Leave of Absence (LOA) and Separations

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COURSE WORKBOOKNC DPS HUMAN RESOURCES

Leave of Absence (LOA)

and

Separations

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Central HR

Leave Policy Program Contact Information

Leave Policy Program Manager: Heather Garrett 919-457-1176

[email protected]

mailto:[email protected]

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Table of Contents Objectives ..................................................................................................................................................... 4

LOA Reasons.................................................................................................................................................. 4

FML/PPL/FIL - LOA Packet ............................................................................................................................ 4

FML/LOA Rquest ...................................................................................................................................5

FML-HBR/LOA Request ..........................................................................................................................6

FML-PAR .............................................................................................................................................. 7

FML Provisional Designation Letter .................................................................................................... 8

FML Designation Letter ....................................................................................................................... 9

FML to Extended Illness - Newby .................................................................................................... 10

HBR/LOA Request .................................................................................................................... 10

Newby Provisional Designation Letter .....................................................................................11

Newby FML/PAR .......................................................................................................................12

Newby Updated LOA Request ................................................................................................... 13

Newby Designation Letter ........................................................................................................14

Newby Extended Illness/LOA Request .............................................................................. 15

Newby Extended Illness PAR ...............................................................................................16

Newby PPL/LOA Request ............................................................................................. 17

Newby PPL/PAR .............................................................................................................18

FML to PPL - Martin .............................................................................................................................19

Martin FML/LOA Request ........................................................................................................ 19

Martin FML/PAR ...................................................................................................................... 20

Martin Designation Letter ....................................................................................................... 21

Martin PPL/LOA Request ................................................................................................... 22

FML/PPL/FIL Pre-Submission Checklist ............................................................................................ 23

Extended Illness LOA Packet ...................................................................................................................... 24

Extended Illness LOA Request ......................................................................................................... 24

Extended Illness PAR ........................................................................................................................ 25

Extended Illness Pre-Submission Checklist ...................................................................................... 26

Military LOA Packet ................................................................................................................................... 27

Military LOA Request ........................................................................................................................ 27

Military PAR ...................................................................................................................................... 28

Military Example of Orders ............................................................................................................... 29

Military Pre-Submission Checklist .................................................................................................... 30

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Workers' Comp LOA -Salary Continuation..................................................................................................31

Worker's Comp Salary Continuation Process .................................................................................... 31

Salary Continuation/PAR ................................................................................................................... 32

HR 205 WC Leave Request Form (Salary Continuation) ................................................................... 33

Workers' Comp LOA (Non Salary Continuation) ...................................................................................... 34

Workers' Comp PAR With Supplement ............................................................................................. 34

Worker's Comp LOA Request Letter .............................................................................................35-36 Bookmark not defined.-36

LOA Request Form WC with Supplement ......................................................................................... 37

HR 205 WC Leave Request Non-Salary Continuation ....................................................................... 38

WC Pre-Submission Checklist ........................................................................................................... 39

Unapproved Leave /LOA ............................................................................................................................ 40

Voluntary Resignation Without Notice ............................................................................................ 40

Unappoved Leave Packet ................................................................................................................. 40

Samuel Slacker Unapproved Leave Letter Exercise ............................................................ 41-42

Unapproved Leave PAR ............................................................................................................ 43

Additional LOA Packets .............................................................................................................................. 44

Return to Work ........................................................................................................................................... 44

Reinstatement from LOA ............................................................................................................................44

Reinstatement/PAR .......................................................................................................................... 45

Return to work/Reinstatemet Issue ....................................................................................................46

Things to Consider Prior to Reinstatement ...................................................................................... 47

LOA Knowledge Check ................................................................................................................................ 48

Edwards Exercise ................................................................................................................................... 49-53

Scenario Review ..................................................................................................................................... 54-55

Separations ................................................................................................................................................. 56

Important! Before You Begin to Separate ..........................................................................................56

Separation Packet ............................................................................................................................. 57

Separations: Top Two Reasons ......................................................................................................... 57

PAR - For Better Employment .............................................................................................................57

PAR - For Personal Reasons .............................................................................................................. 58

Resignation Letters ........................................................................................................................... 58

Resignaton Letter Examples ......................................................................................................... 59-60

Common Errors to Avoid ................................................................................................................... 61

Links to Policy and Forms...........................................................................................................................61

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Objectives Identify reasons for Leave of Absence (LOA). Identify and apply LOA Packet content requirements and procedures to reduce

common errors. Identify and apply the Reinstatement process from LOA to reduce common errors. Identify and apply Separations Packet content requirements and procedures to reduce

common errors.

Leave of Absence (LOA) Reasons

• Family Medical Leave• Family Illness Leave• Parental Leave• Extended Illness Leave

• Inadequate Documentation forFML

• Non-FML/FIL Event• Not Eligible for FML

• Military Leave• Workers’ Compensation (TTD)• WC Salary Continuation• Other

• FML Expiration• Short-Term Disability• Extended Short-Term Disability

• Unapproved Leave

FML/PPL/FIL LOA Packet

A complete FML/PPL/FIL Packet consists of the following: • Leave of Absence Request Form (LOAR)• Personnel Action Request Form (PAR)• FML/FIL Letter (Provisional, Designation, &/or Both)• Any supporting documentation and comments associated with the qualifying event.

