FMLA Leave Requests

Continuous FMLA Leave for a Mental Health Condition

A fully-written letter you can copy or download. Below the letter we explain why it is written the way it is, the mistakes most people make, and the legal authorities the language invokes.

The letter

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To: HR at [Employer Name]
From: [Your Full Name]
Date: [Today's Date]
Subject: Request for Continuous FMLA Leave

Dear [HR Contact Name],

I am writing to request continuous leave under the Family and Medical Leave Act. I have a serious health condition that is being treated by a licensed provider, and my provider has recommended a leave of absence.

Please send me the WH-380-E medical certification form so my provider can complete it. My provider will set the start and end dates of leave on the form.

So I can plan, I would also appreciate written confirmation of:

1. My eligibility for FMLA leave.
2. Which method the company uses to calculate the twelve-month FMLA period.
3. How my group health insurance will continue during leave, and how I should pay my share of premiums.
4. Whether accrued PTO will be substituted for unpaid leave automatically, or whether I can choose.

I plan to return to my position following treatment.

Thank you,

[Your Full Name]
[Your Work Email]
[Your Phone Number]

Replace every bracketed prompt with your own information before sending. Everything in brackets is for you. Everything outside brackets is the letter.

Before you send this

Many employers do not handle FMLA paperwork themselves. They hand it off to a third-party administrator, usually called a TPA. A TPA is a leave-management vendor, like Sedgwick, Unum, Lincoln, or The Hartford, that your employer pays to process claims. TPAs have an incentive to close claims quickly, and they use a predictable set of tactics to push employees into giving up more than the law actually requires. Watch for these:

Blanket HIPAA authorization forms. These are not required for FMLA. The WH-380-E certification is. A broad HIPAA release can pull therapy notes, substance use records, and unrelated medical history into a corporate vendor's database.
Demands for records beyond the WH-380-E. The law limits what your employer or its TPA can require to what is necessary to determine FMLA eligibility. You are not obligated to provide a full chart.
Artificial delays that trip deadlines. If the TPA says your certification is incomplete, they must tell you in writing exactly what is missing and give you seven calendar days to fix it. Silence is not a legal denial.
Direct calls to your healthcare provider. TPA claim examiners cannot call your provider for general information. Contact for clarification must be routed through a healthcare professional designated by the employer.
Pressure to use an Employee Assistance Program (EAP) instead of accommodations. An EAP is a short-term counseling benefit your employer funds, usually limited to three to eight sessions. An EAP referral is not a response to an ADA accommodation request, and engaging with the EAP can muddy your record.

Watch out for the sign-up process. HR typically sends you to a TPA website to register and "start your claim." Those sign-up flows are where most of the traps live: pre-checked HIPAA authorization boxes, fields asking you to enter your diagnosis, current medications, symptoms, or the contact information for your treating providers. None of that is required to open an FMLA claim. Fill in only the administrative fields (name, employee ID, employer, dates) and leave clinical fields blank.

If the portal will not let you proceed without medical entries, or if anything about the process feels coercive, raise the concern in writing. A short email to HR and the TPA is enough: say that the portal appears to be asking for information that goes beyond what the FMLA certification requires, that you understand the employer's information rights are limited to what is necessary to determine FMLA eligibility, and that you would like to submit your certification through an alternative channel (email or fax to the TPA directly, with your provider sending the completed WH-380-E to that address). Wait for a written response. Only use the alternative if HR or the TPA agrees. Putting the concern in writing either gets you the alternative or creates a paper trail that protects you if the claim is later denied or delayed.

If any of this is happening, read Protecting Your Medical Records, FMLA and HIPAA Privacy Rights, or use the letter that limits records release to a TPA. If you need to talk to someone free of charge, see our list of free legal helplines and crisis lines.

Before you edit it

Keep these lines.

Change the tone, the names, and the details to fit your situation. These particular sentences are doing the legal work, and the letter gets weaker without them.

I have a serious health condition that is being treated by a licensed provider, and my provider has recommended a leave of absence.
The notice sentence. 'Serious health condition' is the statutory term from 29 U.S.C. 2611(11), and attributing the recommendation to your provider keeps the decision clinical rather than something you appear to have chosen.
My provider will set the start and end dates of leave on the form.
This keeps you from committing to dates before your provider has assessed you. Dates you volunteer become the ceiling your employer holds you to, and a return date you guessed at is very hard to extend later.
So I can plan, I would also appreciate written confirmation of:
Each of the four items maps to a separate employer obligation: eligibility notice (29 C.F.R. 825.300), the 12-month calculation method (825.200), continued group health coverage (825.209), and whether paid leave is substituted (825.207). Asking for all four in one letter creates a single dated record of what you were and were not told.
I plan to return to my position following treatment.
Short, and worth keeping. It frames the leave as temporary and preserves the restoration right under 29 C.F.R. 825.214. Employers occasionally treat a leave request as a resignation, and this sentence forecloses that reading.

