Maryland Employer FMLA Response - Form WH-381

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Multi-State
Control #:
US-426EM
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Word; 
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This form is used by an employer to provide a response to a request for leave under the FMLA.
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  • Preview Employer FMLA Response - Form WH-381
  • Preview Employer FMLA Response - Form WH-381

How to fill out Employer FMLA Response - Form WH-381?

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FAQ

Employee's serious health condition, form WH-380-E use when a leave request is due to the medical condition of the employee. Family member's serious health condition, form WH-380-F use when a leave request is due to the medical condition of the employee's family member.

Federal law is clear: Employers are forbidden from discriminating or retaliating against any employee for exercising the right to take FMLA leave. Discriminatory behavior can include refusing to promote an employee who's on FMLA leave or discouraging a worker from taking it altogether.

Benefits Provided Paid family and medical leave provides Massachusetts employees with up to 12 weeks of job-protected, paid family leave, up to 20 weeks of job-protected, paid medical leave, or up 26 weeks of combined family and medical leave in a benefit year.

Fill out Section 2 of the form. If you are completing form WH-380-F, you will be required to provide information about the family member you are caring for during FMLA leave; such as their full name, your relationship to one another, and a description of your methods for providing care for that person.

How to File a Paid Family Leave (PFL) Claim by MailVisit Online Forms and Publications and order a form online. A form will be mailed to you.Obtain the form from your physician/practitioner or employer.Visit an SDI Office.Call 1-877-238-4373. California Relay Service (711) Provide the PFL number (1-877-238-4373)16-Feb-2022

To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employee's or family member's applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.

Employers typically respond to FMLA leave requests by providing the employee with the Notice of Eligibility and Rights & Responsibilities (Form WH-381) and a medical certification form.

EligibilityHave worked for your employer for at least 12 months; and.Have worked for your employer for at least 1,250 hours in the 12 months before you are taking leave; and.Work at a location where your employer has at least 50 employees within 75 miles of your worksite.

Form WH 380-E, Certification of Health Care Provider for Employee's Serious Health Condition, is a form used by employers and sent to the US Department of Labor, Wages and Hour Division. This form verifies that an employee has a serious medical condition.

Doctors aren't the only health care providers who may certify FMLA leave. Podiatrists, dentists, clinical psychologists, optometrists and chiropractors can all certify leave, as can nurse practitioners, nurse-midwives, clinical social workers and physician assistants.

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Maryland Employer FMLA Response - Form WH-381