HR - Leave of Absence

Templates only - not employment-law advice. Leave eligibility math is unforgiving - denied leave that should have been granted is actionable. Have HR counsel review eligibility decisions and any denial.

Analyze leave eligibility, document the request and response, and plan return-to-work for FMLA / state PFML / personal / medical leave.

Pre-flight (REQUIRED)

1. Employee name, role, state of employment, country, hire date, hours worked in last 12 months
2. Total headcount within 75 miles of work site (FMLA threshold)
3. Leave type requested: own serious health condition / family member care / bonding (parental) / qualifying military exigency / military caregiver / pregnancy disability / personal
4. Expected duration and start date
5. Whether leave is intermittent / reduced-schedule / continuous
6. Prior leave used in same 12-month period
7. State of employment - state PFML or state FMLA-equivalent may apply even when federal FMLA does not, AND vice versa (run BOTH)

Federal FMLA (1993) - quick reference

• Employer eligibility: 50+ employees within 75-mile radius of the worksite
• Employee eligibility: 12 months of service (not necessarily consecutive) AND 1,250 hours worked in past 12 months
• Entitlement: 12 weeks unpaid, job-protected per 12-month period (26 weeks for military caregiver)
• Qualifying reasons:
  • Own serious health condition
  • Care for spouse, child (under 18 or adult disabled), or parent with serious health condition
  • Bonding with new child (birth, adoption, foster) within 12 months
  • Qualifying military exigency
  • Care for covered service member with serious injury or illness (26 weeks)
• Pay: unpaid (employee may use PTO concurrently if employer policy allows)
• Health insurance continuation: maintain group health benefits as if active
• Reinstatement: same or equivalent position
• Notice: employee 30 days advance for foreseeable; "as soon as practicable" otherwise. Employer must provide rights and responsibilities notice within 5 business days of becoming aware of qualifying reason.
• Certification: employer may require medical certification (limited scope) within 15 calendar days

State PFML / FMLA-equivalent - quick reference (partial; verify state)

Key: state PFML is generally wage-replacement (state-administered), federal FMLA is unpaid + job-protected. They run concurrently where applicable. Some state laws also provide job protection separate from PFML (CA CFRA, NY PFL).

Eligibility analysis output

## Leave Eligibility Analysis
**Employee:** [Name] | **State:** [State] | **Hire date:** [Date] | **Hours last 12 mo:** [X]
**Headcount within 75 mi:** [X] | **Leave reason:** [Type] | **Requested start:** [Date] | **Duration:** [X wks]

### Federal FMLA
- Employer eligible (50+ within 75 mi)? [Y/N]
- Employee eligible (12 mo + 1,250 hrs)? [Y/N]
- Qualifying reason? [Y/N - which]
- Available balance in 12-mo period: [X weeks]
- **FMLA decision:** [Eligible / Not eligible - reason]

### State PFML / state FMLA-equivalent
- State law: [CFRA / NY PFL / etc.]
- Employer eligible? [Y/N]
- Employee eligible? [Y/N]
- Qualifying reason? [Y/N]
- Available balance: [X]
- Wage replacement: [%, source - state agency vs employer]
- **State leave decision:** [Eligible / Not eligible - reason]

### Concurrent vs sequential
- Federal FMLA + state runs concurrently where both apply (default)
- State-only entitlements that don't have FMLA equivalent (e.g., CA PDL) may run sequential

### Other applicable leaves
- Pregnancy: PWFA accommodation may apply alongside or instead of leave
- ADA: leave may be reasonable accommodation if condition is a disability
- Workers' comp: separate framework if work-related injury
- USERRA: military leave separate
- Personal/unpaid: company policy

### Total leave entitlement
- [X] weeks across [federal FMLA + state PFML + state PDL + other]
- Estimated wage replacement: [$X / %]
- Job protection: [Y, by what statutes]
- Health insurance continuation: [Y, terms]

Output - Leave request response letter

[Date]

[Employee Name]

Dear [Employee],

Thank you for your leave request received on [Date]. Based on our review:

