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FMLA SAMPLE LETTER CONTENTS Denying FMLA for Lack of Qualifying Medical Issue7/2013DateNameAddressDear…..This letter is to inform you that your application for coverage under the Family and Medical Leave Act (FMLA) has been denied. This denial is based on the information provided in the Certification of Health Care Provider. The information provided does not indicate an FMLA qualifying serious medical condition exists at this time.Through this letter you are notified that the preliminary designation of FMLA coverage provided on (DATE) is withdrawn. Absences which occurred under the preliminary designation will not be covered. You may reapply for FMLA coverage at any time in the future if you are experiencing a serious medical condition. Future determination of FMLA coverage will be determined based on the medical information provided on the Certificate of Health Care Provider Form. If you should have any questions, or I can assist you in the future with FMLA issues, you may contact me at (CONTACT INFORMATION).Sincerely,cc: Director/Supervisor File ................
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