FMLA Leave Requests

Intermittent FMLA for Bipolar Disorder

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 Intermittent FMLA Leave

Dear [HR Contact Name],

I am writing to request intermittent leave under the Family and Medical Leave Act for a serious health condition that is chronic and episodic. I have worked at [Employer Name] since [Start Month, Year] and have worked well over 1,250 hours in the past twelve months, so I meet FMLA eligibility.

My condition is under ongoing treatment by a psychiatrist and a therapist. Intermittent leave is medically necessary, and I expect to use it in three categories:

1. Scheduled medical appointments: typically one psychiatry visit every four to six weeks and one therapy session per week, each one to two hours.
2. Unscheduled episodes of incapacity that I cannot plan around. These are typically one to three days, may occur in clusters, and can affect my ability to concentrate, sleep, or participate safely in meetings.
3. Medication-adjustment periods of up to one week following a change in dosage or medication, during which side effects like fatigue, cognitive slowing, or nausea may make work unsafe or unproductive.

My clinicians will certify these categories and an estimated frequency on the WH-380-E form. When I am not in an episode or an adjustment period, I am fully able to perform the essential functions of my position.

Please send me the WH-380-E and confirm my FMLA eligibility in writing within five business days. I will submit the completed form within the required window.

For unscheduled absences, I will notify [designated contact, such as my supervisor or the leave administrator] as soon as practicable, typically by email or voicemail before the start of my shift. I am happy to discuss a clear call-in procedure so that we have the same expectation.

I am not disclosing my specific diagnosis here, and my understanding is that the certification does not require one. Please keep any medical documentation in a confidential file separate from my personnel file.

Thank you for processing this promptly.

Sincerely,

[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.

When to use this letter

You have an established bipolar diagnosis and are in regular treatment (psychiatrist, therapist, or both). You want intermittent FMLA leave for scheduled appointments, for episodes of incapacity, and for medication-adjustment periods when side effects interfere with work.

Bipolar-specific intermittent leave looks different from anxiety or depression leave because episodes can be unpredictable, short, and cyclical. The letter below explains the pattern in a way a reasonable HR person can administer: scheduled visits on one hand, and symptom-driven absences on the other.

The Sixth Circuit decision in Hunt v. Thorp (2024) is a caution: if the employer later argues you cannot perform essential functions, FMLA and ADA protections narrow. Naming the categories of absence (appointments, manic episodes, depressive episodes, medication changes) and affirming that you can perform essential functions when not in an episode helps defend against that argument.

Why the letter is written this way

Each paragraph is doing specific legal work.

01
Why split the pattern into three numbered categories
Bipolar disorder does not fit the 'one appointment a week' template. Separating scheduled visits, episodic incapacity, and medication-adjustment periods gives your provider clean buckets to certify and prevents the employer from arguing that any unscheduled absence is not FMLA-qualifying.
02
Why affirm you can perform essential functions when not in episode
Hunt v. Thorp, 2024 WL 1159323 (6th Cir.), denied FMLA and ADA protection to a bipolar employee because she could not perform essential dispatching functions on return. Affirming that you can perform your essentials outside of episodes directly counters that framing. It also supports any ADA accommodation request you may layer on later.
03
Why spell out a call-in procedure
29 C.F.R. § 825.303 requires 'as soon as practicable' notice for unforeseen leave. Employers cannot impose notice procedures that are more stringent than their regular attendance policy, but they can enforce a reasonable policy. Putting your proposed procedure in writing prevents a later argument that you failed to follow 'company policy' that was never explained.
04
Why name both a psychiatrist and a therapist
Having two providers documents that your treatment is more than casual. 29 C.F.R. § 825.125 lists licensed providers who can complete FMLA certification, and courts treat ongoing combined psychiatric and therapeutic care as strong evidence of a serious health condition.

Don't do this

The mistakes that undo the letter.

01Describing an episode in clinical detail (mania, hypomania, mixed state). The certification form can include functional impacts without the diagnostic label. Writing the label into a letter invites stigma without adding legal protection.
02Promising to always give 24 or 48 hours notice for unscheduled absences. Episodes are unpredictable. The FMLA requires 'as soon as practicable,' which for a sudden episode can mean the morning of the absence.
03Not mentioning medication-adjustment periods. These are some of the most reliable times you will need leave, and they are often missed on certification forms because the employee thinks of them as 'just side effects.'
04Telling HR that you are 'managed' or 'stable.' This language can be used to argue later that you do not have a serious health condition. 'Under continuing treatment' is the right framing.
05Forgetting to layer on an ADA accommodation request. If essential functions are ever at issue, you will want to have asked for modified duties, reduced schedule, or a transfer under 29 C.F.R. § 1630.2(o) in parallel with the FMLA request.

Legal authorities cited

The language invokes real regulations.

29 C.F.R. § 825.115(c): Chronic serious health condition
29 C.F.R. § 825.202: Medical necessity for intermittent leave
29 C.F.R. § 825.303: Notice of unforeseen leave
29 C.F.R. § 825.306(a)(3): Certification does not require a diagnosis
29 C.F.R. § 825.125: Healthcare providers who can certify
29 C.F.R. § 1630.2(o): Reasonable accommodations under the ADA
Hunt v. Thorp, 2024 WL 1159323 (6th Cir. Mar. 18, 2024): Essential functions and bipolar disorder

Keep reading

Where to go next.

LeaveRights es una herramienta educativa gratuita y no proporciona asesoramiento legal. No se recopilan ni almacenan datos. La información proporcionada es solo para orientación general. Consulte a un abogado laboral calificado para obtener asesoramiento específico a su situación.

Each paragraph is doing specific legal work.

Why split the pattern into three numbered categories

Why affirm you can perform essential functions when not in episode

Why spell out a call-in procedure

Why name both a psychiatrist and a therapist

The mistakes that undo the letter.

The language invokes real regulations.

Where to go next.