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LOA Request

Employee or authorized agent on Employee’s behalf completes:

1. General Information: Full Name, Personnel #, Address, Work Location, Work Phone and Position Title

2. Reason for Request: Qualifying Reason. If birth of a child, EE must provide a date of birth, If C-Section or natural birth, and if married to baby’s mother.

3. Expected Length of Leave: Beginning Date and Expected Return to Work Date.

4. Leave Exhaustion Request Specify the leave type to be exhausted.

5. Employee signs and dates

6. Checks acknowledgement: Understanding of policy and responsibilities while on LOA.

Lower Section to be completed by HBR:

7. Last day worked Begin Date of LOA and Expected Return to Work Date.

8. Medical, PPL document or Reinstatement Certification Required? Check and complete appropriate boxes.

9. Denied and Reason for Denial: If Denial check box and state reason.

10. HBR Signature/ Date

11. Checks acknowledgement Certifies Leave Kit given and copy of LOA given to employee.

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The LOA Request Form (Required if employee is out for 15 or more calendar days) Employee completes the Leave of Absence (LOA) Request Form 30 days prior to start of leave, when possible.

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If the employee is going to be out for 15 or more calendar days and has not completed the LOA Request, the HBR will attach an LOA Request form with the Provisional Letter to the employee for completion.

The HBR will also prepare

a “pre” LOA Request completing:

1. Section with employee information. 2. REASON FOR REQUEST 3. EXPECTED LENGTH OF LEAVE. 4. For Employee’s Signature record “unavailable to sign”. 5. Complete lower section normally completed by facility. If out for 15 or more days, send PAR, LOA request form and designation letter to LOA/Separation email service account: [email protected] Note: Ensure Last Day Worked, Begin and Expected Return dates are correct and match with PAR and Provisional or Designation Letter.

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HBR/Personnel Action Request

1. Complete top section general employee information and date completed by the HBR.

2. Check box for #2.

3. Enter Last Day Worked Begin Date of LOA and Expected Date of Return.

4. Click Dropdown box for Reason. Select: “Family Medical Leave

(FML) (Attach FML Designation Letter”.

5. Record any Comments if needed.

6. Signatures and Dates of Manager and Division Director or designee.

Note: Ensure Last Day Worked, Begin Date of LOA and Expected Return dates are correct and match with the LOA Request and Provisional or Designation Letter. Please make sure all time has been entered and approved up to the current date when the PAR is sent.

The forms should be scanned and sent to the LOA/Separation email service account [email protected] along with the LOA Request and supporting documentation.

The person completing the PAR, can’t sign off on it.

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Page 1. Please ensure:

The LOA beginning and ending dates match the dates on LOAR and PAR, and the 12 month FMLA Entitlement Period is correct. Page 2. (not shown)

If an LOA Request has not been previously submitted, then have employee complete LOA Request as an attachment to return to named (Manager) by (Date). If the employee previously completed the LOAR, only delete the last sentence in the LOA Request paragraph. Page 3. (not shown)

Template requires a Facility/HR contact person and phone #, and the name/title of the person sending the letter. No other template requirements are needed unless LOA Request Form has been previously submitted. If that’s the case, delete it from “Attachments” at bottom of the template page. Templates:

https://www2.ncdps.gov/Index2.cfm?a=000002,002675

Under Human Resources, then FML forms.

Provisional Designation Letter








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FML Designation Letter is basically a revised Provisional Letter.

The only addition to the Designation template is on page 2 “After the Period of FML Entitlement paragraph” The facility contact will enter three dates (1) Physician Certified (date) employee expected to take leave through. (2) Return to work (date) and (3) Return to work or recertified return to work (date)

If the employee will be out for 15 or more days, the HBR will submit a PAR to the LOA Section.

If the health care provider certification is not received within the 15 days allowed in the provisional designation then the revocation letter is done and a revised PAR is sent to the LOA/Separations Section to revise the LOA reason from FML to some other reason, depending on the circumstances.

Again it is imperative that all dates and timeframes match consistently with all documentation in the packet and in the HR/Payroll System.

FML Designation Letter

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John Newby was in a serious vehicle crash on 5/2/19. The HBR:

• Completes an “Unavailable to Sign” LOA Request (pending specific Physician Certification) • Completes the PAR • Completes Provisional FML Designation Letter • Forwards to the Central HR LOA Section. • Mails a complete FMLA Leave Kit to Newby with Provisional Letter and LOA Request form.

The HBR prepares a “pre” LOA Request by completing: 1. General employee

information. 2. REASON FOR REQUEST 3. EXPECTED LENGTH OF

LEAVE 4. Employee’s Signature as

“Unavailable to Sign” 5. - Last Day Worked,

Begin Date of LOA and Return date.

