Walmart FMLA Leave of Absence Form: Sedgwick Filing and Deadlines

To take FMLA leave from Walmart, you file the leave of absence claim through Sedgwick, Walmart’s third-party leave administrator, either online at mySedgwick.com or by calling 800-492-5678.¹ There is no single “Walmart FMLA leave of absence form” you download and hand to your manager. Instead, Sedgwick opens a claim, sends you a medical certification form for your doctor to complete, and reviews the paperwork against federal FMLA rules. Getting the claim approved comes down to three things: confirming you’re eligible, giving your provider a clear certification form to fill out, and returning it within 15 calendar days.

Confirm You’re Eligible Before You File

Three requirements all have to be true before Walmart owes you FMLA protection. You need at least 12 months of employment with Walmart (they don’t have to be consecutive), at least 1,250 actual hours worked in the 12 months right before your leave starts, and a work location where Walmart employs 50 or more people within a 75-mile radius.²¹

That 1,250-hour count is stricter than most people expect. Only time actually worked on the clock counts. Paid time off, vacation, and sick leave don’t add to the total.³ If you’re close to the line, your People Lead or the GTA Portal can pull your hours. Associates who don’t clear all three thresholds may still be able to take a personal or non-FMLA leave through Sedgwick, but that leave won’t carry federal job protection.

FMLA covers up to 12 workweeks of unpaid, job-protected leave in a 12-month period for your own serious health condition, to care for a spouse, child, or parent with a serious health condition, for the birth of your child or placement of a child through adoption or foster care, or for a qualifying military exigency.⁴ A separate 26-workweek entitlement exists for military caregiver leave.⁵

Give Notice on Time

If you know your leave is coming — a scheduled surgery, a due date, a course of treatment — federal law requires at least 30 days’ notice before it starts.⁶ For an emergency, notify Walmart the same day or the next business day. For maternity leave, Walmart specifically recommends opening the Sedgwick claim before the baby’s due date so pay and benefits aren’t delayed.¹ Waiting to report an absence can rack up occurrences in the attendance system before your leave is even open.

Open the Claim with Sedgwick

Start online at mySedgwick.com or by phone at 800-492-5678.¹ Have this information in front of you when you file:

Your WIN (Walmart Identification Number), which links the claim to payroll and scheduling
Your facility number, found on your pay stub or in the associate portal
Your supervisor’s name and contact information, so Sedgwick can coordinate coverage
Your healthcare provider’s full name, office address, phone number, and fax number, because Sedgwick can send the certification form directly to the office
Anticipated leave dates, including a start date and an expected return date even if approximate

If your state runs its own paid family leave program, you file with the state separately in addition to opening the Sedgwick claim. Your initial Sedgwick packet flags any state program that applies to you.¹

When you open the claim, Sedgwick asks whether your leave will be continuous (one uninterrupted block, such as six weeks of surgical recovery) or intermittent (periodic absences, such as recurring treatment or flare-ups of a chronic condition). Both draw from the same 12-workweek bank, but intermittent leave is tracked in smaller increments. Whatever you pick, your doctor’s certification has to match it. A mismatch is a common cause of delay.

Get the Medical Certification Right

The medical certification is where most claims stall. Your provider does most of the writing, but the responsibility to get it completed correctly and returned on time is yours. The Department of Labor publishes two standard forms, and Sedgwick will typically send one of them: WH-380-E for your own serious health condition, and WH-380-F for leave to care for a family member.⁷ If Sedgwick doesn’t send the form, you can download it from the DOL site.

What Your Doctor Must Document

The certification isn’t a request for your full medical file. It asks for the specific facts that establish the leave qualifies under federal law:⁸

The approximate date the condition began or is expected to begin
The probable duration of treatment or recovery
Relevant medical facts, such as symptoms, diagnosis, hospitalizations, prescribed medications, or referrals
A statement that you cannot perform one or more essential job functions, when that is the basis for leave

For intermittent leave, the provider also has to estimate how often episodes will occur and how long each one will last.⁹ Answers like “unknown” or “indefinite” usually aren’t specific enough. Ask your doctor for concrete estimates based on their medical judgment, even if approximate. Blank sections and vague answers are the two most common reasons Sedgwick sends a certification back.

