As a mental health provider, you may be asked to complete FMLA (Family and Medical Leave Act), state leave, or disability paperwork for a client. It’s a meaningful opportunity to advocate for their well-being, and also a moment to pause and reflect on your clinical role, documentation, and ethical boundaries.
This guide walks you through the key considerations, questions, and best practices to help you determine whether completing the requested paperwork aligns with your scope, clinical judgment, and the client’s needs.
Step 1: Do I Qualify as a Certifying Provider?
Before you complete any leave of absence paperwork, it’s important to confirm that you’re legally allowed to do so. To start, you must be independently licensed in your state and permitted to diagnose and treat mental health conditions. For further guidance on how to determine this, see our help center article.
Step 2: Understand Leave Types - Intermittent vs. Block Leave
When a client wants to request FMLA leave, you should first determine which type of leave matches their clinical needs. Choosing the correct type ensures that the client receives the right level of support while maintaining compliance with Rula partner requirements. For further guidance on best practices and partner requirements, see our help center article.
Step 3: Evaluate Clinical & Ethical Considerations
Before agreeing to complete leave of absence documentation, it can be important to take a step back and evaluate all aspects of this request, such as:
Assessment of symptoms:
- Do I have enough experience treating this client to accurately assess this client’s condition, needs, and functional impairments?
- Does the client’s condition rise to the level of a serious health condition as defined by FMLA? Here’s a useful tool from the US Department of Labor to help you decide!
- How has the client’s condition negatively impacted their ability to function in their job?
- Would time off support the client’s treatment goal(s)?
Clinical Boundaries and Ethics:
- Would another provider (e.g., psychiatrist, PCP) be better suited to evaluate this client’s need for a leave of absence?
- Am I qualified and comfortable determining the impact of this condition on their ability to work?
- Is there any risk to our therapeutic relationship (e.g., role strain, pressure to overstate symptoms) or to the client?
- Have I engaged the client in an exploration of the pros and cons of FMLA/disability leave and explored potential alternatives, such as additional treatment, engaging the client’s supervisor, and self-help resources?
- Am I staying within my legal and ethical boundaries?
Documentation:
- Do I have sufficient clinical documentation to support their request? Do my clinical notes reflect the severity and duration of symptoms?
Asking yourself these questions helps ensure that completing leave of absence paperwork is clinically appropriate, ethically sound, and aligned with your professional scope. This protects both you and your client by supporting care and reducing risk.
Step 4: Support the Client
Once you have evaluated the appropriateness of the request, you have the ability to proceed forward with one of two paths:
- Path 1: Collaborating with the client to complete required paperwork, or
- Path 2: Explaining to the client why you cannot assist the client with their request and offer referral for an evaluation by an MD, if clinically appropriate.
Path 1: Best Practices for Completing Leave of Absence Paperwork
If your licensing board allows for completion of LOA paperwork and your clinical assessment is that the client would benefit from a leave of absence, be sure to adhere to the following best practices:
1. Be Clear and Objective
Avoid jargon. Use behavioral descriptions, such as: “Client reports daily panic attacks that prevent them from driving and attending team meetings, leading to increased absenteeism.”
2. Focus on Function, Not Just Diagnosis
FMLA is typically based on impairment, not the presence of a mental health condition alone. Describe how symptoms impact your client’s ability to perform essential work tasks.
“Client reports that daily panic attacks have resulted in frequent trips to the ER and other medical appointments during work hours for evaluation, resulting in work absenteeism. She also reports 3 separate instances in which she missed up to 3 days of work after a panic attack due to feeling fatigued and dissociated. Client reports that as a result of her panic attacks, she was placed on a performance improvement plan at work due to missed work days and poor productivity rates.”
3. Be Thoughtful About Duration
Whether recommending a modified schedule or intermittent leave, align your recommendation with the clinical course and prognosis. Avoid requesting a continuous leave period (especially of >2 weeks) without evaluation by an MD treating the client (such as their PCP or psychiatrist).
4. Document Your Process
If you agree to complete paperwork, make sure to document your rationale, conversations with the client, and other relevant information in the medical record.
Path 2: Best Practices for Declining Leave of Absence Requests
There may be times when completing FMLA/disability paperwork isn't clinically appropriate, falls outside your scope, or could compromise your ethical boundaries. Here are some suggestions on how to do it with professionalism, clarity, and care:
1. Clarify the Reason Internally First
Before speaking with the client, ensure you’re clear on why you’re declining. Common, valid reasons include:
- You haven’t seen the client long enough to assess functional impairment.
- The client’s condition doesn’t meet the criteria for a serious health condition.
- You’re not eligible to complete the paperwork.
- The request feels ethically concerning (e.g., pressure to misrepresent symptoms).
2. Communicate Transparently and Compassionately
Aim for a tone that’s collaborative, boundaried, and affirming of the client’s needs, while also clear on your limits.
Try language like:
“I understand that taking leave may feel necessary right now, and I want to support your well-being. However, based on our limited clinical history and my current understanding of your symptoms, I’m not the right provider to complete this paperwork.”
3: Offer Alternatives
When appropriate, support your client by suggesting a next step:
- Refer to a psychiatrist, primary care provider, or other qualified clinician for further evaluation.
- For non-Kaiser clients, you can refer to a Rula medication management provider for a mental health evaluation using this form.
- Kaiser clients should always be referred back to Kaiser for Continuous Leave of Absence evaluations.
- Explore other supports (e.g., flexible work schedules, ADA accommodations, short-term coping tools).
4. Document
Document the request in the client’s chart along with your clinical rationale for declining and any referrals or alternatives discussed.
Example: “Client requested FMLA paperwork. Informed client that due to brief treatment duration and insufficient clinical evidence of functional impairment, therapist cannot complete form on their behalf. Offered to refer to PCP. Client verbalized understanding.”
Additional Ways to Support a Client’s Leave of Absence or Disability Request
Even if you choose not to complete leave of absence paperwork, you can still support your client by providing a Treatment Summary. This can accompany documentation from a certifying provider to strengthen the client’s request.
Please note that a Treatment Summary is not sufficient on its own for leave of absence approval, but can support your client’s case.
Best Practices:
- Secure written consent before sharing any information with a third party.
- Include only the minimum necessary information to protect client privacy.
- Keep the tone objective, professional, and clinically focused.
What to Include:
-
Overview of Treatment:
- Start/end dates of care
- Primary concerns or diagnosis (if applicable)
- Symptom severity and impact on functioning
-
Treatment Goals:
- Goals established in therapy
- Status: in progress or achieved
-
Progress in Treatment:
- Notable improvements or barriers
- Plans for ongoing care or reason for ending treatment (if applicable)
Completing FMLA paperwork is an opportunity to support your client during a vulnerable time. It's also a moment to center clinical integrity, thoughtful boundaries, and best practice. If you're ever unsure, don't hesitate to reach out to quality@rula.com for support!
To learn more about FMLA and Disability requests, please read this article:
Disability and FMLA Requests: Therapist Scope and Compliance Guidelines
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