Sedgwick FMLA and leave forms, explained

What is Sedgwick, and why is its name on your leave paperwork?

Sedgwick is a company that administers leave and disability claims for employers. Its absence-management page says its experts "manage all statutory and company-specific leave of absence policies," and that it also manages short- and long-term disability claims.

The page lists FMLA (Family and Medical Leave Act) leave, paid family and medical leave, military leave and ADA (Americans with Disabilities Act) compliance, for "employers of all types and sizes."

Your claim is managed on mySedgwick, which Sedgwick's help page also calls OmniClaims. That's where your letters, forms and claim status appear.

Some employers name Sedgwick in public. Walmart's leave overview, for example, calls Sedgwick "our leave administrator." Forms aren't the same at every employer. Work at Walmart? See the Walmart leave guide.

Who decides your leave: Sedgwick or your employer?

Sedgwick administers. The rules come from your employer's leave policy and benefit plan, plus the law.

Sedgwick's public pages don't say who makes the final decision. The letters in your case are the record of the decision. In mySedgwick, the Summary tab of your claim shows its status, such as Approved, and an LOA Specialist is listed under Important Contacts. Keep each letter, with its date.

Does Sedgwick pay you during a leave of absence?

Not from its own funds. Sedgwick administers claims; any pay during a leave comes from a plan your employer provides, such as short-term disability or a paid-leave plan, under that plan's terms. Where Sedgwick administers the plan, the disability claim is a separate claim from the leave claim in mySedgwick, with its own forms.

FMLA leave itself is unpaid, and paid leave can run alongside it. Short-term disability is pay under a plan, a separate decision, and the same weeks can count against both. The short-term disability vs FMLA guide sets the two side by side.

Pregnancy and childbirth follow the same split: FMLA can cover the time away if you're eligible and the leave is designated, and pay comes from a disability or paid-leave plan where one exists. The attending physician statement guide covers the form a disability plan sends.

How do you start a Sedgwick leave and send your forms?

Start the way your employer's instructions say. Sedgwick's help page says to "fill out any forms or paperwork needed and send back to Sedgwick," and that you can upload files to your claim in mySedgwick.

For intermittent leave, the certification covers the pattern of absences, and each absence is reported the way your employer's instructions say. Keep a copy of what you send and every letter you receive.

Request the leave the way your employer says.

Its instructions name the route.

Sign in to mySedgwick and open your claim.

Your forms are in the Documents tab near the top of the Claim page.

Get the provider's part completed.

Your own treating provider can do it, or a state-licensed provider through Certicare.

Return the form by the route your letter gives.

The mySedgwick help pages say some forms can be completed and signed inside mySedgwick; others are download-only and go back as an uploaded copy.

Check the Certifications tab.

It shows the status of the certification and a timeline of certification dates, and any request for clarification appears below it.

What forms will Sedgwick ask your provider to complete?

For FMLA leave, a medical certification. The Department of Labor's WH-380-E is one version, and your employer may use its own form instead. Either way, the federal rule sets out what it may ask for, including when the condition started, how long it's likely to last, the medical facts supporting the leave, and whether you can do the job's essential functions. A diagnosis isn't required on it.

For a disability claim, the plan's own form, addressed to your health care provider, such as an attending physician statement. For a mental-health claim the questions center on functioning; see short-term disability for mental health. The provider fills in the provider's part, not you.

For a workplace accommodation, the route depends on your employer. Sedgwick's accommodations page describes "administrative or consultative support," and some employers handle accommodations in-house, so ask your employer which team handles it.

Separately, FMLA eligibility has three tests: 50 or more employees within 75 miles of your worksite, 12 months with the employer, and 1,250 hours in the preceding 12 months. Meeting them is necessary, not sufficient. The reason must also qualify, and your employer designates the leave; what counts as a serious health condition is its own question.

What happens if the form comes back incomplete or late?

For an FMLA certification, you get at least 15 calendar days after the employer's request to return it. That deadline doesn't apply where returning it on time isn't practicable despite your diligent, good-faith efforts, so keep a dated record of what you asked your provider and when. If it's incomplete or insufficient, the employer must say in writing what's missing and generally allow seven calendar days to fix it. mySedgwick also shows clarification requests below the Certifications timeline; go by the written notice you receive.

If the certification is late, the rule depends on the leave. For leave you planned ahead, the employer may deny FMLA coverage until you provide it. For leave you couldn't plan, it may deny FMLA coverage for the days after the deadline until a sufficient certification arrives, unless something outside your control, like a medical emergency, made returning it on time impractical. Read about FMLA denials for what can still be fixed.

Disability-plan forms follow the plan's rules, not the FMLA's clocks. Go by any deadline in your letter.

Work at Walmart? Walmart's Sedgwick timeline and denial pages carry the detail for that employer.

Who completes the provider's part for you?

If the provider already treating you will complete the form, that's the simplest route. Certicare is for when that isn't available, or not in time.

A state-licensed provider completes and signs the provider's part of the form you were sent, after an online evaluation, where the evaluation supports it. Upload the form with your intake; usually no appointment. A provider may follow up for more detail before deciding.

An evaluation doesn't mean a signature: the provider signs only what the evaluation supports. The completed form comes back to you by email, usually within 24 hours after we have everything needed. You return it the way your letter says.

The fee is $49 for the medical leave forms service. If we can't complete your request, for any reason, you're refunded in full.

This service is for your own condition. For a family member, see family care leave forms.