Disability & Medical Leave

Questions?
Contact Wayne County Benefits & Disability Administration at 313-224-5157 or email disability@waynecountymi.gov. Disability Administration fax number is 313-967-1243.

Leave of Absence Information

Healthcare Provider Forms

Note: It is important that the department personnel officer is immediately made aware of any leave in order to comply with Federal notice regulations under the Family Medical Leave Act.

• Family Medical Leave Act(PDF, 488KB)
• Employee - Certification of Health Care Provider(PDF, 285KB)
• Family Member - Certification of Health Care Provider(PDF, 358KB)
• Military Family - Certification of Qualifying Exigency(PDF, 258KB)
• Injured Service Member(PDF, 163KB)
• Leave of Absence Request Form(PDF, 531KB)
• Return From Leave Notice(DOC, 45KB)
• Eligibility and Rights #26 Responsibilities(PDF, 369KB)
• Authorization to Release Health Care Information(DOC, 117KB)

Know Your Rights

• Know Your Rights Poster (June 2023)(PDF, 493KB)

Long-Term Disability Plan Information

• County LTD Plan(PDF, 125KB)
• TCC LTD Plan(PDF, 816KB)

Workers' Compensation Information

• Injury Report(PDF, 285KB)
• Approved Work Comp Medical Facilities(PDF, 57KB)
• Michigan Workers' Disability Compensation Rights & Responsibilities(PDF, 51KB)