Acting In Good Faith

Client 

The oldest grocery store chain west of the Mississippi River has been a Work & Well client since 2008. Work & Well manages this client’s intermittent and straight FMLA cases and has reduced the average lost days per case significantly through robust medical review.

Situation

An employee submitted an intermittent FMLA claim for chronic lower back pain. The medical forms completed by his healthcare provider certified the employee for one to four days per month for flare-ups over the next 12 months. The employee was using six to eight days a month with a pattern for Sundays

Action Taken

Since the employee took excessive days off for his condition, Work & Well became concerned. The medical documentation provided by the employee’s health care provider did not justify the excessive absences. Consequently, Work & Well requested and scheduled a second opinion by an independent medical examiner to determine if his medical condition changed and the resulting time off was justified.

Results

The employee refused to sign an authorization to release medical information to the physician scheduled to conduct the second opinion examination. The employee stated that his FMLA certification was for 12 months and his time was not up. In accordance with the FMLA Guidelines, the employee is required to cooperate and provide the necessary medical documentation when a second opinion is requested.

Consequently, Work & Well cancelled the exam and the employee’s FMLA was denied.  The employee subsequently filed a complaint with the Department of Labor (DOL).

DOL Conclusions

The DOL investigation confirmed Work & Well acted properly and did not violate the employee’s FMLA rights by denying his claim. The DOL stated that the employee was not acting in good faith due to his refusal to authorize the release of his medical information to the Independent Medical Examiner.