DMEC CLMS CERTIFICATION QUESTIONS &
ANSWERS
Benjamin submits a request for a two-week absence. Benjamin's employer provides him
with the necessary FMLA paperwork and gives him 15 days to complete and return it.
The employer also tells Benjamin to contact the vendor that handles their short-term
disability benefit. After 9 days, the disability is approved as the vendor reached out to
the physician directly. A report of approval is provided to the employer. However, this
employer does not receive the FMLA certification form back from Benjamin. His FMLA
leave request is denied for failure to provide the requested certification. Since he had
been on a performance management plan for absenteeism, Benjamin is also
terminated. True or False: Benjamin's employer was within their rights to terminate his
employment because under the FMLA, an employer has the right to require employees
to follow absence procedures. - Answer -False
True or False: Because Patrick's three-week absence for surgery was approved and
paid for under the workers' compensation program, he does not need coverage under
the FMLA. The time will only be covered by workers' compensation. - Answer -False - It
is important to know that when an absence qualifies for WC, and a claim is denied
under WC, this does not impact FMLA.
Tracy, who lives in Texas, requests an absence of five weeks to care for her terminally
ill mother. At the end of week three, her mother passes away and Tracy remains out to
tend to funeral services and take bereavement time. Tracy's employer informs her that
weeks one through three will be covered under federal FMLA. However, since her
mother passed away at the end of week three, her absence is no longer covered under
the federal FMLA. Tracy is entitled to five days of bereavement leave, but she will need
to return at the beginning of week five of her original request. The state of Texas does
not have a state FMLA leave. The federal FMLA and bereavement leave do not run
concurrently as it is not a qualified event under the federal FMLA. There are some
states, such as Oregon, which do cover bereavement as part of their state leave laws.
Which regulation or program directs the requirement of Tracy's return to work one -
Answer -Company policy
Workers' compensation covers which of the following benefits?
A. Income replacement
B. Death benefits to dependents
C. Medical coverage in addition in income replacement
D. All of the above - Answer -D
James was hire on Sept. 1. When he injures himself in Peru, the two days he spends in
a local hospital on May 16 and 17 count towards his FMLA leave. He is able to return to
work on May 19. However, on May 22, he calls in sick as a result of neck pain, and the
absence lasts 14 work days. He returns on June 11. Yes or No: On Nov. 5, James
, injures himself again and needs 14 weeks off. using the "calendar year" counting
method, will James exhaust his 12 weeks of leave? - Answer -No
True or False: An employer may use an employee's genetic information if the employee
is exhibiting related health issues that may impact the safety of the employee or others
around the employee. - Answer -False
What specific information is protected by HIPAA?
A. An individual's past, present or future physical or mental health condition
B. The provision of healthcare to an individual
C. The payment for the provision of healthcare
D. All of the above - Answer -D
Which of the following examples would NOT qualify as a serious health condition:
A. Fri/Mon absence due to allergies, with a non-working weekend in between
B. Morning sickness as a result of a normal pregnancy without complications
C. Bi-annual colonoscopy prep day and procedure
D. Bringing a parent to a one-hour physical therapy appointment - Answer -C
True or False: The individual with the serious health condition must always be under a
treatment plan. - Answer -False
True or False: The FMLA defines a serious health condition as one in which an
employee is unable to perform ONE of the essential functions of the employee's
position. - Answer -True
Which of the following medical conditions would likely have a predictable absence
schedule, requiring the employee to provide advance notice of leave?
A. Migraine headaches
B. Back pain
C. Pre-natal routine care
D. Allergies - Answer -C
Which option accurately reflects qualified FMLA time off for bonding offered to an
employee?
A. Birth of a biological child, adoption of a child, or placement of a foster child
B. Birth of a biological child, adoption of a child, or placement of a foster child, and/or
addition of a stepchild
C. Birth of a biological child, adoption of a child, or placement of a foster child and/or a
child who is a ward of the state - Answer -A
True or False: All employees who are entitled to leave may take a total of 480 hours of
leave. - Answer -False
ANSWERS
Benjamin submits a request for a two-week absence. Benjamin's employer provides him
with the necessary FMLA paperwork and gives him 15 days to complete and return it.
