Employment Department
Chapter 471
Division 70
Paid Family Medical Leave Insurance
471-070-1120
Benefits: Verification of a Serious Health Condition
(1) A claimant applying for Paid Family and Medical Leave Insurance (PFMLI) benefits for their own serious health condition or to care for a family member with a serious health condition must provide one of the following forms of verification:
(a) The PFMLI Verification of a Serious Health Condition Form;
(b) The Oregon and Federal Family and Medical Leave Health Care Provider Certification issued by the Oregon Bureau of Labor and Industries (BOLI);
(c) The Family and Medical Leave Act (FMLA) certification of health care provider for a serious health condition form issued by the U.S. Department of Labor;
(d) A FMLA certification for a serious health condition form issued by an employer;
(e) A document issued by a health care provider; or
(f) Another document approved by the department for this purpose.
(2) The forms of verification listed in section (1) of this rule must include:
(a) The health care provider’s:
(A) First and last name;
(B) Type of medical practice/specialization;
(C) Contact information, such as mailing address and telephone number; and
(D) Handwritten or electronic signature. If issued before the start of leave, the verification document must be signed by the health care provider within 60 calendar days before the claimant’s leave start date;
(b) The patient’s first and last name;
(c) The claimant’s first and last name, when different from the patient identified in section (2)(b) of this rule;
(d) The approximate date on which the serious health condition commenced or when the serious health condition created the need for leave;
(e) A reasonable estimate of the duration of the condition or recovery period for the patient;
(f) A reasonable estimate of the frequency and duration of intermittent leave and estimated treatment schedule, if applicable; and
(g) Other information as requested by the department to determine eligibility for the PFMLI benefits; including:
(A) For medical leave, information sufficient to establish that the claimant has a serious health condition, including but not limited to a diagnosis; or
(B) For family leave, information sufficient to establish that the claimant’s family member has a serious health condition, including but not limited to a diagnosis.
(3) If any of the documents listed in section (1) of this rule do not include the full name of the patient or the claimant, when different from the patient identified in section (2)(b) of this rule, or do not show the family relationship of the claimant and the patient, the claimant must submit at least one of the following documents to meet the verification requirements described in this rule:
(a) A legal marriage certificate;
(b) A certified Declaration of Domestic Partnership;
(c) A legal birth certificate; or
(d) One or more documents issued by an independent and verifiable third party that establishes marriage, domestic partnership, or a significant family relationship between claimant and patient. The document must be issued within six months before the claimant’s start of leave.
[Publications: Contact the Oregon Employment Department for information about how to obtain a copy of the publication referred to or incorporated by reference in this rule.]
Statutory/Other Authority: ORS 657B.340 & ORS 657B.090
Statutes/Other Implemented: ORS 657B.090
History:
ED 2-2024, temporary amend filed 03/13/2024, effective 03/15/2024 through 09/10/2024
ED 5-2023, amend filed 07/31/2023, effective 08/01/2023
ED 9-2022, adopt filed 07/22/2022, effective 07/22/2022