Medical Leave of Absence Example Letters

Mary Gormandy White
Leave of Absence Letter Sample

If you need to take an extended period of time off for work for medical reasons, it's a good idea to submit a formal letter of request to your employer. Before writing your letter, make sure you are aware of company policies regarding medical leave and find out whether or not your employer is covered under the Family Medical Leave Act (FMLA). Once you have written and submitted your letter, follow up with your supervisor or the appropriate human resource management representative to verify approval and complete any leave certification documentation that may be required.

Sample Letters for Medical Leave Requests

The three most common reasons to submit a letter to request a medical leave of absence are the need for surgery, diagnosis of a serious illness, or diagnosis with a chronic condition that may require intermittent leave.

Medical Leave of Absence Request: Surgery

Your full name, job title
Home Address
City, State, Zip code

Date

Mr./Mr. Last Name:

I am writing to you to submit a formal request for a medical leave of absence due to my own serious health condition that requires surgery. My doctor has scheduled a surgical procedure for (insert date) and expects that I will need (insert number) of weeks for recovery before being released to return to work. My physician will be happy to provide a formal medical certification document on my behalf.

Please let me know the next steps I should take to secure approval for this request. Thank you in advance for your consideration.

Sincerely,

Your signature

Your typed name

Medical Leave of Absence Request: Serious Illness

Your full name, job title
Home Address
City, State, Zip code

Date

Mr./Mr. Last Name:

I am writing to you to formally request a medical leave of absence due to a serious health condition that I have been diagnosed with. Due to my illness, my physician has advised me to seek an immediate medical leave from work and expects that I will be unable to return to work for (insert number) weeks or longer, depending on my response to treatment and recovery progress. I will be happy to have my doctor submit a medical certification form to verify the need for leave.

Please let me know what additional information is needed in order to process this request. I greatly appreciate your assistance with this important matter.

Sincerely,

Your signature

Your typed name

Medical Leave of Absence Request: Intermittent Leave

Your full name, job title
Home Address
City, State, Zip code

Date

Mr./Mr. Last Name:

I am writing to you to submit a formal request for approval for intermittent medical leave as a result of my diagnosis with (insert condition). While this illness does not require me to need an extended leave of absence, there may be times when I am unable to work due to this condition. My physician can provide you with a medical certification documenting this serious medical condition and possible intermittent leave needs associated with it.

Please let me know what steps I should complete next to move forward with my leave request. Your assistance with this important matter is greatly appreciated.

Sincerely,

Your signature

Your typed name

Tips for Requesting Medical Leave

Be sure that you know and follow your company's policies regarding leave requests and be sure that you follow the requirements to the letter. Most companies have specific guidelines that employees must follow when requesting leave. Look in your employee handbook for your company's policies or ask your human resources representative for information.

It's advisable to begin the process of requesting approval for medical leave as soon as you know that you need time off from work for a qualified situation. Most companies request 30 days advance notice when it is practical. The fact that you are writing a letter of request will not excuse you from following official company procedure. Do not assume that your request has been approved simply because you submitted a letter.

Be prepared to complete official FMLA forms to request leave and for medical certification if you are eligible for this type of leave and if your company is covered by the law. See DOL.gov to learn more about FMLA eligibility and requirements. Even if your company is not obligated to provide you with leave under FMLA, your request may be granted if doing so is practical for the organization.

Reasonable Accommodation Considerations

If the reason you need leave is protected as a disability under the Americans with Disabilities Act or Americans with Disabilities Amendments Act, you may be able to request leave as a reasonable accommodation for your disability. If your company is not covered under FMLA and does not grant medical leave as a matter of policy, your initial request can be for a reasonable accommodation. If your company does provide FMLA or policy-based leave, but you need more time off for your health condition, requesting extended leave as a reasonable accommodation may be a good option for you. Learn more about disability rights and laws at ADA.gov.

Medical Leave of Absence Example Letters