- Check Medical Certification Required

- For this example, Check “Reinstatement Certification Required” due to Criminal Justice Certified position.

- Check Leave Kit box and Mail Leave Kit with LOA request.

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Newby FML

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Page 1. Please ensure: 1 - The LOA beginning and ending dates are correct. 2 - The 12 month FMLA Entitlement Period is correct.

Page 2. (Not Shown) If an LOA Request has not been previously submitted, then have employee complete LOA Request as an attachment to return to named (Manager) by (Date). If the employee previously completed the LOAR, only delete the last sentence in the LOA Request paragraph.

Page 3. (Not Shown) Template requires a Facility/HR contact person, phone #, and the name/title of the person sending the letter. No other requirements are needed unless LOA Request Form has been previously submitted. If that’s the case, delete it from “Attachments” at bottom of the template page.

Newby Provisional Designation Letter

Templates: https://www2.ncdps.gov/Index2.cfm?a=000002,002675 Under Human Resources, then FML forms.

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1. Check box for #2. 2. Enter Last Day

Worked, Begin Date of LOA and Expected Date of Return.

3. Click Dropdown box for Reason and select:

“Family Medical Leave (FML) (Attach FML Designation Letter)”

4. Record any Comments to support the LOA.

The HBR will forward LOA Request, a Personnel Action Request (PAR) and a copy of the Provisional Letter to Central HR LOA Section at [email protected]


Newby / PAR

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Newby Updated LOA Request

1. Notice the Expected Returned to Work Date changed from 7/1 to 7/25.

2. The HBR assisted Jennifer in explaining the projection of sick and holiday leave exhaustion.

3. She signed and dated on John’s behalf 5/16/19.

John’s wife Jennifer provided a completed Leave Kit with all information needed including Medical Certification.

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Newby Designation Letter

• FML Designation Letter is basically a revised Provisional Letter. The LOA ending date has changed from 7/01/19 to 7/24/19.

• The only addition to the Designation template is on page 2, “After the Period of FML Entitlement” paragraph. The facility contact will enter three dates: (1) Physician Certified (date) employee expected to take leave through. (2) Return to work (date), and (3) Return to work or recertified return to work (date).

• If the health care provider certification is not received within the 15 days allowed in the provisional designation, then the revocation letter is done.

• Again it is imperative that all dates and timeframes match consistently with all documentation in the packet and in the HR/Payroll System.

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Newby Extended Illness

LOA Request

• John has had a setback. Jennifer has provided a revised Medical Certification.

• Since John has exhausted his 480 hours of FML a revised LOA and PAR are completed.

1. Notice the Begin Date has changed from 5/2 to 7/25 and the Expected Return to Work Date changed from 7/25 to 8/30.

2. Leave Exhaustion for Extended Illness.

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Newby Extended Illness PAR

1. Look at Check box #2, LOA: • Last day worked is still 5/01 • Begin Date of LOA for Extended Illness is 7/25. • Expected Date of Return is now 8/30. • Reason: Extended Illness –Not eligible for FML.

2. Comments Section:

• Provide Specifics related to the change.

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Newby PPL/LOA Request

• John has worked several months since recovering from his crash. • Now his wife is expecting a child and is requesting a 4 week LOA

for Paid Parental Leave from 2/14/20 – 03/12/20.

1. Reason for Request – Birth of a Child, Date of Birth, type of delivery and if Married to Baby’s Mother. 2. EXPECTED LENGTH OF LEAVE (4 weeks).

3. LEAVE EXHAUSTION: Check PPL box and number of hours.

4. HBR completes lower section.

• Ensure Last Day Worked, Beginning Date of LOA and Return dates match.

• Paid Parental Leave Documentation is Required and maintained at the Work Location.

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Newby PPL/PAR



3. Click Dropdown box for Reason and select: “Parental Leave”

4. Comments: Provide details for the Reason for the PAR.

Mail the LOA Request to the employee and email copies of LOA Request and PAR to the Central HR LOA Section at [email protected]


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Martin FML/PPL

• Catrina Martin is 2 weeks from her delivery date. • Her Physician placed on bed rest for high blood pressure and lower back pain until delivery. • She is eligible for and must use FML for these 2 weeks and/or up to the day prior to the

delivery date. • Once the delivery occurs PPL will be begin and FML will run concurrent with PPL.

1. INDICATE REASON FOR REQUEST:

• Personal Illness 2. ENTER EXPECTED

LENGTH OF LEAVE. • i.e., 12/10/19 -

12/23/19 3. LEAVE EXHAUSTION

REQUEST: • The employee is

exhausting + or - 80 hours of Sick Leave depending on date of delivery.

4. HBR completes lower section. • Ensure Last Day

Worked, Beginning Date of LOA and Return dates match.

• Any required Medical Certifications?

Note: The HBR should assist the employee completing 1-3 to ensure accuracy and to check appropriate leave selections/balances.

FML/LOA

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Martin FML/PAR



3. Click Dropdown box for Reason and select: “Family Medical Leave (FML) (Attach FML Designation Letter)”

4. Comments: Provide details for the Reason for the PAR.


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Martin FML Designation

1. LOA beginning date is 12/10/19 and ending 02/24/20 has been designated as FML. 2. FML 12-month

period is 12/10/19 – 12/09/20.

