When should a request be submitted?
Employees must provide their departments at least 30 days’ advance notice about the need for FMLA if known (for example, planned surgery or pregnancy).
When the need for FMLA is unexpected (for example, if a family member is injured in an accident), employees MUST provide notice as soon as possible.
While employees do not have to specifically ask for FMLA leave to initiate a covered leave, enough information must be provided to alert management that an absence may be covered by the FMLA.
How is a request submitted?
Either the employee or manager can submit a claim for FMLA coverage (may be in written form or verbally identified).
- Employee or manager completes the Work Connections Illness Injury referral form (online or via fax)
- The manager should provide FMLA certification paperwork to the employee for completion.
- Once the certification paperwork has been provided, the employee must provide a completed certification within 15 calendar days. The certification is required to determine whether the need for time off qualifies for FMLA coverage.
- Certification paperwork should be submitted directly to Work Connections
What medical certification is needed?
If the employee does not provide the certification, the employee’s request for FMLA leave may be denied.
In order to be considered for eligibility, employees must provide documentation from a health care provider that includes:
- Contact information for the health care provider;
- When the serious health condition began;
- How long the condition is expected to last;
- Appropriate medical facts about the condition (which may include information on symptoms, hospitalization, doctors’ visits, and referrals for treatment);
- Purpose of necessary absences; and
- Whether leave will be continuously or intermittently. If intermittently, the certification should include an estimate of how much time will be needed for each absence, the frequency of absences and information establishing the medical necessity for taking such intermittent leave
A medical certification form can be found at:
Certification of Serious Health Condition
Employees are not required to disclose personal health information to their department.
There are four ways to submit the completed FMLA certification form to Work Connections:
- Scan and email directly to the case manager assigned to the case
- Fax FMLA forms to Work Connections at 734-936-1913
- Drop off in person to Work Connections located at G300 Wolverine Tower
- Send via U.S. Mail to:
Work Connections
G300 Wolverine Tower
3003 S. State Street
Ann Arbor, MI 48019-1269
