Download Sample Letter - Princeton University

Date
SAMPLE LETTER #1
Name
Address
City, State Zip
Dear
:
Our office has been notified that you have been absent from work due to an illness, nonwork related injury, or pregnancy since _____________. You may be eligible to receive
short term disability benefits. To determine if you are eligible to receive benefits for this
period of absence, the enclosed Application for Temporary Disability Benefits and
Medical Certificate must be completed by you and your attending state-authorized health
care provider and returned to the Office of Employee Health by (2 weeks from 1st day
out). If the application and medical certificate are not received in a timely manner, your
short term disability claim will not be processed and your absence may be charged to
leave without pay and you may be subject to disciplinary action, including termination.
Time absent from the workplace because of a documented short term disability is also
counted as time taken under the federal Family and Medical Leave Act (FMLA). FMLA
covers regular full-time and part-time employees who have at least one year of benefits
eligible service. It provides that an employee may take leave of up to 12 weeks within a
12-month period for a serious personal illness, and it guarantees that the employee can
return to the same or comparable position.
The University pays short term disability benefits to employees who are ill or injured
provided they are: 1) approved for benefits through the application process; 2) under the
continuous care of a health care provider; and 3) are unable to work. The maximum
amount of time you are eligible to receive short term disability benefits is twenty-six (26)
weeks.
If your application is approved and you are eligible to receive disability benefits, your
physician will be required to submit medical updates on a regular basis, if applicable.
When your health care provider indicates that you are able to return to work, you must
call the Office of Employee Health at (609) 258-5035 to schedule an appointment with
the employee health care provider on or preferably before the morning of your return to
work.
If you have any questions regarding the short term disability policy, please feel free to
contact the Office of Human Resources at (609) 258-3302.
Sincerely,
Department Designee
Title
Enclosures
c:
Human Resources