What records they can actually require

Four different federal and state frameworks govern workplace mental-health leave and accommodation. Each has its own scope, its own certifier rules, and its own limits on what the employer or insurer can see. They are not interchangeable. This page lays them out side by side.

Share:Email Facebook X LinkedIn

On this page

Why This Chart Exists
The Four Programs, Side by Side
Who Can Sign: Psychiatrist vs. Therapist
The Psychotherapy-Notes Rule
When They Ask for More

Why This Chart Exists

The most common records overreach we see is that HR or a third-party administrator hands a worker a single blanket authorization and treats it as if it covers all four frameworks at once. It does not. FMLA, ADA, short-term disability, and workers' comp each have their own statutory or contractual scope. The document that satisfies one does not, and should not, satisfy the others.

For mental health claims the stakes are higher, because sensitive records can be swept into a wider release than the law actually authorizes. Understanding which framework you are in, and what that framework allows, is the difference between handing over your therapy file and handing over a one-page certification that does the job.

Nothing on this page is legal advice. These are reference summaries with citations, meant to help you read the forms in front of you critically. If you are in a live dispute, consult an employment or ERISA attorney.

The Four Programs, Side by Side

Each of the four programs below has its own legal basis, its own certifier pool, and its own limits. Scroll down for the full detail on each, or use this summary as a quick orientation.

Program	Who asks	Standard form	Who can sign
FMLA	HR or leave TPA	WH-380-E (for your own serious health condition).	MD, NP, LCSW, psychologist
ADA	HR / accommodations coordinator	No federal form.	Any qualified provider
STD	Disability insurer	Insurer-specific.	Insurer-specific; MD preferred
Workers' Comp	Workers' comp carrier / TPA	State-specific.	Usually MD/psychiatrist

FMLA (Family and Medical Leave Act)

Legal basis: 29 USC 2601 et seq.; regulations at 29 CFR Part 825. Scope of certification: 29 CFR 825.306 and 825.307.
Covered employers: Private employers with 50 or more employees within 75 miles of the worksite; all public agencies and schools. Employee must have worked 1,250 hours in the prior 12 months.
Who asks for records: Your HR department directly, or, more often, a third-party administrator (TPA) contracted by your employer to process leave. Common TPAs include Sedgwick, The Hartford, Lincoln Financial, Unum, Matrix Absence Management, and Reed Group.
Standard form: WH-380-E (for your own serious health condition). The Department of Labor form is optional for the employer to use, but the scope of certification it defines is not optional.
What they can require: That a health care provider certify you have a serious health condition.
The date the condition began, and its probable duration.
Medical facts sufficient to show you cannot perform the essential functions of your job.
The frequency and duration of incapacity or treatment (for intermittent leave).
What they cannot require: A diagnosis, if one is not volunteered by the provider.
Your underlying trauma history, treatment history, or records from prior providers.
A blanket HIPAA authorization giving them access to your full medical file.
Psychotherapy notes (protected separately under 45 CFR 164.508(a)(2)).
Copies of office visit notes from your therapist.
Who can certify: Any health care provider defined in 29 CFR 825.125. That includes MDs and DOs, but also clinical psychologists, licensed clinical social workers (LCSWs), nurse practitioners, and physician assistants operating within their scope of practice. A therapist can sign the WH-380-E in most jurisdictions; an MD is not required.
Psychotherapy notes: Fully protected. Under 45 CFR 164.508(a)(2), HIPAA requires a separate, specific authorization for psychotherapy notes. A general records release does not cover them, and an employer cannot require their release as a condition of FMLA leave.
Your leverage: If the certification is incomplete, the employer must tell you in writing what is missing and give you at least seven calendar days to cure (29 CFR 825.305(c)). They cannot deny leave without that notice. If they request more than the regulation allows, document the overreach and escalate.

ADA (Americans with Disabilities Act)

Legal basis: 42 USC 12101 et seq.; confidentiality of medical information at 42 USC 12112(d)(3)(B) and 29 CFR 1630.14. EEOC Enforcement Guidance on Disability-Related Inquiries (2000).
Covered employers: Private employers with 15 or more employees; state and local governments regardless of size.
Who asks for records: HR or a designated accommodations coordinator. The ADA accommodation process is separate from the FMLA leave process and, in most employers, is handled by a different person.
Standard form: No federal form. Many employers use internal accommodation request forms. The EEOC takes the position that documentation must be limited to what is needed to establish the disability and the need for the accommodation.
What they can require: Enough information to confirm you have a qualifying disability.
Information about functional limitations relevant to the job.
An explanation of how the requested accommodation addresses those limitations.
What they cannot require: Information about conditions unrelated to the accommodation request.
Your full medical history.
The specific diagnosis, if functional limitation information is enough to establish the need.
Access to psychotherapy notes.
Documentation disproportionate to the request (a quiet workspace request does not justify a full psychiatric history).
Who can certify: Any qualified health care professional with relevant expertise. EEOC guidance is permissive here: a therapist, counselor, or primary care provider who knows your condition can supply the documentation, as long as they can speak to functional limitations.
Psychotherapy notes: Protected. HIPAA 45 CFR 164.508(a)(2) applies to ADA documentation the same way it applies to FMLA. Employers who demand psychotherapy notes as part of an accommodation request are asking for something the law does not authorize.
Your leverage: The ADA requires an interactive process. If the employer demands more documentation than the regulation allows, the failure-to-engage itself is a violation. EEOC charges for information-disclosure overreach under 42 USC 12112(d) are a recognized cause of action.

