FMLA Job-Protected Leave

Forms

• WH-380-E — Certification of Health Care Provider for Employee's Serious Health Condition link

Step-by-step

1. 1. Notify your employer 30 days in advance when possible

   For unforeseeable needs (acute injury, urgent surgery), notify as soon as practicable.

   Next: Ask HR for an FMLA designation notice and the WH-380-E form.

2. 2. Return the medical certification on time

   You typically have 15 calendar days to return WH-380-E.

   Next: Ask your hand surgeon to be specific about expected duration and restrictions.

3. 3. Track FMLA hours used

   Keep your own log; intermittent leave for therapy visits also counts.

   Next: Confirm reinstatement to the same or equivalent role on return.

Evidence to gather

Check off items as you collect them — progress is saved only on this device (same keys as the main benefits guide).

• Completed WH-380-E from your provider — This is the document that triggers FMLA approval.
• Proof of hours worked in the last 12 months — FMLA requires 1,250 hours with the employer.

Common reasons claims get denied

• Worked fewer than 1,250 hours in the prior 12 months
• Employer has fewer than 50 employees within 75 miles
• Condition does not meet 'serious health condition' definition
• Late or incomplete medical certification

Sources

• U.S. Department of Labor — FMLA · accessed 2026-04-22