Certification of Medical Necessity UPG 10.04

1
Certification of Medical Necessity (UPG 10.04)
Leave Statements

• UW-Madison
• Sick Leave Policy for Academic Staff, Faculty,
  and Limited Appointees

2
Certification of Medical Necessity Requirement
for Faculty, Limited Appointees, and Academic
Staff use of Sick LeaveBoard of Regent
Resolution 9068Effective October 7, 2005

• UPG10.04(c) UW institutions shall require
  written certification from a health care provider
  of the medical necessity for use of sick leave
  for absences of more than 5 consecutive full
  working days, except where the use of sick leave
  is authorized in advance, pursuant to the
  Wisconsin or Federal Family and Medical Leave
  Acts.
• Where an institution is aware of an emergency
  that prevents communicating with or obtaining
  information about the condition of the employee,
  such written certification shall not be required
  until such time as communication is possible and
  appropriate, given the condition of the employee.
• In cases of suspected abuse of the sick leave
  privilege, the institution shall be authorized to
  require written certification from a health care
  provider to verify the medical necessity for the
  employee's absence regardless of the length of
  absence.

3
Why did the Regents add this requirement?

• To respond to public concern that was raised
  regarding the potential for sick leave abuse.
• To insure compliance with sick leave policies.
• To protect a valuable component of our benefit
  package.
• To provide UW supervisors and managers with a
  specific process for monitoring sick leave to
  prevent possible misuse.

4
What Options were Considered?

• Regents considered three options
• Provide authority to request medical
  certification regardless of the length of time of
  the absence
• Establish requirement of medical certification if
  absence is more than 10 consecutive work days
• Establish requirement of medical certification if
  absence is more than 5 consecutive work days
• Why was a more than 5 consecutive full work day
  requirement established?
• The 5-day trigger option was chosen because it is
  a common practice in the private sector and,
  based on feedback, had institutional support.

5
Requesting Medical Certification

• Employee should be notified by his/her supervisor
  of the need to provide medical certification.
  The Request for Medical Certification for
  Academic Staff, Faculty, and Limited Appointees
  form should be used.
• Employees must be provided at least 15 days, from
  the day of their return to work, to secure their
  health care providers medical certification.
• The request for medical certification is separate
  from requests related to "confidential medical
  information." Only Divisional Disability
  Representatives (DDRs) are authorized to request,
  receive and maintain medical information related
  to disability or medical condition under the ADA
  and/or WFMLA/FMLA.

6
Requesting Medical Certification

• Employees should submit the Request for Medical
  Certification for Academic Staff, Faculty, and
  Limited Appointees form to their Supervisor or
  the Department, as determined by the Department
  Human Resources Office.

7
What does the Request for Medical Certification
form include and not include?

• The request form includes a Health Care Provider
  statement that absence from work is justified
  based on medical necessity.
• It includes a statement of the specific time
  period for which an absence is medically
  necessary.
• If the employee has the form completed prior to
  his/her return to work, the physician/practitioner
  should provide a best guess return to work
  date.
• It should not include any confidential medical
  information.

8
Requesting Medical Certification

• When an institution is aware of an emergency that
  prevents communicating with or obtaining
  information about the condition of an employee,
  such written medical certification shall not be
  required until such time as communication is
  possible and appropriate given the condition of
  the employee.
• Managers, Supervisors or Department Chairs are
  authorized to request medical certification for
  use of sick leave if they suspect the request for
  sick leave is inappropriate, regardless of the
  length of the absence. The department must
  consult with the divisional Human Resources
  Representative prior to making a request to the
  employee.
• Such requests should be presented in writing to
  the employee, who must be provided at least 15
  days to secure the medical certification. The
  requested information should be provided to the
  Divisional Disability Representative.

9
Does the new requirement affect the leave
provisions provided by FMLA?

• If the medically-related absence is authorized in
  advance, pursuant to the Wisconsin or Federal
  Family and Medical Leave Acts, additional medical
  certification is not required.
• Information about the Family Medical Leave Acts
  can be found in the UPG 10.11 and Balancing
  Family and Work.

10
Failure to Return Medical Certification

• If the faculty, academic staff, or limited
  appointee does not provide the requested medical
  certification within the required timeframe,
  he/she cannot use sick leave to cover the
  absence.
• The employee will have to use other paid leave
  options, or will be required to take a leave
  without pay.
• Is the leave approved?

