The Essential Guide to Family & Medical Leave

appendix B | company policies regarding FMLA leave | 345
Sample
[Option 2—if company policy does not provide for more than 12 weeks of leave]
An eligible employee may take up to 12 weeks (60 work days) of family or medical
leave in the 12-month leave year for any of the following reasons:
• because the employee’s own serious health condition makes the employee
unable to work
• to care for a spouse, child, or parent who has a serious health condition, or
• to care for a newborn or newly adopted son or daughter or a recently placed
foster child.
If you have questions about how much leave time is available to you, please
contact ___________________.
2. Serious Health Condition—Examples
Here are some examples of serious health conditions for which an eligible employee
may take family or medical leave (Note: this is not an exhaustive list, but is for
purposes of illustration):
• A condition requiring inpatient care includes, for example, medically necessary
surgery.
• A condition that results in incapacity for three or more days and treatment by a
health care provider includes, for example, a stroke.
• Incapacity due to pregnancy or prenatal care includes, for example,
hypertension requiring bed rest.
• A chronic condition includes, for example, epilepsy.
• A condition for which treatment may not be effective includes, for example,
terminal cancer.
• Absence for multiple treatments for restorative surgery includes, for example,
skin grafts following a burn.
• A condition that could require an absence of more than three days if not
treated includes, for example, kidney disease requiring dialysis.