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Unum CL-1334-CO: Colorado FAMLI Provider Certification

Employers whose Colorado FAMLI coverage is a private plan insured by Unum send paid leave claims to Unum, and this eight-page packet carries the medical certification. The provider of the employee, or of the family member receiving care, completes pages 6 and 7: when the condition started, how long it will last, which serious health condition category applies and how much continuous, intermittent or reduced-schedule leave is needed.

Who completes it

The employee completes the statement on pages 1 and 2, the authorization on page 3 and the top of page 6 (patient, relationship, care to be given), and the employer completes pages 4 and 5. The health care provider answers Medical Facts questions 1 to 7 and question 8 on leave needed, then signs page 7.

Submitting and payment

How to submit it
Fax or mail the certification to Unum's Benefits Center in Columbia, South Carolina, using the details printed on each page. The employee's complete application is due within 30 calendar days from the start of leave, so a prompt return matters.

Good to know

  • Give specific estimates of frequency and duration. The provider instructions warn that answers such as lifetime, unknown or indeterminate may not be enough to decide FAMLI coverage.
  • Question 7 asks you to check a serious health condition category, such as Absence Plus Treatment or Chronic Conditions Requiring Treatment; page 8 defines each category.
  • Question 8 splits leave into a continuous period, intermittent flare-ups or appointments (with hours per week or visit frequency) and a reduced schedule in days per week.
  • Leave out genetic information and family medical history, as the GINA notice on page 6 asks, and limit answers to the condition behind the leave request. Revision 08/26 is current.

Get the official form

Download the current version from the source each time; forms change without notice.

Colorado FAMLI Certification of Health Care Provider

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who signs Unum form CL-1334-CO?

The health care provider of the employee or of the family member signs page 7 and adds a printed name, type of practice or job title, a provider certification license number (NPI if practicing out of state), phone and fax. The employee signs separately at the top of page 6 and on the employee statement.

What does Absence Plus Treatment mean on CL-1334-CO?

Page 8 defines it as incapacity of more than three consecutive calendar days that also involves treatment two or more times, in person or by telehealth, or one treatment that leads to a regimen of continuing treatment under a provider's supervision. Pregnancy, chronic conditions and multiple treatments are separate categories.

Does CL-1334-CO apply to every Colorado FAMLI claim?

No. It is Unum's certification for employers whose FAMLI coverage is a private plan insured by Unum, so the claim is decided by Unum. Unum pairs the packet with its CL-1088-PFL authorization, which appears as page 3 of the packet.