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In the world of the Family and Medical Leave Act (FMLA), some scenarios pose more questions for employers than others. Some medical conditions, as they pertain to the FMLA, are not always clear cut, such as back issues. While eligible employees may take job-protected FMLA leave for qualifying reasons, such as a serious health condition, not all back issues are serious health conditions as defined by the law and regulations. Similarly, not all health care service providers are considered health care providers for purposes of the FMLA. Take chiropractors, for example. They can be health care providers, but only if certain criteria are met.

How to know if chiropractic care applies

For a chiropractor to be considered an FMLA health care provider, the employee must have treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist. No X-ray, no FMLA protections.

That requirement is fairly straightforward, but how do you, as the employer, know if the employee has a subluxation demonstrated by X-ray to exist?

Court cases have covered the issue of chiropractors and X-rays, but then, attorneys can obtain evidence (such as X-rays) to help defend a client/employee. If you’re like most employers, you would rather not head to court to determine whether an employee’s treatment did meet the FMLA criteria.

Turn to the certification

If an FMLA certification points to a chiropractor as a health care provider, asking that the certification include such X-ray information should be safe since, without it, you are really unable to determine whether the employee has a serious health condition or not. To help streamline the process, when employees request leave for back issues, you may indicate to them that if they receive treatment from a chiropractor, they will benefit from asking the chiropractor to include such information about X-rays in the certification.

If employees wonder about your request, feel free to explain why it’s important; that you are working on providing the FMLA protections, but might not be able to without the information. Without the FMLA protections, their jobs might not be protected.

If employees persist, you could show them the applicable regulation (29 CFR 825.102) to indicate that you are not simply making this up. The terms are listed alphabetically, and the information on chiropractors is found in the definition of “health care provider” in paragraph (2)(i).

Sharing the regulatory information may lessen the risk of employees thinking you are being overly burdensome. It shows that you are simply trying to comply with the provisions and are protecting employees’ FMLA leave rights.