FMLA Claim Denied? How to Appeal

The Family and Medical Leave Act (FMLA) gives eligible employees the right to take up to 12 weeks of unpaid, job-protected leave per year for qualifying medical and family reasons. When an employer denies FMLA leave — or retaliates against you for taking it — you have legal rights and remedies available. Understanding them is the first step to protecting yourself.

Who Is Eligible for FMLA Leave?

FMLA coverage depends on meeting both employer and employee eligibility requirements:

Employer coverage: The FMLA applies to private employers with 50 or more employees within 75 miles of the employee's worksite, as well as all public agencies and schools regardless of size.

Employee eligibility: To be eligible, you must have:

• Worked for your employer for at least 12 months
• Worked at least 1,250 hours in the 12 months before the leave begins
• Worked at a location where the employer has at least 50 employees within 75 miles

If you do not meet all three criteria, federal FMLA does not apply to your situation — though state equivalents may still protect you (more on this below).

Qualifying Reasons for FMLA Leave

FMLA leave may be taken for:

• A serious health condition that makes you unable to perform your job
• Caring for a spouse, child, or parent with a serious health condition
• The birth, adoption, or foster placement of a child
• Qualifying military exigency related to a family member's covered military service
• Care for a covered servicemember with a serious injury or illness (up to 26 weeks)

A "serious health condition" is a key term of art. It means an illness, injury, impairment, or physical or mental condition that involves inpatient care or continuing treatment by a healthcare provider. Routine illness that does not require ongoing treatment typically does not qualify.

Common Reasons FMLA Claims Are Denied

Employer argues you are ineligible. Employers sometimes incorrectly apply the eligibility criteria — for example, miscounting hours worked or misapplying the 50-employee threshold. If you believe you are eligible, request documentation of the employer's determination and review it carefully.

Condition does not meet the "serious health condition" definition. The employer or its third-party administrator argues that your medical condition does not require inpatient care or continuing treatment. Your healthcare provider's certification is the key document here.

Incomplete or deficient medical certification. FMLA regulations allow employers to request medical certification from your healthcare provider. If the certification is incomplete or insufficient, the employer must provide written notice and give you at least seven calendar days to cure the deficiency. A denial based on a deficient certification without this notice may violate FMLA regulations.

Failure to provide timely notice. When leave is foreseeable, you must provide at least 30 days' advance notice. For unforeseeable leave, you must give notice as soon as practicable. Failure to notify can give the employer grounds to delay or deny leave.

Retaliation disguised as a legitimate action. Sometimes what is framed as a "denial" is actually retaliation — discipline, demotion, termination, or adverse assignment following FMLA leave. This is illegal under the FMLA regardless of whether the underlying leave was approved.

Your Employer's Obligations Under FMLA

Employers covered by FMLA have specific obligations:

• Provide a Notice of Eligibility within five business days of receiving a leave request, along with the Rights and Responsibilities notice
• Provide a Designation Notice within five business days after receiving sufficient information to determine whether leave qualifies as FMLA
• Maintain group health insurance during FMLA leave on the same terms as if the employee had not taken leave
• Restore the employee to the same or an equivalent position upon return from leave

A failure to meet any of these obligations may be an independent FMLA violation.

State FMLA Equivalents: Broader Protections in Many States

Many states have enacted their own family and medical leave laws that provide broader protections than federal FMLA:

• California (CFRA / PDL) — covers employers with 5 or more employees, includes domestic partners and grandparents, grandchildren, and siblings
• New York (NYPFL) — provides paid family leave
• New Jersey (NJFLA / NJ FLI) — covers employers with 30 or more employees, provides paid leave
• Washington — paid family and medical leave program
• Connecticut, Massachusetts, Oregon — also have paid leave programs with coverage for more family members

If federal FMLA does not cover your situation, your state law may. Check your state's labor department resources or consult an employment attorney.

Filing a Complaint with the Department of Labor

If you believe your employer violated the FMLA, you can file a complaint with the Wage and Hour Division of the U.S. Department of Labor (DOL). The DOL investigates FMLA complaints and can require employers to comply with the law, restore your position, and pay any wages and benefits lost due to the violation.

You can also file a private lawsuit in federal or state court. The FMLA allows recovery of lost wages, benefits, other compensation, interest, liquidated (double) damages in cases of willful violations, and attorney's fees.

Believe your FMLA rights were violated? Start your appeal at ClaimBack and take the first step toward enforcing your legal rights.

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