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What is a Serious Health Condition?
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What is a serious health condition?
A serious health condition is an illness, injury or impairment or physical or mental condition that involves inpatient care or continuing treatment.
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Incapacity + Treatment
A period of incapacity of more than three (3) consecutive full calendar days, and any subsequent treatment or period of incapacity relating to the same condition, that also involves:
- Two or more in-person visits to a healthcare provider for treatment within 30 days of the first day of incapacity, unless extenuating circumstances exist. The first visit must be within 7 days of the first day of incapacity; or
- At least one in-person visit to a healthcare provider for treatment within seven days of the first day of incapacity, which results in a regimen of continuing treatment under the supervision of the healthcare provider.
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Pregnancy
Pregnancy means any period of incapacity due to pregnancy, including pre-natal appointments.
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Chronic conditions requiring treatment
Chronic conditions requiring treatment refers to any period of incapacity due to or treatment for a chronic serious health condition which requires periodic visits for treatments by a healthcare provider at least 2 times per year and recurs over an extended period of time. It may cause episodic rather than a continuing period of incapacity.
Examples: asthma, migraine headaches, diabetes, epilepsy
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Permanent/Long-Term conditions
Permanent/long-term conditions refers to a period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective, but which requires the continuing supervision of a healthcare provider.
Examples: Alzheimer's disease, terminal stages of cancer, severe stroke
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Multiple treatments for non-chronic conditions
Multiple treatments for non-chronic conditions refers to restorative surgery after an accident or other injury, or a condition that would likely result in a period of incapacity of more than 3 consecutive full calendar days if the employee did not receive treatment.
Examples: chemotherapy, physical therapy
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What is NOT considered a serious health condition?
The following ailments are NOT considered to be a “serious health condition” unless complications develop such that inpatient care or continuing treatment, as defined above, is required:
- routine physical examinations
- common cold
- flu
- earaches
- upset stomach
- minor ulcers
- headaches, other than migraines
- routine dental work or orthodontia problems
- periodontal disease
- cosmetic treatments, such as most treatments for acne or outpatient plastic surgery
Note: Restorative dental or plastic surgery after an injury or removal of cancerous growths are serious health conditions provided all the other conditions are met.
Substance Abuse: Leave may be taken only for treatment for substance abuse by a healthcare provider or by a provider of health care services on referral by a healthcare provider, but not for absences caused by an employee’s use of the substance.
Serious Health Condition Requires Both Incapacity and Treatment by a Healthcare Provider
Frequently Asked Questions
Simply being exposed to COVID-19 or even being diagnosed with COVID-19 is not necessarily a serious health condition as defined by CT Paid Leave. Therefore, it is not necessarily a qualifying reason for income replacement benefits under CT Paid Leave.
An eligible worker may receive CT Paid Leave benefits in connection with an exposure to or diagnosis with COVID-19 only if they can provide medical documentation from their health care provider demonstrating that the COVID-19 exposure/diagnosis results in the person having a condition that rises to the definition of a "serious health condition".
The elements of the definition of a "serious health condition" that are most likely to apply are as follows:
- The condition requires an overnight stay in a hospital or other medical care facility; or
- The condition incapacitates the employee (for example, unable to work) for more than three consecutive days and that include ongoing medical treatment (either multiple appointments with a health care provider, or a single appointment and follow-up care, such as prescription medication) or,
- The condition results in or exacerbates a chronic condition that causes occasional periods when the employee is incapacitated, and which require treatment by a health care provider at least twice a year.
Similarly, an eligible worker may receive CT Paid Leave benefits because they need to serve as a caregiver to a family member who was exposed to or diagnosed with COVID-19 only if the family member’s health care provider certifies that the family member’s exposure/diagnosis results in the family member having a serious health condition.