Letter to Employees to Initiate Fmla s1

[COMPANY]

LETTER TO EMPLOYEE: FMLA/CFRA LEAVE DURING WORKERS’ COMPENSATION

Dear [employee name]:

[The Company] ______has received information indicating you are absent due to a work-related injury, or Workers’ Compensation. This qualifies you for state and federal family and medical leave. Effective the date of this notice, we are placing you on FMLA/CFRA. FMLA/CFRA entitles you to twelve (12) weeks of leave in a twelve (12) month period. Your FMLC/CFRA leave will run concurrently with your Workers’ Compensation leave. You previously have used ______[days/hours] of FMLA/CFRA during the current 12-month period and thus the total remaining FMLA/CFRA available to you is ______[days/hours].

Workers’ Compensation will cover your costs related to your treatment of your work-related injury as well as provide you with partial wage replacement.

While on FMLA/CFRA leave, your health benefits will continue for a maximum of twelve weeks. If you currently contribute to the payment of benefits, you must continue to do so while on leave, beginning on ______[date]. The amount of each payment is $______and must be paid to the Company. The payments will be due on or before the ____ [day] of each month. Your coverage will end on ______if you do not return to work at which time you will be eligible for COBRA. Information pertaining to COBRA will be sent at that time.

You will find enclosed a Request For Leave Of Absence form and a Certification Of Health Care Provider form. Please return these forms to [Company] on or before ______[insert date, allow 15 days].

Please contact ______at (___)___-____ if you have any questions or would like any more information regarding FMLA/CFRA leave, Workers’ Compensation or other benefits. We wish you the best and look forward to your return.

Sincerely,

______

P•A•S Associates has expertise in human resources and other areas involving employment issues. P•A•S Associates, in providing this form, does not represent that it is acting as an attorney or that it is giving any form of legal advice or legal opinion. P•A•S Associates recommends that before making any decision pertaining to human resource issues or employment issues, including the utilization of information contained on this website, the advice of legal counsel to determine the legal ramifications of the use of any such information be obtained.ÓP·A·S Rev. 03/09