Short-Term Disability (STD)

Legal basis: Private insurance contract. If the plan is employer-sponsored and subject to ERISA, 29 USC 1001 et seq. applies to claim procedures. State insurance law also governs.
Covered employers: Varies. STD is a benefit, not a statutory entitlement. Coverage depends on whether your employer offers STD and whether you enrolled.
Who asks for records: The disability insurer directly (Unum, The Hartford, Lincoln Financial, MetLife, Guardian, Aflac). The insurer is not your employer and is not bound by FMLA regulations.
Standard form: Insurer-specific. Usually a claim form for you, an attending-physician statement for your provider, and an employer statement. Many insurers demand a blanket HIPAA authorization at claim opening.
What they can require: Evidence that you are disabled as defined by the policy (most policies use an own-occupation definition for STD).
Objective medical evidence supporting the claim, which for mental health claims can be clinical observation, mental status exams, and treatment notes.
Ongoing updates during the benefit period.
In some policies, independent medical examinations (IMEs).
What they cannot require: Disclosure broader than the policy terms authorize.
Psychotherapy notes, which remain protected under HIPAA 45 CFR 164.508(a)(2) and require a separate authorization.
Waiver of your state insurance complaint or ERISA appeal rights.
Who can certify: Varies by insurer. Most STD plans accept attending-physician statements from a licensed provider treating the condition, but many insurers scrutinize mental health claims more heavily and prefer or require documentation from an MD/DO psychiatrist, particularly when a therapist without prescribing authority is the only treating provider. Some insurers will ask for a psychiatrist co-sign even when the therapist has been the primary clinician.
Psychotherapy notes: Still protected. STD insurers routinely hand out blanket HIPAA authorizations that ask you to sign away rights you can hold. You can line-edit the authorization to exclude psychotherapy notes and limit the release to the claim period and condition.
Your leverage: STD disputes are contract disputes. If denied, you have ERISA appeal rights (if the plan is ERISA-governed) or state insurance remedies. Document every records request. Narrower releases rarely cost you the claim; they do protect the records that matter most.

Workers' Compensation (mental-health claims)

Legal basis: State-by-state workers' compensation statutes. No single federal standard for private-sector mental-health claims. Federal employees are covered under FECA (5 USC 8101 et seq.).
Covered employers: Essentially all employers in most states (thresholds vary). Mental-only claims (mental stimulus leading to mental injury) are disfavored or excluded in many states.
Who asks for records: Your employer's workers' comp carrier or third-party administrator. Many states allow the carrier to direct your care, at least initially.
Standard form: State-specific. In New York, the C-4 series. In California, the DWC-1 plus the treating physician's PR-2. Most states have an equivalent.
What they can require: Evidence of a work-related injury causing the mental health condition.
A DSM-5 (or ICD) diagnosis from a qualified provider, often an MD/DO psychiatrist.
Evidence that the work condition was the predominant cause (standard varies by state; some require clear and convincing evidence).
Attendance at independent medical examinations ordered by the carrier.
What they cannot require: Disclosure of pre-existing mental health history that is unrelated to the claim, beyond what is necessary to apportion causation.
Psychotherapy notes without a separate authorization.
Waiver of the right to dispute the carrier's denial through the state workers' comp board.
Who can certify: State-specific. Many states require an MD/DO, and for psychiatric claims, commonly a psychiatrist. Some states allow licensed psychologists. Therapists (LCSW, LPC, LMFT) can supply supporting treatment records but are rarely the sole certifier for the causation opinion.
Psychotherapy notes: Protected under HIPAA, but carriers will sometimes attempt to compel production through the state workers' comp process. The right to object depends on state law and the scope of the claim. Consult a workers' comp attorney before signing broad releases.
Your leverage: Workers' comp is adversarial. You have a right to a hearing, and in most states a right to your own independent medical opinion. Mental health claims under workers' comp are hard to win; if you have both a workers' comp theory and an ADA/FMLA theory, the latter is often the stronger route.