• Again it is imperative that all dates and timeframes match consistently with all documentation in the packet and in the HR/Payroll System

• Mail the LOA Request and completed FML Designation Letter to the employee and email copies of each and PAR to the Central HR LOA Section at [email protected]

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FML Templates: https://www2.ncdps.gov/Index2.cfm?a=000002,002675 Under Human Resources, then FML forms.












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Martin PPL/LOA Request

1. Reason for Request: Birth of a Child, Date of Birth and Type of Delivery. 2. EXPECTED LENGTH OF LEAVE 12/24/19 – 2/25/20 (8 weeks + 5 Holidays). 3. LEAVE EXHAUSTION: Check PPL box and number of hours. 4. HBR completes lower

section. • Ensure Last Day

Worked, Beginning Date of LOA and Return dates match.

• Paid Parental Leave Documentation is Required and maintained at the Work Location.

FML must be used in conjunction with PPL and Holidays.

Catrina delivered on the day expected, 12/24/19. Her PPL Reason Begin Date starts on 12/24/19. However, the use of paid entitlement begins on 12/27/19 after 3 Christmas Holidays.

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Pre-Submission Checklist for FML PA-20

• Look at the Action Screen (Info Type 0000) to verify that the employee is eligible for FML &/or if the employee has a recent FML Action.

PTFMLA –FMLA Workbench • The HBR must create and or/verify eligibility of an FML Event n PTFMLA • Verify any intermittent or outstanding FML periods. • PTFMLA will track the FML periods and any FML hours that have been used. • Link to FMLA Workbench training instructions:

https://files.nc.gov/ncosc/documents/files/ptfmlaprocessingfmlaevents.pdf

PA-30 • Create a 5x8 Work Schedule Rule (WSR) D01N08GN for the employee beginning on the same

date the LOA is effective. • Every Action must have a WSR Change (even if the EE is already on the 5x8 WSR D01N08GN).

CATS_DA • Enter time through the end of the month. • Make sure the Last Day Worked (LDW) is correct. • Make sure the employee’s Time Entries meet the 160-hour requirement for the 28-day pay

cycle in which the LOA begins and the previous two 28-day pay cycles. • EXAMPLE: If the employee’s LOA begins on 01/19/19, you would check the 28-day pay cycle

of 01/06/19-02/02/19, as well as the 28-day cycle of 11/11/18-12/08/18 and 12/09/18-01/05/19.

PT-50 • Check to ensure Leave balances are correct. • All time Positive Time (Leave, Holiday, Sick, etc.) must be entered prior to LWOP/9400, unless

the employee indicates he/she would like to retain any leave balances. • The FML/FIL policy has a chart with leave usage options and in some cases employees

have the option to save their leave. • The work location is responsible for exhausting 9300 on all holidays during the LOA period. If

the holiday has not been loaded, contact your LOA Case Specialist to have it loaded (LOA Military RAD 30 days, Military RAD and WC TTD does not apply).

For ANY LOA Packet sent to the email service account, follow this format for the subject line:

• EE’s Work Location – EE’s First and Last Name – LOA - REASON (taken from the PAR). • Example: NCCIW-John Doe-LOA Military Leave.

When submitting Updated LOA Request form to extend the absence, format the subject line:

• EE’s Work Location – EE’s First and Last Name – LOA Request extending duration- LOA Reason. • Example: Jane Doe - LOAR Extended Duration – FML.




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Reasons • Inadequate Documentation for FML

• Include Provisional and Revocation letters to Extended Illness Packet.

• Non-FML/FIL Event • Not Eligible for FML • FML 480 hours passed • Not Eligible for FML

This is an Extended Illness Example (Non-FML-FIL Event)

1. INDICATE REASON FOR REQUEST: • Personal Illness

2. ENTER EXPECTED LENGTH OF LEAVE. • i.e., 11/5 – 12/09

3. LEAVE EXHAUSTION REQUEST: • The employee

elected to use 168 hours of Sick Leave plus 3 holidays.

4. HBR completes lower section. • Ensure LDW,

Beginning and Return dates match.

• Required Medical Certifications

Note: The HBR should assist the employee completing 1-3 to ensure accuracy and to check appropriate leave

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Extended Illness

A complete Extended Illness Packet consists of the following: • Leave of Absence Request Form (LOAR) • Personnel Action Request Form (PAR) • Any Supporting Documentation • Not Eligible for FML

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PAR for Extended Illness

For Extended Illness:

1. Check box 2. 2. Enter Last Day Worked, Begin Date of LOA and Expected Date of Return. 3. Reason:

Select one of the three of the appropriate Extended Illness selections from the dropdown menu. - In our example we used

Extended Non-FML/FIL Event.

4. Always make sure you make good notes in the comments section of the PAR as to why the employee is not eligible for FML/FIL or LOA Section will question it. The more information, the better.

