Family Medical Leave Act (FMLA)
Medical or Maternity/Parental Leave of Absence Highlights
- Submit a written, signed, and dated request for leave to your supervisor indicating:
- Reason for requesting leave
- Dates of planned absence including the intended return to work date
- Amount of each type of leave (e.g., sick leave, unpaid leave, etc.) to be used.
- Your request must be in compliance with bargaining agreement/personnel plan provisions.
- Notify the FMLA Coordinator in Human Resources of any leave of absence and provide a copy of the written request so they can determine the following:
- If leave qualifies under FMLA
- If you have disability benefits for which a claim may be filed OR
- If a Workers Compensation claim needs to be filed
- Have your health care provider supply medical updates to the HR FMLA Coordinator and to your supervisor if required. You will be notified in writing if medical updates are required and how often they must be provided.
- If you have short-term disability insurance, obtain and complete the benefits claim form from HR and send the completed claim form to the disability insurance company.
Extending Your Leave of Absence
- If you need an extension of your medical leave, submit a written request to your supervisor or chair/dean. Provide verbal notification if necessary, but be sure to follow up in writing. Your request should include:
- Reason you need to extend your leave of absence
- Additional dates you plan to be absent and the date you plan to return to work
- Amount of each type of leave (e.g., sick leave, unpaid leave, etc.) you plan to use
- Notify the HR FMLA Coordinator of your need to extend the leave and send a copy of the written request.
- If you have filed a claim for disability benefits, notify the disability insurance company that your leave will be extended (The Hartford: 1-800-752-9713).
- Provide medical certification from your health care provider to the HR FMLA Coordinator and, if applicable, to the disability insurance company for the requested extension.
Returning to Work
- Contact your supervisor in advance to confirm the date you will return to work.
- Prior to returning to work, have your health care provider complete a Fitness for Duty Certification (obtain from the HR FMLA Coordinator).
- Send the certification to Human Resources in advance or bring it in on the date you return to work. Your return to work may be delayed if you do not provide a Fitness for Duty Certification.
- Work with your supervisor, Human Resources, and/or Office Services to accommodate work restrictions if necessary.
- Contact the HR FMLA Coordinator if you will not be able to return to work. There may be additional benefits or other resources available in cases of long-term or permanent disability.
Please refer to your collective bargaining agreement or personnel plan and the Family and Medical Leave Act for additional information about your rights and responsibilities.
Family Medical Leave Act Information
- Revised Statewide Policy on FMLA (PDF)
- FMLA FAQs (PDF)
- Employee Rights and Responsibilities Under FMLA (PDF)
- Tennessen Warning (PDF)
Family Medical Leave Act Forms
- Certification of Health Care Provider for Employee's Serious Health Condition (PDF)
- Certification of Health Care Provider for Family Member's Serious Health Condition (PDF)
- Certification of Qualifying Exigency for Military Family Leave (PDF)
- Certification for Serious Injury or Illness Covered Servicemember for Military Family Leave (PDF)
- Notice of Eligibility (PDF)
FMLA Coordinator: Jessica White
30 East 7th Street, Suite 350
Saint Paul, MN 55101
Minneapolis Disability Service Center
3800 American Blvd. West
Bloomington, MN 55431