Workers Compensation and FMLA Concurrent Sample Letter: Guide For Employers & Employees

Getting hurt on the job throws every part of your life into chaos—especially when you’re trying to protect both your pay and your job security. Many people don’t realize you can run workers comp and FMLA leave at the same time, and having the right documentation makes this process painless. That’s why a proper Workers Compensation and FMLA Concurrent Sample Letter is one of the most valuable tools you can have during recovery.

Too many people lose benefits or job protection because they submit unclear, incomplete notices. Even small mistakes on leave documentation can lead to delayed pay, denied claims, or unexpected termination. Every example here follows federal DOL guidelines so you can adapt them with confidence.

What Makes Concurrent Leave Documentation Different?

When you run workers compensation and FMLA at the same time, you aren’t just requesting time off. You are formally notifying your employer that your leave qualifies for both legal protections at once. Submitting the correct letter prevents your employer from counting your recovery time against your attendance or terminating your position while you heal.

Most people make one of three common mistakes when filing:

• Only notifying HR about one benefit program
• Missing the 5-day notice window for workers comp
• Failing to attach required medical documentation

The below table shows how these two benefits interact when filed correctly:

Workers Compensation and FMLA Concurrent Sample Letter: Employee Initial Notification

Subject: Formal Notice: Concurrent Workers Compensation & FMLA Leave Request

Dear [HR Manager Name],

I am writing to formally notify you that I sustained a work-related back injury on October 12, 2024, while lifting inventory at the west warehouse. Per federal guidelines, I am requesting that my upcoming medical leave be designated as concurrent Workers Compensation and FMLA leave effective immediately.

Attached you will find the work injury report, my doctor’s off-work order, and completed FMLA certification form. I will provide status updates every 14 days as requested. Please confirm receipt of this request within 3 business days.

Regards,
[Employee Full Name]
[Employee ID #]

Workers Compensation and FMLA Concurrent Sample Letter: Employer Acknowledgement

Subject: Confirmation: Your Concurrent Workers Comp & FMLA Leave Request

Dear [Employee Name],

We have received and reviewed your request for concurrent Workers Compensation and FMLA leave dated October 13, 2024. This letter confirms your leave has been approved for both benefits effective October 12, 2024.

Your FMLA job protection will remain active through January 10, 2025. Workers compensation wage replacement payments will begin processing within 7 business days. You may contact the benefits team at any time with questions.

Sincerely,
[HR Benefits Coordinator]
Company Human Resources

Workers Compensation and FMLA Concurrent Sample Letter: Leave Extension Request

Subject: Request: Extension of Concurrent Workers Comp & FMLA Leave

Dear HR Department,

My treating physician has ordered an additional 4 weeks of rest following my follow-up appointment on November 20, 2024. I am requesting to extend my concurrent Workers Compensation and FMLA leave through December 21, 2024.

Attached is the updated medical work restriction form and signed FMLA extension certification. I will notify you immediately if my return to work date changes.

Thank you,
[Employee Name]

Workers Compensation and FMLA Concurrent Sample Letter: Partial Return To Work Notice

Subject: Notice: Partial Return To Work On Concurrent Leave

Dear Manager & HR Team,

My doctor has cleared me to return to work on modified light duty effective December 5, 2024. I will remain on concurrent Workers Compensation and FMLA leave for the remaining hours I am unable to work each week.

Attached are the official light duty work restrictions. Please coordinate with my supervisor to assign appropriate work tasks that align with these limits.

Regards,
[Employee Name]

Workers Compensation and FMLA Concurrent Sample Letter: Claim Denial Appeal

Subject: Appeal: Incorrect Leave Designation For Work Injury

Dear Workers Comp Coordinator,

I am appealing the decision to only assign FMLA leave for my October 12 work injury. This leave qualifies for concurrent Workers Compensation and FMLA coverage per DOL regulation 825.203.

Attached you will find witness statements for the injury, emergency room records, and a formal claim appeal form. Please review this request and respond within the required 14 day window.

Sincerely,
[Employee Name]

Workers Compensation and FMLA Concurrent Sample Letter: Supervisor Internal Notification

Subject: Internal Notice: Team Member On Concurrent Leave

Dear Department Supervisors,

This notice is to inform you that [Employee Name] has been approved for concurrent Workers Compensation and FMLA leave effective October 12, 2024. This employee is protected from adverse employment action for the duration of this leave.

Do not contact this employee for work related matters unless pre-approved by HR. All schedule adjustments for this role should be coordinated through the operations lead.

Thanks,
HR Department

Workers Compensation and FMLA Concurrent Sample Letter: Return To Work Full Clearance

Subject: Notice: Full Return To Work & End Of Concurrent Leave

Dear HR Department,

I am writing to notify you that my doctor has cleared me for full unrestricted work duty effective January 12, 2025. This letter serves to formally end my concurrent Workers Compensation and FMLA leave on that date.

Attached is the full medical clearance form. Please confirm my scheduled return shift time with my direct supervisor.

Thank you for your support during my recovery,
[Employee Name]

Frequently Asked Questions about Workers Compensation and FMLA Concurrent Sample Letter

Can I run Workers Compensation and FMLA at the same time?

Yes, federal law allows you to use both benefits concurrently for work-related injuries. This gives you wage replacement from workers comp and job protection from FMLA at the same time.

When do I need to submit this letter?

You should submit this letter within 5 business days of your work injury or medical diagnosis. Most employers and state workers comp boards require formal written notice.

Do I need a doctor's note with this letter?

Yes, always attach a signed medical certification with your letter. Both FMLA and workers comp require official medical documentation to approve your leave.

Can my employer refuse concurrent leave designation?

Your employer can only refuse if you do not meet eligibility requirements for either benefit. If you qualify for both, they are legally required to allow concurrent designation.

How long can concurrent leave last?

Concurrent leave can last up to 12 weeks while FMLA protection is active. After that, workers compensation benefits may continue if you are still recovering.

Who should I send this letter to?

Send this letter to both your direct supervisor and your company's HR benefits coordinator. Always keep a dated copy for your personal records.

Can I use this letter for all work injury types?

This letter works for all work related injuries, illnesses, and required medical recovery periods. You can adjust the details to match your specific injury situation.

What happens if I don't file a formal letter?

Without formal written notice, your employer is not required to apply both benefit protections. You may lose pay, job security, or have your workers comp claim delayed.

Navigating work injury benefits does not have to be confusing or stressful. Using the right Workers Compensation and FMLA Concurrent Sample Letter ensures you protect both your income and your job while you focus on healing. Every example in this guide follows current federal guidelines, so you can adapt them quickly for your situation.

Save this page for reference if you or a coworker ever experiences a work injury. Always send letters via tracked email or certified mail, and keep copies of all documentation. If you have unique circumstances, reach out to your state labor board or a local workers comp advocate for additional support.