When to use this letter

You need to step away from work entirely for a defined period for a mental health condition. Your doctor or therapist has recommended a leave of absence to focus on treatment.

Continuous FMLA leave is for when you cannot work at all for a defined period. Your provider's WH-380-E will set the timeline. This letter asks HR to open the file, send the certification form, and answer the practical questions you need answered before leave begins.

You do not need a specific duration in mind to send this. Your doctor or therapist will supply the start date, end date, and any updates on the form.

How to send it

Email to HR from your work account, and save a dated copy outside the work system before your leave starts. People on continuous leave routinely lose email access during the absence, sometimes without notice, so do this while you still can.

Why the letter is written this way

Each paragraph is doing specific legal work.

01
Why let your provider set the dates
The WH-380-E is where start and end dates belong. Pre-stating a duration in your letter can lock you into a timeline that does not match what your doctor or therapist later certifies, and that mismatch gives HR a reason to delay.
02
Why ask which 12-month method the employer uses
Under 29 C.F.R. § 825.200, employers can choose from four methods of calculating the 12-month FMLA period. Which one applies changes how much leave you have available today. If the employer has not chosen a method in advance, the method most favorable to the employee applies. Asking in writing forces them to commit to one.
03
Why ask about insurance continuation
Under 29 U.S.C. § 2614(c), your group health benefits must continue during FMLA leave, but you still owe your share of premiums. Failure to pay can end coverage even on protected leave. Asking up front prevents that.
04
Why ask about paid time off substitution
29 C.F.R. § 825.207 lets employers require you to use accrued PTO during FMLA leave, or lets you choose. Clarifying this in writing prevents an HR person from quietly burning your PTO and leaving you with no paid buffer when you return.
05
Why mention plans to return
Stating you plan to return signals a continuing employment relationship and forecloses any later argument that the leave was an effective resignation.

Don't do this

The mistakes that undo the letter.

01Naming a specific diagnosis to your supervisor while keeping HR vague. Supervisors talk. If a diagnosis ends up in a personnel review, it can be used against you.
02Pre-stating how long you will be out before talking to your provider. Let the WH-380-E set the timeline.
03Starting leave before paperwork is filed. Employers can retroactively designate leave as FMLA (29 C.F.R. § 825.301), but if the paperwork is incomplete they can also deny FMLA protection for the early days.
04Not asking about health insurance. Coverage continues only if your share of premiums is paid.
05Accepting a verbal 'take as long as you need.' This is the pattern the court flagged as FMLA interference in Donovan v. Nappi Distributors (D. Me. 2023). Informal permission is not FMLA protection.

What happens next

The replies you should expect.

HR answers the leave question but ignores the four numbered items: Common, and worth a short follow-up naming only the unanswered items. The health insurance question matters most: under 29 C.F.R. 825.209 coverage continues on the same terms during FMLA leave, and you need to know how to pay your share so coverage does not lapse while you are out.
You are told your PTO will be used up first automatically: That is often lawful. 29 C.F.R. 825.207 lets an employer require you to substitute accrued paid leave for unpaid FMLA leave. What matters is that the substituted time runs concurrently with FMLA rather than after it, so it does not extend your 12 weeks.
HR asks for a return-to-work date before your provider has given one: Say the certification will supply it. A date you invent under pressure becomes the date you are expected to return, and asking to extend it later looks like a change of plan rather than a clinical judgment.
Your leave is approved but nobody says it is FMLA: Ask for the designation notice in writing. 29 C.F.R. 825.300(d) requires the employer to tell you whether leave is designated as FMLA. Leave that is never designated may not count against your entitlement, but it also may not carry FMLA protection, which is the half that hurts.

Legal authorities cited

The language invokes real regulations.

29 U.S.C. § 2612(a)(1): 12 weeks of FMLA leave per 12-month period
29 U.S.C. § 2614(c): Continuation of group health benefits
29 C.F.R. § 825.113: Definition of serious health condition
29 C.F.R. § 825.200: Methods of calculating the 12-month period
29 C.F.R. § 825.207: Substitution of paid leave
29 C.F.R. § 825.305: Certification timing
29 C.F.R. § 825.312: Fitness-for-duty certification

Keep reading

Where to go next.

LeaveRights is a free educational tool and does not provide legal advice. No data is collected or stored. Information provided is for general guidance only. Consult a qualified employment attorney for advice specific to your situation.

Keep these lines.

Each paragraph is doing specific legal work.

Why let your provider set the dates

Why ask which 12-month method the employer uses

Why ask about insurance continuation

Why ask about paid time off substitution

Why mention plans to return

The mistakes that undo the letter.

The replies you should expect.

The language invokes real regulations.

Where to go next.