Template for Denial of Family and Medical Leave (FML)

  • The letter should be utilized once the unit/college has a request for FML and the employee is not eligible the leave.
  • The letter shall be issued no later than 5 days after receiving notification of the absence. Once issued, both employee and unit supervisor should receive a copyof the letter and a copy retained in the employee’s confidential leave file maintained by the HR representative for the unit/college. A copy of the letter should be forwarded to the UIC HR Service Center via an HR Front End (HRFE) Administrative-ADM transaction.
  • Letters should mirror the template below and be placed on unit/college letterhead. [Portions in brackets are to be filled in with the appropriate information. Specific instructions are provided in italics]

[DATE]

[Employee]

[Address]

[City, State Zip Code]

Dear [employee name]:

[Department Name]received your request for [intermittent / block of time] Family and Medical Leave (FML) for your [self/spouse/mother/father/son/daughter].

In order to be eligible for FML, an employee must be employed by the University for at least twelve months and have worked for at least 1250 hours during the previous twelve months. In addition, the request for leave must qualify under the FML guidelines.

Unfortunately, although your request for leave may qualify under the FML guidelines, [insert one of the statements below here]

[you have not worked at least 1250 hours during the previous twelve months prior to the request date for leave; therefore, you are not currently eligible for FML.]

[you have not been employed by the University for at least twelve months prior to the request date for leave; therefore, you are not currently eligible for FML.]

[the medical facts and supporting documentation submitted by you and the treating physician does not qualify as a “serious health condition” under FML]

[you are not eligible for FML as you have exhausted your twelve weeks of FML effective [Date] from a previous leave.]

[designation of “family member” under FML applies to son, daughter, spouse and parent. Your request for FML for your [insert family member - relationship] cannot be granted as it does not meet the criteria listed under FML.]

As a result, your request for FML, effective[DATE], cannot be approved as an FML qualifying event.

However, if you feel the need to re-apply for FML, you may submit a new FML application and current Certification of Health Care Provider for review.

If you feel the need to take a [block of time / intermittent] leave, please contact [insert HR representative contact information] to discuss other leave options.

Please refer to the University vacation and sick leave policies and departmental policies for use of your benefits.

If you have any questions or concerns in regards to the information contained in this letter, please do not hesitate to contact me.

Kindest regards,

[HR Leave Coordinator]

cc:[Supervisor]

UIC HR Service Center

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