Forms For Employee/Claimant To Download
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	Disability Forms Physician's Certificate for Disability Benefits - PDF If your Physician prefers to submit a paper form rather than phone Sedgwick CMS with your initial medical certification, please download this form, complete Part 1 and give it to your Physician to complete and return to Sedgwick CMS. Request for Extension of Self-Insured Disability Benefits - PDF If you have not recovered or you are not able to return to work on your scheduled return to work date, and your Physician is unable or unwilling to phone Sedgwick CMS with your extension for disability benefits, download this extension form, complete Part 1 and give it to your physician to complete and return to Sedgwick CMS in order to continue your disability benefit payments. Authorization for Release of Information (ROI) - PDF Every new leave request filed with Sedgwick CMS requires this completed form. Please download this form, complete and sign both sections and return it to Sedgwick CMS immediately. If you complete this form prior to receiving the form in the mail, please ignore the one you receive in the mail. Sedgwick CMS only needs one copy of this signed form for our files. Right of Reimbursement (ROR) - PDF Every new leave request filed with Sedgwick CMS requires this completed form. Please download this form, complete and sign it, and immediately return the form to Sedgwick CMS. If you complete this form before receiving the form by mail, please disregard the form you receive by mail. Sedgwick CMS only needs one copy of this signed form on file. Paid Family Leave Forms Physician's Certificate For Paid Family Leave - PDF If your Physician prefers to submit a paper form rather than phone Sedgwick CMS with your initial medical certification, please download this form and immediately give it to the Physician to complete and return to Sedgwick CMS. Paid Family Leave Bonding Evidence of Relationship (EOR) - PDF For specific information on what constitutes evidence of relationship with your child for bonding purposes, please download this informational document. Authorization for Release of Information Paid Family Leave Bonding (ROI) - PDF Every new claim filed with Sedgwick CMS requires this completed form. Please download this form, complete and sign it, and immediately return the form to Sedgwick CMS. If you complete this form before receiving the form by mail, please disregard the form you receive by mail. Sedgwick CMS only needs one copy of this signed form on file. Right of Reimbursement for Paid Family Leave (ROR) - PDF Every new claim filed with Sedgwick CMS requires this completed form. Please download this form, complete and sign it, and immediately return the form to Sedgwick CMS. If you complete this form before receiving the form by mail, please disregard the form you receive by mail. Sedgwick CMS only needs one copy of this signed form on file. Care Recipient's Authorization for Release of Information Paid Family Leave (ROI) - PDF Every new claim filed with Sedgwick CMS requires this completed form. Please download this form, have the care recipient complete and sign it, and immediately return the form to Sedgwick CMS. If the care recipient completes this form, please disregard the form you receive by mail. Sedgwick CMS only needs one copy of this signed form on file. Authorization for Release of Information for Paid Family Leave (ROI) - PDF Every new claim filed with Sedgwick CMS requires this completed form. Please download this form, complete and sign it, and immediately return the form to Sedgwick CMS. If you complete this form before receiving the form by mail, please disregard the form you receive by mail. Sedgwick CMS only needs one copy of this signed form on file. Right of Reimbursement for Paid Family Leave Bonding (ROR) - PDF Every new claim filed with Sedgwick CMS requires this completed form. Please download this form, complete and sign it, and immediately return the form to Sedgwick CMS. If you complete this form before receiving the form by mail, please disregard the form you receive by mail. Sedgwick CMS only needs one copy of this signed form on file. Family Medical Leave Forms CFRA (California Family Rights Act) Certification - PDF This form is applicable for California employees that have filed for Unpaid Leave (FML or CFRA). Please download this form and have your Physician complete it and return it to Sedgwick CMS immediately. FML (Family Medical Leave) Certification - PDF This form is applicable for employees that have filed for Unpaid leave (FML). Please download this form and have your Physician complete it and return it to Sedgwick CMS immediately. PDF file requires Adobe Acrobat Reader