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The forms should be scanned and sent to the LOA/Separation email service account [email protected] along with the LOA Request and supporting documentation. The person completing the PAR, can’t sign off on it.

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Pre-Submission Checklist – Extended Illness PA-20

• Look at the Action Screen (Info Type 0000) to verify that the employee is eligible for FML &/or if the employee has a recent FML Action.

PTFMLA–FMLA Workbench • HBR must verify ineligibility of an FML Event in PTFMLA. • Verify any intermittent or outstanding FML periods. • PTFMLA will track the FML periods and any FML hours that have been used.

PA-30 • Create a 5x8 Work Schedule Rule (WSR) D01N08GN for the employee beginning on the same

date the LOA is effective. • Every Action must have a WSR Change (EVEN IF EMPLOYEE IS ALREADY ON A 5x8 WSR

D01N08GN).

CATS-DA • Enter time through the end of the month. • Make sure the Last Day Worked (LDW) is correct. • Make sure the employee’s Time Entries meet the 160-hour requirement for the 28-day pay

cycle in which the LOA begins and the previous two 28-day pay cycles. • EXAMPLE: If the employee’s LOA begins on 01/19/19, you would check the 28-day pay

cycle of 01/06/19-02/02/19, as well as the 28-day cycle of 11/11/18-12/08/18 and 12/09/18-01/05/19.

PT-50 • Check to ensure Leave balances are correct. • Check to ensure all Positive Time (Leave, Holiday, Sick, etc.) is entered prior to LWOP/9400,

unless the employee has the option and indicates he/she would like to retain any leave balances.

• The work location is responsible for exhausting 9300 on all holidays during the LOA period. If the holiday has not been loaded, contact your LOA Case Specialist to have it loaded (LOA Military RAD 30 days, Military RAD and WC TTD does not apply).

For ANY LOA Packet sent to the email service account, follow this format for the subject line: • EE’s Work Location – EE’s First and Last Name – LOA - REASON (taken from the PAR).

• Example: NCCIW-John Doe-LOA Military Leave.

When submitting Updated LOA Request forms to extend the duration of the absence, format the subject line:

• EE’s Work Location – EE’s First and Last Name – LOA Request extending duration- LOA Reason. • Example: Bertie - Jane Doe - LOAR Extended Duration – FML

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Military LOA Packet

A complete Military Leave Packet consists of the following: • Leave of Absence Request Form (LOAR) • Personnel Action Request Form (PAR) • Military Orders • Any supporting documentation and comments.

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LOA Request For Military Leave:


• Check Military-Reserve Active Duty or Military Duty Training.

2. ENTER EXPECTED LENGTH OF LEAVE. • For example:

01/05/2019 – 02/11/2020

3. LEAVE EXHAUSTION REQUEST: • The employee

elected to Retain all Leave.

4. HBR completes lower section. • Ensure LDW,

Beginning and Return dates match.

Note: The HBR should assist the employee completing 1-3 to ensure accuracy and to check appropriate leave selections /balances.

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For: Military Leave


2. Enter Last Day Worked Begin date of LOA and Expected Date of Return. (Dates must match LOA Request and Military Orders).

3. Click Dropdown box for Reason and select: • “Military Leave

(Attach Orders)

4. Record in Comments Section of the employee’s leave election.

Note: The forms should be scanned and sent to the LOA/Separation email service account [email protected] along with the LOA Request, Military Orders and any supporting documentation.

The person completing the PAR, can’t sign off on it. Please make sure all time has been entered and approved up to the current date when the PAR and or Packet is sent.

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PAR for Military Leave


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ExamplE of ordErs

Verification of Employee Reserve Active Duty LOA

From January 5, 2019 To February 11, 2020

(400 days)

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Pre-Submission Checklist - Military Leave

Recheck dates and information on Military Orders.

PA-20 • Look at the Action Screen (Info Type 0000) to verify that the employee is eligible for Military Leave.

PA-30 • Create a 5x8 Work Schedule Rule (WSR) D01N08GN for the employee beginning on the same date

the LOA is effective. • Every Action must have a WSR Change (EVEN IF EMPLOYEE IS ALREADY ON A 5x8 WSR

D01N08GN).

CATS-DA • Enter time through the end of the month. • Make sure the Last Day Worked (LDW) is correct. • Make sure the employee’s Time Entries meet the 160-hour requirement for the 28-day pay cycle in

which the LOA begins and the previous two 28-day pay cycles. • EXAMPLE: If the employee’s LOA begins on 01/19/19, you would check the 28-day pay cycle of

01/06/19-02/02/19, as well as the 28-day cycle of 11/11/18-12/08/18 and 12/09/18-01/05/19.

PT-50 • Check to ensure Leave balances are correct. • Check to ensure all Positive Time (Leave, Holiday, Sick, etc.) is entered prior to LWOP/9400, unless the

employee has the option and indicates he/she would like to retain any leave balances. • The Military Leave policy has leave usage options and in some cases employees have the

option to save their leave.


• Example: NCCIW-John Doe-LOA Military Leave.


