Lonicki v. Sutter Health Central

MORENO, J., Concurring and Dissenting.

I agree with part IV of the lead opinion. The fact that plaintiff held a part-time job at a different workplace performing similar duties while on medical leave is not conclusive evidence that she was able to perform the full-time job for which she had taken leave. I disagree, however, with part III of that opinion. I would hold that under the Moore-Brown-Roberti Family Rights Act (CFRA) (Gov. Code, § 12945.2),1 an employer who fails to obtain a second or third opinion as to an employee’s medical condition is bound by the opinion of the employee’s health care provider, assuming that opinion contains the information required by the statute.

To understand why this is the case, I first review the pertinent statutory scheme. As the lead opinion explains, the CFRA is patterned after the federal Family and Medical Leave Act of 1993 (FMLA). (29 U.S.C. §§ 2601-2654.) The CFRA allows an employee, under certain circumstances, up to 12 weeks of unpaid “family care and medical leave” for family needs such as the birth or adoption of a child, serious illness of a family member, or when “an employee’s own serious health condition . . . makes the employee unable to perform the functions of the position of that employee.” (§ 12945.2, subd. (c)(3)(C).) The CFRA defines a “serious health condition” as “an illness, injury, impairment, or physical or mental condition that involves either of the following: [][] (A) Inpatient care in a hospital, hospice, or residential health care facility, [f] (B) Continuing treatment or continuing supervision by a health care provider.” (§ 12945.2, subd. (c)(8).)

Under the CFRA, if an employee requests medical leave, an employer may require an employee seeking medical leave to submit a certification by the employee’s health care provider, which “shall be sufficient if it includes all of *222the following: [][] (A) The date on which the serious health condition commenced, [f] (B) The probable duration of the condition. [][] (C) A statement that, due to the serious health condition, the employee is unable to perform the function [sic] of his or her position.” (§ 12945.2, subd. (k)(l), italics added.) State regulations make clear that employers may not ask for additional information from the employee. (Cal. Code Regs., tit. 2, § 7297.4, subd. (b)(2)(A)(l).) The regulations further provide that an employer “shall respond to the leave request as soon as practicable and in any event no later than ten calendar days after receiving the request.” (Id., § 1291 A, subd. (a)(6).)

What the statute means when it says that the employee’s certification “shall be sufficient” can be fairly implied from the context of the entire statute. An employee whose certification is “sufficient” is entitled to medical leave, except under the statutorily defined circumstances discussed below. As the court stated in Sims v. Alameda-Contra Costa Transit Dist. (N.D.Cal. 1998) 2 F.Supp.2d 1253, 1262 (Sims): “the certification procedures ... are the exclusive means for an employer to challenge the medical facts underlying the employee’s certification. Although the regulations explicitly permit an employer to deny leave to an employee who fails to produce ‘a requested medical certification,’ 29 C.F.R. § 825.312(b), there is no explicit authority for an employer to deny leave to an employee who does produce medical certification. To the contrary, Congress stated that if an employee’s medical certification meets certain requirements, it ‘shall be sufficient.’ 29 U.S.C. § 2613(b).”

The statute does not make the employee’s certified medical opinion the last word. The employer “may” seek a second opinion “[i]n any case in which [it] has reason to doubt the validity of the certification” (§ 12945.2, subd. (k)(3)(A)), and a third, binding opinion if the first two disagree (id., subd. (k)(3)(C), (D).) These opinions are similarly limited to the facts covered in the original certified opinion. (§ 12945.2, subd. (k)(3)(A), (C); see Sims, supra, 2 F.Supp.2d at p. 1262.) The third health care provider is to be designated or approved jointly by the employer and the employee. (§ 12945.2, subd. (k)(3)(C).) Thus, “upon the submission of a sufficient medical certification, an employee is entitled to ‘FMLA protection unless and until there is contrary medical evidence.’ ” (Miller v. AT & T (S.D. W.Va. 1999) 60 F.Supp.2d 574, 580.)2

*223In sum, the statute and accompanying regulations detail the circumstances in which, and the procedures by which, an employer may deny an employee medical leave. The statute allows the employer to deny such leave (1) if the employee fails to provide sufficient certification as set forth in the statute or (2) if a second and third medical opinion conclude that the employee has no serious health condition that would prevent him or her from working. (§ 12945.2, subd. (k)(3).) If an employer doubts an employee’s serious health condition, it cannot compel the employee’s medical provider to provide more information about the condition. Rather, the statute mandates that the employer seek a second and third opinion and prescribes how the health care provider rendering the third, binding opinion is to be selected.

