MetLife uses one certification for the state paid family and medical leave claims it administers or insures, covering the employee's own serious health condition, care of a family member, bonding, military leave, safe leave and organ or bone marrow donation. The employee completes Section 1, and the treating provider completes Section 2, certifying the condition, treatment and hospital dates, and the continuous or intermittent absence needed.
The treating health care provider completes Section 2 and signs it with license number and state. The employee completes Section 1 and, when they apply, Sections 3 to 5 on bonding, military and safe leave.
Download the current version from the source each time; forms change without notice.
Paid Family & Medical Leave Certification Form
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The treating health care provider of the patient, who may be the employee or the employee's family member. The provider certifies the serious health condition, treatment and hospital dates, and expected absences, then signs with name, license number, state and business name.
Not always. For bonding, Section 3 lets the employee supply a copy of the birth certificate or adoption or foster placement documents instead, with the healthcare provider certification in Section 2 as one of the listed options.
MetLife warns that forms marked lifetime, unknown, as needed, indeterminate or similar may be returned as incomplete. The employee's name and claim number are needed on every page so MetLife can match the certification to the absence request, and intermittent leave needs a frequency and episode length.