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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