The lead opinion reads ambiguity into a fairly clear statute and determines that an employer may simply ignore the procedures set forth in section 12945.2 and deny a validly certified medical leave without obtaining a second or third opinion. To arrive at this conclusion, it relies a great deal on the use of the word “may” in the statute: “Here, the pertinent statutory language does not require an employer faced with two conflicting health care provider opinions to obtain a binding decision from a third health care provider, and it does not say that an employer who fails to obtain such a decision will be barred, in litigation with the employee, from claiming that the employee did not suffer from a serious health condition making the employee unable to work. What the statutory language denotes is a legislative intent to offer the employer a choice of obtaining or not obtaining a binding decision from a third health care provider, if there is a difference of opinion between plaintiff’s health care provider and the one designated by the employer. Subdivision (k)(3)(C) of section 12945.2 simply states that an employer may resort to that remedy. (See § 14 [‘ “Shall” is mandatory and “may” is permissive.’].)” (Lead opn., ante, at p. 210.)

The lead opinion’s reliance on the use of the word “may” is misplaced. It would make little sense for the government to require an employer who has reason to doubt an employee’s certification to obtain a second or third opinion. An employer who doubts the employee may still wish to give the employee the benefit of the doubt. Or the employer may satisfy its doubts in the employee’s favor by means other than obtaining a second medical opinion. Or the cost and trouble of obtaining a second or third opinion may *224not be worth it for the employer, for example, when the employee is asking for very little time off. The use of “may” merely means that the decision about whether to seek a second and third opinion is up to the employer. But “may” does not tell us the consequences of an employer’s decision not to seek a second or third opinion. Those consequences are set forth elsewhere in the statute—namely, that an employee’s certification “shall be sufficient” to authorize medical leave if it contains the required information from a bona fide health care provider and if it is not challenged by a second and third opinion, as discussed above. (§ 12945.2, subd. (k)(l).)

Moreover, what is left unsaid in the statute is at least as pertinent as what is said. If the statute were intended to function as the majority of this court says it does, one would expect it to spell out how the process is supposed to work if the employer elects not to seek a second or binding third opinion. But the statutory or regulatory provision that states, “Notwithstanding sufficient employee certification, and the lack of a favorable second or third opinion, an employer may deny medical leave if it has good reason to doubt that the employee has a serious health condition” is conspicuous by its absence. After going into detail about what an employee must do to obtain certification of a serious health condition and what an employer can do to contest it, one would think Congress or the Legislature would have at least mentioned that the employer could essentially ignore the certification and the second/third opinion remedies and refuse the medical leave request. That no mention is made of this option must be attributed not to faulty legislation but to the fact that Congress and the Legislature never intended it.

Why would Congress or the Legislature make the dispute-resolution procedure optional? The lead opinion responds that the procedure is primarily for the benefit of the employer, a safe harbor to ensure the employer’s immunity from subsequent litigation. (See lead opn., ante, at p. 211.) But that supposition finds no support in either the language or history of the statute. The purpose of the FMLA, and presumably the CFRA is, among other things, to rectify the “inadequate job protection for . . . employees who have serious health conditions that temporarily prevent them from working.” (Presidential Signing Statement, Feb. 5, 1993, 29 Presidential Documents 145.) In other words, the statute was intended to free employees from having to make a choice between keeping their jobs or taking care of their health. Unlike other employment decisions, such as decisions about promotion, transfers, and the imposition of discipline, which can be contested through internal grievance procedures or subsequent litigation, the decision about whether to grant medical leave due to a serious health condition is generally extremely time sensitive. The statutory procedure and accompanying regulations allow employees to have the decision made quickly, and to assure employees that if their medical claims are valid, they will be able to take medical leave with the peace of mind of knowing that the employer must lawfully give them *225back their jobs. Otherwise, if the second and third opinions go against them, they will know they have no legal right to the leave. Ensuring that the employee is expeditiously provided with a decision on the leave based on the opinion of a neutral health care provider rather than of the employer, which may be biased by economic considerations, is completely in accord with the remedial purpose of the statute. On the other hand, the majority’s interpretation—that the procedure is optional and essentially for the purpose of giving employers the opportunity to immunize their leave denial from litigation— does not promote any stated purpose of the CERA or the FMLA.

Thus, the dispute-resolution procedure furthers the statute’s purpose—job security for those who take bona fide medical leave—while allowing employers to ferret out bogus medical leave requests. The contrary position—that after the employee has done everything asked of her to certify the seriousness of her medical condition, the employer can still refuse her leave without consulting an independent medical opinion—encourages litigation and job insecurity, and leaves a hole of uncertainty in the middle of a statute that seems designed to inform employers and employees clearly of their rights and obligations. The employee with a serious medical condition who is terminated for taking medical leave would then have to engage in a costly suit to get her job back, in the course of which she would have to litigate the seriousness of her medical condition at the time she took the leave, sometimes long after that condition had ceased. (See Sims, supra, 2 F.Supp.2d at p. 1261.) Or she would have to sacrifice her health for the sake of job security. There is no reason to believe Congress or the Legislature intended either of these results. Rather, all indications are that Congress and the Legislature regarded the question of whether an employee had a serious health condition warranting up to three months’ unpaid medical leave to be primarily a medical question, to be settled by doctors at the time the leave is requested, not by judges or juries years later.