Who Can Sign: Psychiatrist vs. Therapist

The single most common mistake we see is workers assuming they need a psychiatrist to sign their FMLA certification. For most mental-health leave under FMLA, and for most ADA accommodation requests, a licensed therapist can sign. The rules tighten as you move into STD and workers' comp.

Provider type	FMLA	ADA	STD	Workers' Comp
Psychiatrist (MD/DO) Diagnose, prescribe medication, sign most medical certifications.	Accepted universally.	Accepted universally.	Strongly preferred by most STD insurers for mental-health claims.	Usually required as the certifier for psychiatric workers' comp claims in most states.
Psychiatric Nurse Practitioner (PMHNP) Diagnose and prescribe in most states (scope varies). Provides medication management and often therapy.	Accepted under 29 CFR 825.125 as a nurse practitioner within scope.	Accepted.	Accepted by most insurers, though some will request a psychiatrist co-sign.	Acceptance varies by state.
Clinical Psychologist (PhD, PsyD) Diagnose, provide therapy, conduct psychological testing. Cannot prescribe except in five states (as of 2026: New Mexico, Louisiana, Illinois, Iowa, Idaho).	Accepted under 29 CFR 825.125.	Accepted.	Accepted, especially when ongoing therapy is the primary treatment.	Accepted in many states for psychiatric claims.
Licensed Clinical Social Worker (LCSW) / Licensed Professional Counselor (LPC) / LMFT Diagnose within their scope, provide therapy, and most insurance plans reimburse their services.	Accepted for FMLA: 29 CFR 825.125(a)(2) lists clinical social workers as health care providers. LPCs and LMFTs are not explicitly listed but are accepted in practice where state scope of practice covers diagnosis.	Accepted under EEOC's qualified-health-care-professional standard.	Often accepted alone, but insurers for mental-health STD claims increasingly demand a psychiatrist co-sign or independent review. Expect pushback.	Rarely sufficient as the sole certifier for the causation opinion. May serve as the treating provider with a separate physician attestation.
Primary Care Provider (PCP) Diagnose common mental-health conditions, prescribe SSRIs/SNRIs, refer out for specialist care.	Accepted.	Accepted.	Often accepted, but for mental-health STD claims, insurers commonly require a specialist referral within a short window.	Usually insufficient for psychiatric claims; referral to a psychiatrist or psychologist is typically needed.

FMLA health-care-provider scope is defined in 29 CFR 825.125. ADA documentation standards are set out in EEOC Enforcement Guidance on Disability-Related Inquiries (2000). STD rules are set by the insurance contract. Workers' comp certifier rules are state-specific.

The Psychotherapy-Notes Rule

HIPAA treats psychotherapy notes differently from the rest of your medical record. 45 CFR 164.508(a)(2) requires a separate, specific authorization before a covered entity can release them. A general authorization does not cover them. This rule applies whether the requester is an employer, a TPA, an STD insurer, or a workers' comp carrier.

Psychotherapy notes, as defined by 45 CFR 164.501, are notes recorded by a mental health professional documenting or analyzing the contents of a counseling session, kept separate from the rest of the medical record. They do not include medication prescription and monitoring, counseling session start and stop times, modalities and frequencies of treatment, results of clinical tests, or summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress. Those items are part of the main record and are governed by ordinary HIPAA rules.

In practical terms: a one-page FMLA certification, an ADA accommodation letter, or an attending-physician statement for STD can say everything an employer or insurer legally needs, without touching the psychotherapy notes at all.

When They Ask for More

The pattern that costs survivors the most is signing a blanket release the first day, because the form is thick and the HR email was short. You do not have to do that. The following steps are consistent with FMLA, ADA, HIPAA, and ERISA claim procedures:

Ask, in writing, which program they are processing. FMLA, ADA, STD, or workers' comp. If they say “all of them,” ask for a separate certification for each. The forms are different because the law is different.
Narrow the HIPAA authorization. Line-edit it to limit the release to the condition and date range relevant to the claim. Exclude psychotherapy notes explicitly. Most releases are drafted as open-ended; you can revise them.
Ask your provider to complete the certification, not the full release. For FMLA and ADA, a targeted response to the form is almost always enough. You do not need to hand the TPA your clinical record.
If denied for incomplete records, demand the seven-day cure notice. Under 29 CFR 825.305(c), FMLA-covered employers must give you written notice of what is missing and at least seven calendar days to fix it before they can deny.
Document every request. Keep copies of every form, every email, every phone call with dates. Records overreach is the subject of active DOL and EEOC enforcement.

If you are reading this because HR or a TPA has asked you for your mental-health records, read our deeper guide on the clinical and legal harm of that pattern.

One of the Worst Things an Employer Can Ask For: Your Mental Health Records Step 4: Certification

LeaveRights is a free educational tool and does not provide legal advice. No account needed, and the letters you write stay on your device. Information provided is for general guidance only. Consult a qualified employment attorney for advice specific to your situation.