11
Other changes to UW-Madison Sick Leave Policies

• On November 30, 2005, Chancellor Wiley sent a
  memo to all academic staff, faculty and limited
  appointees informing them of changes made to the
  monthly leave statement.
• The leave statement now includes a statement
  certifying that the leave accounting is accurate,
  and states that misrepresentation can lead to
  disciplinary action.
• Effective immediately, the employees immediate
  supervisor (the department chair for faculty) is
  responsible for signing the monthly leave
  statements.

12
Why is it important for academic staff, faculty,
and limited appointees to turn in monthly leave
statements?

• At retirement sick leave accrued is converted
  to credits to pay health insurance premiums.
• State law caps the annual sick leave accrual at
  6.4 days per year for 9 month staff and 8.5 days
  for 12 month staff.
• The sick leave cap has been waived for
  UW-Madison based on our agreement to meet certain
  conditions, such as monthly reporting of sick
  leave usage.
• Compliance with UW sick leave policies will
  help to insure the continued availability of the
  waiver on the sick leave cap.

13
Role of Supervisor/Manager

• Please encourage the faculty, academic staff and
  limited appointees you supervise to turn in leave
  statements in a timely fashion.
• Stress the importance of the sick leave cap
  waiver, and the potential loss of its benefits to
  all employees.

14
Examples

• To assist in the administration of this policy
  the following examples are provided.

15
What is meant by more than 5 Consecutive Full
Working Days?

• Example 1
• Staff members work schedule is Monday through
  Friday from 8 am to 5 pm. Staff member is out
  ill and uses sick leave for the entire 1st week,
  returning the following Wednesday.
• For this individual, 8 am to 5 pm is a full work
  day. A full work day represents the period of
  time an individual is scheduled to work for that
  day. Thus the employee was out a total of 7 days.
  
• A written Medical Certification would be required
  as of Monday, the 6th day of absence.

16
What about Part-Time or Variable Work Schedules?

• Example 2
• Staff members work schedule is Monday through
  Friday from 8 am to Noon, 4 hours per day. Staff
  member is out ill an entire 1st week, returning
  the Wednesday of the following week. Thus the
  employee was out a total of 7 days.
• A full work day represents the period of time an
  individual is scheduled to work for that day.
  For this individual, 8 am to noon is a full work
  day.
• A written Medical Certification would be required
  as of Monday, the 6th day of absence.

17
What about Part-Time or Variable Work Schedules?
(cont.)

• Example 3
• Staff members work schedule is 8 am to 5 pm on
  Monday, Wednesday and Friday.
• This individual would not have more than 5
  consecutive full working days until the end of a
  two week period.
• Day 1 Monday Day 4 Monday
• Day 2 Wednesday Day 5 Wednesday
• Day 3 Friday Day 6
  Friday
• A medical certification is required when the
  individual uses sick leave for more than 5
  consecutive full working days.
• Remember The requirement states 5 consecutive
  full working days, not consecutive calendar days.

18
Is Colleague Coverage counted the same when used
in conjunction with Sick Leave?

• Example 4
• No. Leave charged to Colleague Coverage used in
  lieu of sick leave should not be counted the same
  as sick leave. They are different leave benefits
  (refer to UPG 10.02).
• For example The employee has a full-time
  schedule, Monday through Friday, 800 a.m. to
  500 p.m. Assume the following leave categories
  were charged.
• Day 1 Sick leave Day
  5 ½ Colleague Cov.
• Day 2 Sick leave ½ Sick leave
• Day 3 Sick leave Day 6 ½ Colleague Cov.
• Day 4 ½ Colleague Cov. ½ Sick
  Leave
• ½ Sick Leave Day 7 Returned to Work
• In this example only 3 consecutive working days
  were charged to sick leave. No Medical
  Certification would be required.

19
References

• Unclassified Personnel Guideline Chapter 10
  http//www.uwsa.edu/hr/upgs/upg10rev_oct7_2005.pdf
  
• Balancing Family and Work UW-Madison Leave
  Related Policies for Faculty, Academic Staff, and
  Limited Appointees http//www.ohr.wisc.edu/polpr
  oced/FamilyLeaveBrochure_10-05.doc

20
Questions?

• Managers, Supervisors, and Department Chairs
  should contact the divisional Human Resources
  Representative if they have any questions or
  compliance issues.
• For questions about UPG 10, contact Catharine
  DeRubeis at clderube_at_bascom.wisc.edu