Section 31-51rr-41 - Certification for leave taken to care for a covered servicemember (military caregiver leave) (29 CFR Section 825.310)(a)Required information from health care provider. When leave is taken to care for a covered servicemember with a serious injury or illness, an employer may require an employee to obtain a certification completed by an authorized health care provider of the covered servicemember. For purposes of leave taken to care for a covered servicemember, any one of the following health care providers may complete such a certification:(1) A United States Department of Defense (DOD) health care provider;(2) A United States Department of Veterans Affairs (VA) health care provider;(3) A DOD TRICARE network authorized private health care provider;(4) A DOD non-network TRICARE authorized private health care provider; or(5) Any health care provider as defined in section 31-51rr-1(15) of the Regulations of Connecticut State Agencies.(b) If the authorized health care provider is unable to make certain military-related determinations outlined below, the authorized health care provider may rely on determinations from an authorized DOD representative, such as a DOD Recovery Care Coordinator, or an authorized VA representative. An employer may request that the health care provider provide the following information: (1) The name, address, and appropriate contact information, such as telephone number, fax number, and/or email address, of the health care provider, the type of medical practice, the medical specialty, and whether the health care provider is one of the following: (A) A DOD health care provider;(B) A VA health care provider;(C) A DOD TRICARE network authorized private health care provider;(D) A DOD non-network TRICARE authorized private health care provider; or(E) A health care provider as defined in section 31-51rr-1(15) of the Regulations of Connecticut State Agencies.(2) Whether the covered servicemember's injury or illness was incurred in the line of duty on active duty or, if not, whether the covered servicemember's injury or illness existed before the beginning of the servicemember's active duty and was aggravated by service in the line of duty on active duty;(3) The approximate date on which the serious injury or illness commenced, or was aggravated, and its probable duration; and(4) A statement or description of appropriate medical facts regarding the covered servicemember's health condition for which FMLA leave is requested. The medical facts must be sufficient to support the need for leave. (A) In the case of a current member of the Armed Forces, such medical facts must include information on whether the injury or illness may render the covered servicemember medically unfit to perform the duties of the servicemember's office, grade, rank, or rating and whether the member is receiving medical treatment, recuperation, or therapy.(B) In the case of a covered veteran, such medical facts shall include:(i) Information on whether the veteran is receiving medical treatment, recuperation, or therapy for an injury or illness that is the continuation of an injury or illness that was incurred or aggravated when the covered veteran was a member of the Armed Forces and rendered the servicemember medically unfit to perform the duties of the servicemember's office, grade, rank, or rating; or(ii) Information on whether the veteran is receiving medical treatment, recuperation, or therapy for an injury or illness that is 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 fifty (50) percent or greater, and that such VASRD rating is based, in whole or in part, on the condition precipitating the need for military caregiver leave; or(iii) Information on whether the veteran is receiving medical treatment, recuperation, or therapy for an injury or illness that is 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(iv) Documentation of enrollment in the Department of Veterans Affairs Program of Comprehensive Assistance for Family Caregivers.(5) Information sufficient to establish that the covered servicemember is in need of care, as described in section 31-51rr-12 of the Regulations of Connecticut State Agencies, and whether the covered servicemember will need care for a single continuous period of time, including any time for treatment and recovery, and an estimate as to the beginning and ending dates for this period of time;(6) If an employee requests leave on an intermittent or reduced schedule basis for planned medical treatment appointments for the covered servicemember, whether there is a medical necessity for the covered servicemember to have such periodic care and an estimate of the treatment schedule of such appointments; or(7) If an employee requests leave on an intermittent or reduced schedule basis to care for a covered servicemember other than for planned medical treatment, whether there is a medical necessity for the covered servicemember to have such periodic care, which can include assisting in the covered servicemember's recovery, and an estimate of the frequency and duration of the periodic care.(c)Required information from employee and/or covered servicemember. In addition to the information that may be requested under subsection (b) of this section, an employer may also request that such certification set forth the following information provided by an employee and/or covered servicemember: (1) The name and address of the employer of the employee requesting leave to care for a covered servicemember, the name of the employee requesting such leave, and the name of the covered servicemember for whom the employee is requesting leave to care;(2) The relationship of the employee to the covered servicemember for whom the employee is requesting leave to care;(3) Whether the covered servicemember is a current member of the Armed Forces, the National Guard or Reserves, and the covered servicemember's military branch, rank, and current unit assignment;(4) Whether the covered servicemember is assigned to a military medical facility as an outpatient or to a unit established for the purpose of providing command and control of members of the Armed Forces receiving medical care as outpatients, such as a medical hold or warrior transition unit, and the name of the medical treatment facility or unit;(5) Whether the covered servicemember is on the temporary disability retired list;(6) Whether the covered servicemember is a veteran, the date of separation from military service, and whether the separation was other than dishonorable. The employer may require the employee to provide documentation issued by the military which indicates that the covered servicemember is a veteran, the date of separation, and that the separation is other than dishonorable. Where an employer requires such documentation, an employee may provide a copy of the veteran's Certificate of Release or Discharge from Active Duty issued by the U.S. Department of Defense (DD Form 214) or other proof of veteran status; and(7) A description of the care to be provided to the covered servicemember and an estimate of the leave needed to provide the care.