The employer also tells Benjamin to contact the vendor that handles their short-term
disability benefit. After 9 days, the disability is approved as the vendor reached out to
the physician directly. A report of approval is provided to the employer. However, this
employer does not receive the FMLA certification form back from Benjamin. His FMLA
leave request is denied for failure to provide the requested certification. Since he had
been on a performance management plan for absenteeism, Benjamin is also
terminated. True or False: Benjamin's employer was within their rights to terminate his
employment because under the FMLA, an employer has the right to require employees
to follow absence procedures. - Answer -False
True or False: Because Patrick's three-week absence for surgery was approved and
paid for under the workers' compensation program, he does not need coverage under
the FMLA. The time will only be covered by workers' compensation. - Answer -False - It
is important to know that when an absence qualifies for WC, and a claim is denied
under WC, this does not impact FMLA.
Tracy, who lives in Texas, requests an absence of five weeks to care for her terminally
ill mother. At the end of week three, her mother passes away and Tracy remains out to
tend to funeral services and take bereavement time. Tracy's employer informs her that
weeks one through three will be covered under federal FMLA. However, since her
mother passed away at the end of week three, her absence is no longer covered under
the federal FMLA. Tracy is entitled to five days of bereavement leave, but she will need
to return at the beginning of week five of her original request. The state of Texas does
not have a state FMLA leave. The federal FMLA and bereavement leave do not run
concurrently as it is not a qualified event under the federal FMLA. There are some
states, such as Oregon, which do cover bereavement as part of their state leave laws.
Which regulation or program directs the requirement of Tracy's return to work one -
Answer -Company policy
Workers' compensation covers which of the following benefits?
A. Income replacement
B. Death benefits to dependents
C. Medical coverage in addition in income replacement
D. All of the above - Answer -D
James was hire on Sept. 1. When he injures himself in Peru, the two days he spends in
a local hospital on May 16 and 17 count towards his FMLA leave. He is able to return to
work on May 19. However, on May 22, he calls in sick as a result of neck pain, and the
absence lasts 14 work days. He returns on June 11. Yes or No: On Nov. 5, James
, injures himself again and needs 14 weeks off. using the "calendar year" counting
method, will James exhaust his 12 weeks of leave? - Answer -No
True or False: An employer may use an employee's genetic information if the employee
is exhibiting related health issues that may impact the safety of the employee or others
around the employee. - Answer -False
What specific information is protected by HIPAA?
A. An individual's past, present or future physical or mental health condition
B. The provision of healthcare to an individual
C. The payment for the provision of healthcare
D. All of the above - Answer -D
Which of the following examples would NOT qualify as a serious health condition:
A. Fri/Mon absence due to allergies, with a non-working weekend in between
B. Morning sickness as a result of a normal pregnancy without complications
C. Bi-annual colonoscopy prep day and procedure
D. Bringing a parent to a one-hour physical therapy appointment - Answer -C
True or False: The individual with the serious health condition must always be under a
treatment plan. - Answer -False
True or False: The FMLA defines a serious health condition as one in which an
employee is unable to perform ONE of the essential functions of the employee's
position. - Answer -True
Which of the following medical conditions would likely have a predictable absence
schedule, requiring the employee to provide advance notice of leave?
A. Migraine headaches
B. Back pain
C. Pre-natal routine care
D. Allergies - Answer -C
Which option accurately reflects qualified FMLA time off for bonding offered to an
employee?
A. Birth of a biological child, adoption of a child, or placement of a foster child
B. Birth of a biological child, adoption of a child, or placement of a foster child, and/or
addition of a stepchild
C. Birth of a biological child, adoption of a child, or placement of a foster child and/or a
child who is a ward of the state - Answer -A
True or False: All employees who are entitled to leave may take a total of 480 hours of
leave. - Answer -False