Of course, an employer may have all sorts of reasons to doubt the validity of an employee’s medical certification—the employee may have a history of poor credibility, or may have been seen performing activities that indicate his or her ability to perform the employment tasks, or may have been rumored to have told another employee that the certification was fraudulent. But the CFRA speaks directly to these situations. The dispute-resolution mechanism is not to be invoked routinely, but specifically “[i]n any case in which the employer has reason to doubt the validity of the [employee’s] certification.” (§ 12945.2, subd. (k)(3)(A), italics added.) The statute expressly contemplates that an employer may, for nonmedical reasons, entertain doubts about an employee’s certification, but makes clear that those doubts ultimately must be confirmed through second and third medical opinions.

*226Behind the lead opinion’s reading of the statute appears to be an assumption that a legislative requirement that disputes about medical leave be settled only through an alternative dispute-resolution procedure, rather than through litigation, is “such a dramatic step” (lead opn., ante, p. 211) that the Legislature must explicitly state that it means to bar such litigation. That assumption might be correct if the CFRA were similar in form and content to other statutes in which such litigation was clearly authorized, or if barring subsequent litigation would be contrary to the evident purpose of the CFRA, or if such a bar were contrary to some well-established public policy. (Cf. Reno v. Baird (1998) 18 Cal.4th 640, 653 [76 Cal.Rptr.2d 499, 957 P.2d 1333].) But none of these is true. The CFRA is a unique statute that uses the opinions of health care providers to resolve disputes about whether an employee should be given medical leave. Moreover, as discussed, the “dramatic step” of barring employers from circumventing the prescribed procedures is wholly consistent with the purpose of CFRA—to make it relatively easy for employees with bona fide serious health conditions to obtain medical leave, while at the same time allowing employers to contest questionable medical claims at the time they are made. Nor is a legislative mandate to use an alternative dispute-resolution procedure to make the process of determining medical leave eligibility simpler and less costly for employees and employers alike contrary to any public policy. Thus, I find the lead opinion’s unspoken assumption unfounded that limiting the resolution of disputes about an employee’s medical leave eligibility to the doctor’s office rather than the courtroom is so anomalous that we must require the Legislature to do so explicitly rather than, as here, by clear implication.

Turning to the present case, as the lead opinion recounts, defendant employer Sutter Health Central sought a second medical opinion to test plaintiff Antonina Lonicki’s medical certification, but did not seek a third binding opinion. I would therefore hold that the employer is estopped from contesting in subsequent litigation that plaintiff had a serious health condition.

Amici curiae Employers Group and the California Employment Law Council would distinguish Sims, supra, 2 F.Supp.2d 1253, and its progeny because in the present case, unlike in Sims, the employer had “contemporaneous, irrefutable evidence” that affirmatively invalidated the employee’s medical certification—that the employee was in fact performing the same job for another employer when he or she sought medical leave. But whether or not there is a “contemporaneous, irrefutable evidence” exception to the requirement that the employer either accept the employee’s sufficient certification or obtain a second and third opinion, part IV of the lead opinion makes clear that the exception does not apply in the present case. That opinion rightly concludes that plaintiff’s part-time employment in a different job setting is *227not irrefutable evidence that she was medically disabled from performing full time her job with defendant.

Although the CFRA is reasonably clear in requiring that employers who doubt an employee’s certification obtain a favorable second and third medical opinion before denying the employee medical leave, it is obviously not clear enough. I would urge the Legislature to further clarify its intention in this regard.

All statutory references are to this code unless otherwise indicated.

The lead opinion contends that the placement in subdivision (k)(l) of section 12945.2 of the provision that the certification “shall be sufficient” if certain information is provided somehow weakens my position. I disagree. Viewed in terms of the overall structure and purpose of the statute, there is nothing surprising in how the Legislature drafted this part of the statute. The statute simply spells out clearly what the employee must do to obtain medical leave and what the employer must do to refuse medical leave. At each point the employer has *223a choice. When the employee requests leave, the employer can ask for certification. If the employee provides sufficient certification and the employer is still unsatisfied, it can request a second opinion and, if favorable, a third opinion. Although the Legislature could have drafted the statute differently, it is sufficiently clear. The lead opinion’s alternative explanation of the “shall be sufficient” language—that it is intended simply to limit the information the employee is required to provide—makes little sense. Why take such care to limit the information necessary to certify the need for medical leave if the employer is then free to simply ignore the certification process and deny the leave?