**Eligibility decision**: [Approved / Approved-conditional / Denied]

**Statutes applied**:
- Federal FMLA: [eligible - X weeks] / [not eligible because Y]
- [State PFML]: [eligible - X weeks at Y% wage replacement] / [not eligible because Z]
- [Other applicable: PDL, USERRA, ADA, company personal]

**Leave dates**:
- Start: [Date]
- Expected return: [Date]
- Type: [Continuous / Intermittent / Reduced schedule]

**Pay during leave**:
- Federal FMLA: unpaid; you may use accrued [PTO/sick/vacation] concurrently per company policy
- State PFML wage replacement: file with [state agency] - we will coordinate; estimated [%]

**Health insurance**: Your group health coverage continues as if you were actively at work. You remain responsible for the employee portion of premium ($[X]/[period]); we will coordinate with payroll for [direct billing / payroll deduction on return].

**Other benefits**: [401(k) contributions during paid portion; equity vesting per Plan; PTO accrual per policy]

**Certification**: [If required] Please return medical certification (form attached) within 15 calendar days. Scope is limited to confirming the qualifying condition and need for leave.

**Return to work**:
- Notify HR at least [3 / 5 / 10] business days before return so we can coordinate.
- Fitness-for-duty certification: [required / not required] for return from own-condition leave (must be required uniformly).
- We will reinstate you to your same or equivalent position.

**Anti-retaliation**: This leave is protected; retaliation is prohibited.

**Questions**: [HR contact + state agency portal for PFML].

Sincerely,
[HR Lead]

---
Attachments: medical certification form (if applicable), state PFML claim packet, benefits-during-leave summary.

Intermittent-leave tracking

When leave is intermittent or reduced-schedule:

## Intermittent Leave Tracker - [Employee]
| Date | Hours/Days Used | FMLA Bucket | State Bucket | Cumulative | Notes |
|------|-----------------|-------------|--------------|------------|-------|
| [Date] | [X hrs] | [used] | [used] | [running total] | [reason / certification ref] |

Reset date: [12-month period start]. Rolling backward / calendar / fiscal - match policy.

Return-to-work plan

## Return-to-Work Plan - [Employee]
**Last day of leave:** [Date] | **Return date:** [Date]

- Reinstatement role: same / equivalent - [Title]
- Schedule: [Standard / phased return]
- Accommodations on return: [If any from interactive process - see /hr accommodation-request]
- Fitness-for-duty certification received: [Y/N - if required uniformly]
- Manager 1:1 scheduled: [Date]
- Re-onboarding tasks: [tools, project briefings, key meetings]
- Lactation accommodation (if applicable per PUMP Act + state): [private space, break time]
- Performance: leave is not factored into performance evaluation

Common pitfalls

• Counting only federal FMLA - many states are stricter (CA CFRA 5+ EE, NY PFL 1+ EE)
• Denying state-only leave because federal doesn't apply
• Asking for diagnosis - certification scope is limited
• Charging fitness-for-duty selectively - must be required uniformly
• Counting leave against attendance / performance - interference + retaliation risk
• Not maintaining health insurance during FMLA/state PFML
• Failure to provide rights-and-responsibilities notice within 5 business days

Output Path

Save the analysis to a dated Markdown file in the workspace.

Output footer (REQUIRED on every generated record/letter)

End every record with this block, verbatim:

---
**DRAFT - REVIEW REQUIRED**

This leave analysis was generated as a starting template. It is not employment-law
advice. Eligibility math is unforgiving and statute-driven. Before finalizing:

1. Verify federal FMLA AND state PFML / state FMLA-equivalent eligibility separately.
2. Verify wage-replacement coordination with state agency (CA EDD, NY DOL, etc.).
3. Verify health insurance continuation during leave.
4. Verify rights-and-responsibilities notice issued within 5 business days.
5. Verify medical certification scope is limited (no diagnosis, no full records).
6. If intermittent: confirm tracking method and 12-month reset rule match policy.
7. Have HR counsel review denials.

Generated by Wayland business-hr plugin. Templates only - not employment-law advice.

Templates only - not employment-law advice. Have HR counsel review eligibility decisions and any denial.