• EE’s Work Location – EE’s First and Last Name – LOA Request extending duration- LOA Reason. • Example: Bertie - Jane Doe - LOAR Extended Duration – FML

Notes:

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Worker’s Comp LOA/Salary Continuation

A complete Worker’s Comp Packet for Salary Continuation consists of the following: • Personnel Action Request Form (PAR). • HR 205 WC Leave Request Form.

• The HR 205 must be approved by Central HR Workers Comp section. • Any supporting documentation and comments.

Worker’s Comp Salary Continuation Process

Out 15 or More Calendar Days

• The Work Location submits the HR205 WC Leave Request form and supporting physician’s documentation.

• Central WC Office emails the approval to work location and HR LOA Case Specialist. • The Work Location designee shall submit a PAR designated as Leave of Absence Salary

Continuation action, approved HR 205 and submits it to the HR LOA Case Specialist. • The HR LOA Case Specialist places the employee on Leave of Absence Salary Continuation. • The work location designee shall place the employee on a Monday-Friday 8-hour work

schedule rule (WSR) D01N08GN. • The work location designee continues to request injury leave weekly on the HR 205 WC

Leave Request not to exceed 30 days. • Employee remains in Pay Status at 100%, paid by the Agency as if they are working. • If the 2-year period has been exhausted and the employee is still out of work, a revised

PAR will be required to place employee on “LOA-Workers’ Compensation Leave” in lieu of “LOA-Salary Continuation/Injury Leave”.

Out of work Less than 15 Calendar Days: • Employee remains in Pay Status at 100%, paid by the Agency as if they are working. • Submit the HR 205 Correspondence to Central WC Office. • Approved time is entered as 9685. • Personnel Action Request form (PAR) IS NOT required.

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PAR for WC Without Supplement


2. Enter Last Day Worked, Begin Date of LOA and Expected Date of Return.


“Injury Leave/Salary Continuation (Attach Leave Approval Letter)”.

4. Record in Comments Section any supporting information.

Note: The forms should be scanned and sent to the LOA/Separation email service account [email protected] along with the HR205 WC Leave Request Form and any supporting documentation. The person completing the PAR, can’t sign off on it.


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HR 205 WC Leave Request Form • Work Location completes and submits HR 205 to Central HR WC Office. • Work Location Contact is the HBR/Administrative Representative. • Determine if request is for the Employee being placed out of work or for attending an authorized

doctor’s/physical therapy appointment. • The Form:

1. WC employee to e-mail the form to and general information. 2. Select both specific time period and reason for request.

• In this example: Injured 9/3/19; Check box “July 1, 2015-Present”. Check 9685 for Salary Continuation.

3. Duration of time for approval. 4. Approval Section is for Central HR WC Office.

Note: Attachments – Timesheets/Screen Shots and Supporting Medical Documentation.

Rebecca Hinton

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Workers’ Compensation (non-salary continuation)

• The Work Location submits the HR205 WC Leave Request form and supporting physician’s documentation to Central HR WC Office.

• Employee is in non-pay status; the Third Party Administrator (TPA) pays employee 66 2/3% of their average weekly wage.

• No entries of time are needed unless supplemental leave is applicable. • LOA Packet includes:

• PAR - If employee is out more than 7 days. • LOA Letter • LOA Request Form (Only If EE Elects to Use Supplemental Leave)

• Employee MUST sign and date the LOAR form and indicate Yes they want to supplement their leave in order to be placed on LOA WC with Supplement.

• Work location provides the Continuation of Benefits during Leave of Absence Notice and reviews with employee.

• DO NOT DESIGNATE FAMILY MEDICAL LEAVE when employee is on Leave Without Pay due to Workers' Compensation.

If employee is out of work 7 days or less:

PAR Workers’ Comp Non-Salary Continuation –WITH Supplement



3. Click Dropdown box for Reason and select: • “Workers’

Compensation W/O Supplement”.


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Note: The forms should be scanned and sent to the LOA/Separation email service account [email protected] along with the HR205 WC Leave Request Form and any supporting documentation.









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LOA Letter Example

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LOA Letter Page 2

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• Check Workers’ Compensation

2. ENTER EXPECTED LENGTH OF LEAVE. • For example: 11/27/18 –

12/20/18

3. LEAVE EXHAUSTION REQUEST: • Check

“Supplement Worker’s Comp” and “Yes”. Employee signs / dates.

4. HBR completes lower section. • In this example

the employee is Approved.

• Since the employee is certified, Medical Certification is Reinstatement Certification are required

• Ensure LDW, Beginning and Return dates match.

Note: The HBR should assist the employee completing 1-3 to ensure accuracy and to check appropriate leave selections /balances.

LOA Request Form Worker’s Comp Non-Salary Continuation – WITH Supplement

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Arlene Dawson

HR 205 WC Leave Request Form

1. You must specify the type of Workers’ Comp leave your requesting. This is based on date of injury and type: In this example the employee was injured between July 1, 2015 to Present. This was an LOA-WC TTD. (not a salary continuation injury)

2. The last section are timeframes/hours needed for approval. 3. Approval Section is for Central HR WC Office.

Attachments – Timesheets/Screen Shots and Supporting Medical Documentation.

