MetLife uses this certification when an employee requests FMLA military caregiver leave to care for a covered service member or veteran with a serious injury or illness. The employee fills in Sections 1 and 2 about the service member's branch, rank, unit and retirement list status; the health care provider then classifies the condition, gives treatment dates and supporting medical facts, and estimates the leave needed.
The service member's treating health care provider completes Section 3 (medical condition, using the DoD casualty classification), Section 4 (amount of leave needed) and Section 5 (provider information and signature). The employee completes Sections 1 and 2 before handing it over.
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Certification of health care provider for care of covered service member - Family and Medical Leave Act (FMLA)
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Section 4 asks whether a single continuous absence is needed, with start and end dates, or intermittent absence or a reduced schedule, with dates and an estimate of how often flare-ups occur and how long each lasts. The provider also describes the care needed and why the family member must leave work.
It serves the same purpose as the federal WH-385 certification for military caregiver leave, laid out in MetLife's format for leaves MetLife administers. It adds MetLife's requirements, such as the claim number on every page and its warning about open-ended durations.
The service member's treating health care provider, who attests to being the treating provider and certifies that the employee must be absent or work a modified schedule because of the condition. The form notes that its condition classification is a Department of Defense casualty assistance designation used by DoD providers.