. If you have any questions pertaining to this form, please contact Corporate Payroll at 919-684-2642.

Direction on how to complete the HR Payroll LOA form can be found here.

Step 10: Record Keeping

The "Department Representative" keeps the Request Leave of Absence Form (Form 1001), Health Care Provider Certification (Form 1002), EOHW Determination Form (Form 1004), and any other FMLA related information including attendance records in a SECURE and CONFIDENTIAL location and NOT in the personnel file. FMLA information is never to be shared beyond "need to know" management.

The following forms are maintained in a confidential file and NOT sent to Corporate Payroll:

  1. Personal Leave of Absence Request (Form 1001)
  2. Certification of Healthcare Provider (Form 1002)
  3. Eligibility and Rights Notice (Form 1003)
  4. EOHW Determination Form (Form 1004)
  5. Designation Notice (Form 95)
  6. Tracking Forms

Tracking FMLA

If leave is intermittent, the "Department Representative" must track the number of hours used in a 12 month rolling period. The following tools are provided to assist in doing so:

Intermittent leave is leave taken on a reduced work schedule by decreasing the number of hours in a workday or workweek. It is irregularly based on medical needs, caregiver demands, appointments, etc. *Duke University and Health System Policy does not allow intermittent leave for adoption and paternity leave.

If Intermittent Leave is Disruptive to Operations:

  • Management may temporarily transfer the staff member to an alternate position for which the staff member is qualified and receives equal pay and benefits.
  • Consult Human Resources, Staff and Labor Relations prior to making such a transfer.

*NOTE: Recertification may be requested every 6 months when associated with a leave. A recertification can also be required at any time if an extension to a leave is requested, circumstances described in the last certification have changed (such as a pattern of absences around an employee's scheduled days off), or the employer receives information casting doubt on the employee's stated reason for an absence or the continuing validity of the last certification (such as an employee observed engaging in activities that are inconsistent with a need for time off due to the certified condition). Again allow at least 15 days from the date of the request for recertification.

Step 11: Upon Staff Member's Return from Leave

If the staff member was out on continuous leave for either the birth of a child (maternity) or the staff Member's own serious health condition, please ensure receipt of a "release to work" from the staff member's health care provider, if the end date is modified. This should be obtained prior to the staff member's first day back to work. Questions of Fitness for Duty and return to work must be addressed separately with EOHW.

After obtaining the doctor's release, complete the Payroll LOA form, returning the staff member from leave.

Direction on how to complete the HR Payroll LOA form can be found here.

Step 12: If the Employee Does Not Return From Leave

Sign the form and have it authorized by appropriate departmental personnel. It is advisable that you contact the staff member. If they intend to return to work, but need to be out of work for a period longer than the 12 weeks allotted to them by FMLA, the staff member should be informed that their leave will have to be transitioned to another type of non-FMLA leave You can consult the following Personal Leave policy to determine which leave would apply. Reasonable Accommodation Process may apply if expected to recover within a short period of time. Consult with the Office of Disability Management in these situations.