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Pre-Submission Checklist – Workers’ Comp/LOA

PA-30 • Create a 5x8 Work Schedule Rule (WSR) D01N08GN for the employee beginning on the same date

the LOA is effective. • Every Action must have a WSR Change (EVEN IF EMPLOYEE IS ALREADY ON A 5x8 WSR

D01N08GN).

CATS-DA • Enter time through the end of the month. • Make sure the Last Day Worked (LDW) is correct. • Ensure all A/A types: Injury Leave, Injury Absence, Holidays and applicable supplemental leave are

entered correctly. • If supplementing leave only enter the supplemented leave through the end of the month.

• Make sure the employee’s Time Entries meet the 160-hour requirement for the 28-day pay cycle in which the LOA begins and the previous two 28-day pay cycles. • EXAMPLE: If the employee’s LOA begins on 01/19/19, you would check the 28-day pay cycle of

01/06/19-02/02/19, as well as the 28-day cycle of 11/11/18-12/08/18 and 12/09/18-01/05/19. • Note for supplemental leave: The 28-day cycle that the LOA begins in will not meet the 160

hours because only supplemented leave is being entered during the LOA.

PT-50 • Check to ensure Leave balances are correct if Supplemental Leave applies.


• Example: NCCIW- “John Doe-LOA Workers’ Comp W/O Supplement”


• EE’s Work Location – EE’s First and Last Name – LOA Request extending duration- LOA Reason. • Example: Bertie – “Jane Doe - LOAR Extended Duration – FML”

Notes:

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Unapproved Leave/LOA • There will be occasions when an employee fails to return to work after being out on an approved LOA. • Once the employee does not show up to work on the Expected Date of Return, the work location

must contact the employee to determine the cause of the no show. • After the work location has made several unsuccessful attempts to contact the employee via phone

calls and mailing certified and regular mail, an Unapproved LOA Packet must be processed.

Voluntary Resignation Without Notice • An employee who is absent from work and does not contact their employer for three consecutive

scheduled workdays may be separated from employment as a voluntary resignation. • A factor to be considered when determining whether the employee should be deemed to have

voluntarily resigned is the employee’s liability in failing to contact his or her employer. • Such separations as described above are voluntary separations from State employment and create

no right of grievance or appeal.

Unapproved Leave /LOA Packet A complete Unapproved Leave Packet consists of the following:

• Personnel Action Request Form (PAR). • A letter stating when the LWOP period began. • Any supporting documentation and comments.

Exercise Read the Samuel Slacker Unapproved Letter on pages 28 and 29 and highlight some key points below.

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1. Check box for #2. 2. Enter Last Day Worked, Begin Date of LOA and Expected Date of Return.

•


• “Unapproved Leave (Attach Unapproved Lve Letter)”.


Note:

The PAR and Unapproved Letter should be scanned and sent to the LOA / Separation email service account [email protected] with any supporting documentation.


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Unapproved Leave/PAR









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Additional LOA Packets

• Additional LOA Packets vary depending on the situation, but the packets should still have the PAR and the LOAR.

• In most cases, remember ONLY 9000 or 9400 can be exhausted when placing an employee on LOA/OTHER.

• Refer to the Sick Leave (SL) policy to see the exceptions to this rule. • EXAMPLE: Sick Leave could be used when employee who has worked less

than 12 months and is out to care for an immediate family member. The reason would be Other because it’s not the employee that is sick and they are not eligible for FML or FIL but the sick leave policy does allow employees to use Sick Leave in this instance.

• In this case the PAR Comments section should indicate why they are out so that the use of sick leave is supported.

Reinstatements from LOA • Reinstatements from LOA’s are processed by the Regional Employment Office

(REO) • Submit the PAR to the REO.

Note: Wardens and Assistant Wardens are submitted to Central HR for processing.

Return to Work

Physician’s Release

• Employee must provide work location with documentation from authorized physician, stating they can return with no restrictions. (For employee illness)

• Employee is expected to return on the date the physician indicated their return.

• If the physician indicates restrictions: • The work location can only approve work restrictions for up to 6

weeks. • If work restrictions longer than 6 weeks, employee must request

an ADA accommodation. • If the employee has applied for or been approved for short-term

disability benefits the employee will need to submit completed EJF’s to the Disability Program Manager for approval prior to returning to work.

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1. General employee information and form “Completed By:”

2. Check box 1., Personnel Action

3. The Effective Date: THE FIRST DAY SCHEDULED or REQUIRED BACK TO WORK.

4. Personnel Action: Click dropdown and select “Z2- Reinstatement / Reemployment”

5. Select Reason i.e., Z2 15 Return from FMLA

6. Under B., Proposed Information: Complete ALL Fields • Position

Classification • Banded Level or

Grade • Position Number • To Location • Proposed Annual

Salary THE ABOVE BULLETS CAN ALL BE FOUND IN THE HR/PAYROLL SYSTEM UNDER “ZEMP-EE Overview”

• New Work Schedule Rule (WSR)

• New Working Week

If the employee is returning to the same schedule prior to the LOA, go to PA20 to Planned Working Time and retrieve the (WSR) and Working Week PRIOR TO THE LOA or enter the new “different” (WSR) and Working Week.