Return the Form Within 15 Calendar Days

Once Sedgwick requests the certification, you have 15 calendar days to return it.¹⁰ Miss this window and the consequences depend on whether the leave was foreseeable: FMLA protection can be denied outright for unforeseeable leave, or delayed for foreseeable leave. This deadline is the single most common failure point, and it usually isn’t about the medical facts. It’s about paperwork arriving late.

You can submit the completed form three ways: upload a scanned copy to the mySedgwick portal, fax it to the number in your leave packet, or mail it. Portal uploads confirm receipt fastest. If you fax, save the transmission confirmation. If you mail, use tracking.

If your certification comes back incomplete or insufficient — a section left blank, an answer too vague to evaluate — Sedgwick tells you what’s missing and gives you seven calendar days to cure it.¹¹ Check the mySedgwick portal regularly during this stretch. A cure request that comes through the portal can easily slip past you if you’re only watching email.

What Sedgwick Sends Back

After you file, expect two separate notices. The first is an eligibility notice confirming whether you meet the basic FMLA thresholds; the employer has to issue it within five business days of your request.¹² The second is a designation notice, which tells you whether your leave is approved as FMLA-qualifying and how it will count against your 12-workweek bank. Both come through whichever channel you selected in the portal, email or postal mail.

Coverage and Your Job While You’re Out

Walmart has to keep your group health plan active during FMLA leave on the same terms as if you were still working.¹³ Family coverage stays family coverage. Plan changes offered to other associates while you’re out are offered to you too. Because FMLA leave is unpaid at the federal level, though, your share of the premium still has to be paid, and it can’t come out of a paycheck that isn’t there. Your Sedgwick packet or People Lead will explain how to send premium payments during your leave. Skipping payments can eventually cost you coverage, though Walmart has to give notice and a grace period first.

When your approved leave ends, Walmart has to restore you to your original position or to an equivalent one — same pay, same benefits, same working conditions — even if the role was covered by someone else or restructured while you were gone.¹⁴ “Equivalent” means virtually identical duties, responsibilities, skill level, and authority.¹⁵ A narrow “key employee” exception exists for salaried associates in the highest-paid 10 percent within 75 miles of the worksite, but it doesn’t apply to the vast majority of hourly Walmart associates.¹⁶

If Your Claim Is Denied

Read the denial notice first. The reason is almost always one of three things: a missed deadline, an incomplete medical certification, or not meeting the eligibility thresholds. Paperwork problems are often fixable — resubmit the missing information within the cure window Sedgwick gives you.

If you believe your FMLA rights were violated, whether through a wrongful denial, retaliation for requesting leave, or a failure to reinstate you, you can file a complaint with the U.S. Department of Labor’s Wage and Hour Division. An employer that fails to provide required eligibility or designation notices can be liable for lost compensation, lost benefits, and other damages.¹²

1
Walmart. Leave of Absence (LOA) Overview
2
Office of the Law Revision Counsel. 29 US Code 2611 – Definitions
3
U.S. Department of Labor. FMLA Frequently Asked Questions
4
Office of the Law Revision Counsel. 29 US Code 2612 – Leave Requirement
5
U.S. Department of Labor. Fact Sheet 28M – Using FMLA Leave Because of a Family Members Military Service
6
eCFR. 29 CFR 825.302 – Employee Notice Requirements for Foreseeable FMLA Leave
7
U.S. Department of Labor. FMLA Forms
8
eCFR. 29 CFR 825.306 – Content of Medical Certification
9
U.S. Department of Labor. Certification of Health Care Provider for Employees Serious Health Condition Under the Family and Medical Leave Act
10
eCFR. 29 CFR 825.313 – Failure to Provide Certification
11
eCFR. 29 CFR 825.305
12
eCFR. 29 CFR 825.300 – Employer Notice Requirements
13
eCFR. 29 CFR 825.209
14
eCFR. 29 CFR 825.214 – Employee Right to Reinstatement
15
Office of the Law Revision Counsel. 29 US Code 2614 – Employment and Benefits Protection
16
U.S. Department of Labor. Family and Medical Leave Act Advisor – Key Employees and Their Rights