FMLA, Family Care Leave, & Short-Term Disability Forms

Please Note – As of January 1, 2018, VZ has changed the administrator for short-term disability to Sedgewick.  Metlife will no longer be the administrator.

Verizon has made changes to the administration of FMLA.

  • The company will no longer automatically send FMLA forms.  You need to request them from your supervisor or absence administrator.  You can also download a set of FMLA forms, as well as short-term disability forms below.
  • A reminder, if you are out for more than 5 business days (7 calendar days) YOU must call Sedgewick to open a short-term disability claim.
    • The number to call 800-638-4228
      The fax number for Sedgewick to submit documents is 859-264-4384.
  • For FMLA / Short Term Disability Guidelines Click Here

Application for Family Care Leave (FCL)

FMLA Forms

Sedgewick Attending Physicians Statement

Sedgewick Attending Physicians Statement for Behavioral Health Services

Sedgewick Short Term Disability Authorization to Disclose Medical Info