When FMLA military caregiver leave for a current service member is administered by Sun Life, the service member's provider completes this form, which mirrors the federal WH-385. The provider confirms whether the injury or illness arose in the line of duty, classifies its severity and estimates the continuous, appointment and intermittent care needed.
The employee completes Section 1 (employee and service member information and care to be given); the service member's health care provider completes Section 2, Parts A to C, and signs Section 3.
Download the current version from the source each time; forms change without notice.
Family and Medical Leave Act (FMLA) – Serious Injury or Illness of a Current Service Member for Military Caregiver Leave
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A DoD health care provider, a VA provider, a TRICARE network or non-network authorized private provider, or any health care provider as defined in 29 C.F.R. 825.125. The provider checks which type applies in Part A of Section 2.
The provider indicates whether the injury or illness was incurred in the line of duty on active duty, existed before active duty and was aggravated by service in the line of duty, or neither. Military caregiver leave requires one of the first two.
GAMSFM-11126 covers a covered veteran's serious injury or illness, mirroring the WH-385-V. GAMSFM-11125 is only for current members of the Regular Armed Forces, National Guard or Reserves, including those on the temporary disability retired list.