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This document is used by employers to certify a serious injury or illness of a covered servicemember for purposes of the Family and Medical Leave Act (FMLA). It outlines the necessary information

How to fill out certification for serious injury

How to fill out Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave

1. Obtain the Certification for Serious Injury or Illness of Covered Servicemember form from the Department of Labor or your employer.
2. Fill out the employee information section with your name, contact information, and relationship to the servicemember.
3. Provide the servicemember's details, including their name, service branch, and military identification number.
4. Have a healthcare provider complete the medical certification section, detailing the nature of the servicemember's injury or illness.
5. Include information on the expected duration of care you will provide for the servicemember.
6. Review the form for completeness and accuracy.
7. Submit the completed certification form to your employer's HR department or designated personnel.

Who needs Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave?

1. Family members of servicemembers who are seriously injured or ill and require care.
2. Eligible employees seeking military family leave under the Family and Medical Leave Act (FMLA).

People Also Ask about

Do you have to say why you're taking FMLA?

Yes, when you call in you have to say both FMLA + the condition you are approved to use FMLA for. When you turned in FMLA paperwork, you approved your employer to know about that specific condition, and they need to check to make sure that you are calling off for the specific reason that you are covered for.

Which of the following is a qualifying reason for leave under the FMLA for service members?

A “qualifying exigency” includes: (1) short notice deployment (limited to seven calendar days from date notified of deployment); (2) attending military events and related activities; (3) childcare and school-related activities arising from the military member's covered active duty; (4) financial and legal arrangements

What is an example of a FMLA request?

Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave. Please let me know whether you approve this leave at your earliest convenience.

Can you approve FMLA without medical certification?

There is no requirement for an employer to request medical certification if an employer has enough information to know that an employee's absence is FMLA qualifying. Employers should be consistent, though, in the policy and practice of requiring medical certifications from employees requesting FMLA leave.

What do you say when using FMLA?

There are specific rules to take FMLA. If you are sick, then you tell them you are sick. If your child is sick and needs to go to a doctor, then that's what you tell them. There are specific forms for FMLA leave which are filled out by your doctor.

Is a serious injury or illness covered by FMLA?

TYPES OF SERIOUS HEALTH CONDITIONS. The FMLA defines a serious health condition as an illness, injury, impairment, or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider. Both physical and mental health conditions qualify for FMLA leave.

What do you write in FMLA paperwork?

FMLA Form WH-380-F for Family Health Condition Provide information about the family member and your relation to them to help confirm your eligibility for leave. This form has the same three sections as the above WH-380-E and will ask you to confirm the amount of leave you require.

What to say on FMLA paperwork?

You do not have to tell your employer your diagnosis, but you do need to provide information indicating that your leave is due to an FMLA-protected condition (for example, stating that you have been to the doctor and have been given antibiotics and told to stay home for four days).

For pdfFiller’s FAQs

What is Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave?

The Certification for Serious Injury or Illness of Covered Servicemember is a form that verifies the serious injury or illness of a servicemember, allowing their family members to take leave under the Family and Medical Leave Act (FMLA) to care for them.

Who is required to file Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave?

The certification must be filed by family members of a covered servicemember who are requesting military family leave due to the servicemember's serious injury or illness.

How to fill out Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave?

To fill out the certification, family members should provide detailed information about the servicemember's injury or illness, the relationship to the servicemember, and any medical information as requested on the form.

What is the purpose of Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave?

The purpose of the certification is to officially document the need for family members to take leave to care for a seriously injured or ill servicemember, ensuring they qualify for protections under the FMLA.

What information must be reported on Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave?

The certification must report information such as the servicemember’s name, the nature of the injury or illness, the date of the injury or onset of the condition, and the family member's relationship to the servicemember.