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UCLA Health Human Resources


Employee - Work Related Injury or Illness

 Leave of Absence - UCLA Health Human Resources 

Employee-Work Related Illness or Injury

Step 1) Inform your department head, manager or supervisor about taking a leave of absence as soon as possible.

Inform your department head, supervisor or manager of your leave request 30 days prior to your anticipated leave begin date, or as soon as reasonably possible. It's best to do this as soon as your need arises, so your department can plan your absence. Try to be as specific as possible about the length of time and reasons for the leave of absence.

Step 2) Complete your Employee's Serious Health Condition Leave of Absence Packet.

Print and complete the employee section in the Leave of Absence packet and have your authorized workers' compensation provider/physician complete the Health Care Provider Certification. (This form should be completed and returned within 15 calendar days. If unable to do so please contact your WFA/HR Representative with the reasons for the delay & the date the forms will be provided.) The packet should be completed when you meet with your WFA/HR Representative.

A workers' compensation disability may qualify as own serious health condition for FMLA and the leave will run concurrently.

Step 3) Submit your Leave of Absence Notification (LOAN).

Complete and submit your Leave of Absence Notification and follow as instructed. Please ensure that your LOAN is approved by your supervisor/manager and forwarded to your Workforce Administrator (WFA)/HR Representative.

Step 4) Contact your WFA/HR Representative.

If your worker's compensation has been approved contact Health System HR Workers' Compensation Unit to discuss supplemental pay options to the workers' compensation temporary disability benefits.

--For your review, please see this comparison between the supplemental pay options (link).

If your workers' compensation has been delayed or denied, please discuss with your Human Resources Representative regarding your accrual balance and other disability pay benefits you may be eligible for.

--If your workers' compensation claim is approved at a later date, please contact the Health System Human Resources Workers' Compensation temporary disability benefits with any accruals/disability pay you may have received.

Step 5) Stay in touch.

Keep your supervisor/manager and your WFA/HR Representative informed of any delays on your return date. If there is any need to extend your leave date, you must inform your supervisor/manager and WFA/HR Representative immediately by submitting a doctor's note that states your new anticipated return to work date.

Step 6) Returning to Work.

Submit your Return to Work Certification form to your supervisor/manager and WFA/HR Representative on your first day back from work. If you cancelled your benefits when you were on leave, you have 31 days from your return date to work to re-enroll by submitting a UPAY-850 to your Benefits Analyst.

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