(d) The United States Department of Labor has developed optional forms (WH-385, WH-385-V) for employees' use in obtaining certification that meets FMLA's certification requirements. (The employer may use the form referenced in Appendix A). These optional forms reflect certification requirements so as to permit the employee to furnish appropriate information to support his or her request for leave to care for a covered servicemember with a serious injury or illness. WH-385, WH-385-V, or another form containing the same basic information, may be used by the employer; however, no information may be required beyond that specified in this section. In all instances the information on the certification must relate only to the serious injury or illness for which the current need for leave exists. An employer may seek authentication and/ or clarification of the certification under section 31-51rr-38 of the Regulations of Connecticut State Agencies. Second and third opinions under section 31-51rr-38 of the Regulations of Connecticut State Agencies are not permitted for leave to care for a covered servicemember when the certification has been completed by one of the types of health care providers identified in section 31-51rr-41(a)(1) to 31-51rr-41(a)(4), inclusive, of the Regulations of Connecticut State Agencies. However, second and third opinions under section 31-51rr-38 of the Regulations of Connecticut State Agencies are permitted when the certification has been completed by a health care provider as defined in section 31-51rr-1(15) of the Regulations of Connecticut State Agencies that is not one of the types identified in section 31-51rr-41(a)(1) -(4) of the Regulations of Connecticut State Agencies. Additionally, recertifications under section 31-51rr-39 of the Regulations of Connecticut State Agencies are not permitted for leave to care for a covered servicemember. An employer may require an employee to provide confirmation of covered family relationship to the seriously injured or ill servicemember pursuant to section 31-51rr-10(c) of the Regulations of Connecticut State Agencies.(e) An employer requiring an employee to submit a certification for leave to care for a covered servicemember shall accept as sufficient certification, in lieu of the Department's optional certification forms (WH-385) or an employer's own certification form, invitational travel orders (ITOs) or invitational travel authorizations (ITAs) issued to any family member to join an injured or ill servicemember at his or her bedside. An ITO or ITA is sufficient certification for the duration of time specified in the ITO or ITA. During that time period, an eligible employee may take leave to care for the covered servicemember in a continuous block of time or on an intermittent basis. An eligible employee who provides an ITO or ITA to support his or her request for leave may not be required to provide any additional or separate certification that leave taken on an intermittent basis during the period of time specified in the ITO or ITA is medically necessary. An ITO or ITA is sufficient certification for an employee entitled to take FMLA leave to care for a covered servicemember regardless of whether the employee is named in the order or authorization. (1) If an employee will need leave to care for a covered servicemember beyond the expiration date specified in an ITO or ITA, an employer may request that the employee have one of the authorized health care providers listed under section 31-51rr-41(a) of the Regulations of Connecticut State Agencies complete the United State Department of Labor optional certification form (WH-385) or an employer's own form, as requisite certification for the remainder of the employee's necessary leave period.(2) An employer may seek authentication and clarification of the ITO or ITA under section 31-51rr-38 of the Regulations of Connecticut State Agencies. An employer may not utilize the second or third opinion process outlined in section 31-51rr-38 of the Regulations of Connecticut State Agencies or the recertification process under section 31-51rr-39 of the Regulations of Connecticut State Agencies during the period of time in which leave is supported by an ITO or ITA.(3) An employer may require an employee to provide confirmation of covered family relationship to the seriously injured or ill servicemember pursuant to section 31-51rr-10(c) of the Regulations of Connecticut State Agencies when an employee supports his or her request for FMLA leave with a copy of an ITO or ITA.(f) An employer requiring an employee to submit a certification for leave to care for a covered servicemember must accept as sufficient certification of the servicemember's serious injury or illness documentation indicating the servicemember's enrollment in the Department of Veterans Affairs Program of Comprehensive Assistance for Family Caregivers. Such documentation is sufficient certification of the servicemember's serious injury or illness to support the employee's request for military caregiver leave regardless of whether the employee is the named caregiver in the enrollment documentation.(1) An employer may seek authentication and clarification of the documentation indicating the servicemember's enrollment in the Department of Veterans Affairs Program of Comprehensive Assistance for Family Caregivers under section 31-51rr-38 of the Regulations of Connecticut State Agencies. An employer may not utilize the second or third opinion process outlined in section 31-51rr-38 of the Regulations of Connecticut State Agencies or the recertification process under section 31-51rr-39 of the Regulations of Connecticut State Agencies when the servicemember's serious injury or illness is shown by documentation of enrollment in this program.(2) An employer may require an employee to provide confirmation of covered family relationship to the seriously injured or ill servicemember pursuant to section 31-51rr-10(c) of the Regulations of Connecticut State Agencies when an employee supports his or her request for FMLA leave with a copy of such enrollment documentation. An employer may also require an employee to provide documentation, such as a veteran's Form DD-214, showing that the discharge was other than dishonorable and the date of the veteran's discharge.(g) Where medical certification is requested by an employer, an employee may not be held liable for administrative delays in the issuance of military documents, despite the employee's diligent, good-faith efforts to obtain such documents. In all instances in which certification is requested, it is the employee's responsibility to provide the employer with complete and sufficient certification and failure to do so may result in the denial of FMLA leave.Conn. Agencies Regs. § 31-51rr-41