7. Provide Comments if needed and signature dates.

PAR for Reinstatement

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Return to Work/Reinstatement Issue

• Central HR/LOA section checks when closing out a file that 9500 is keyed on the day the employee returned to work.

• As you can see in the example below the employee was reinstated on 09/18/2019. However, 9200 was recorded on that day.

• The HBR must ensure that: • The reinstatement date or “Effective Date” on the PAR is the date the

employee is required back to work and/or, • 9500 is being entered correctly in the system.

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Things to Consider Prior to Reinstatement

Military • If employee has not completed basic training, attach a copy of the DD-214 to the

PAR.

Workers’ Comp • If No Restrictions, Limited Duty/Regular Hours or Reduced Hours w/ Restrictions:

• Send the PAR to the REO with Comments reflecting one of the above. • Send HR 207 Return to Work Plan to Central HR Workers’ Comp Designee.

Notes:

Short Term Disability • Doctor MUST complete Essential Job Functions when releasing an employee to return to

work. • The employee’s return to work MUST be approved by the Disability Office. • If restrictions are less than 6 weeks, the Disability Office will communicate with work

location to see if accommodations are available. If restrictions are greater than 6 weeks, the employee cannot return to work but can request an ADA Accommodation. NOTE: LOA section does not process reinstatements other than Investigatory Leave.

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Notes

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Edwards Exercise. Please review the following LOA/FML package on pages 50-54. List the issues/corrections needed below for discussion. Note: The information on the LOA Request by the employee is correct and for this exercise there is only 1 page to the Designation letter to review.

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Please review the 3 scenarios below on pages 55 - 56 and determine if any corrections are needed.

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Separations

Separation from State service occurs when an employee leaves the payroll for reasons listed below: • Appointment Terminated • Better Employment (Outside State Government) • Death • Did not Report • Dismissal for Conduct, Grossly Inefficient, or Unsatisfactory Job Performance • Dissatisfied with Work Conditions • Dissatisfied with Pay • Education • Employee Moved • Health • Long Term Disability • Marriage • Military Service • Reduction-in-Force • Resignation – Involuntary • Resigned –No Reason Given • Resigned-Personal Reasons • Resigned-Voluntary without Notice • Resigned while on FIL • Resigned while on FMLA • Resigned while on Workers’ Compensation • Retirement • Other

IMPORTANT! BEFORE YOU SEPARATE

There are many employees that state they are resigning. However, when the Separation packet is forwarded to Central HR, they are actually transferring within DPS or to another state agency. - FOR Transfers within DPS:

• The PAR and required documents for Transfers within DPS are not required to be sent to the LOA/Separations section. The receiving work location is responsible for submitting these documents to their appropriate REO location.

- FOR Transfers to other state agencies (when the releasing work location is not aware of the Transfer to another state agency):

The package is received by the LOA/Separations section (with Separation Reasons). It does NOT indicate the EE is transferring to another state agency resulting in the following errors: • The Separation Action is worked as Personal Reasons (or reason on PAR) in lieu of a Transfer. • Reverse the Action by submitting ticket to BSS to have the Separation deleted. • Payouts for Vacation, Bonus Leave, etc. were paid out and entries must be deleted. • If 9400 isn’t entered after the employee’s last day worked, they could be overpaid by DPS prior to the

transfer of EE’s records. • If not transferred by payroll deadline, they will not receive pay from the receiving state agency. • If paperwork is not sent in a timely manner to DPS, and it’s past 30 days before the transfer occurs,

the employee cannot manage their insurance and would also have a break in creditable service.

Therefore, the HBR or Administrative/Business Officer should have a detailed discussion with the employee regarding Separation vs. Transfer. Also, ensure the EE is not currently on an LOA for any reason.

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Separations: Top Two Reasons

Better Employment • Better employment reasons may mean a transfer!

Personal Reasons • Moved out of state • Health • No baby sitter • Shift work • Don’t like my supervisor

1. Check box 3., Separations

2. Last Workday: The last day the employee was physically at work.

3. Effective Date: Date of Separation and date of Action in the system.

4. Reason for Separation: Select from a dropdown list. Our example “Better Employment (Outside State Government)”.

5. Ensure all leave benefits and balances are current and correct.

6. Comments: Ensure to include comments to support Separation.

7. Signatures: Must be signed by a Supervisor/Manager or Division Director (or Designee).

The PAR cannot be completed by and signed by the same person.

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PAR for Better Employment

Separations Packet

A complete Separations Packet consists of the following: • Personnel Action Request Form (PAR) • Copy of the Resignation Letter or e-mail with a physical signature by the employee.

• If the copy is NOT signed by the employee, a letter must be sent to the employee stating that the work location is accepting/acknowledging the memo, email or verbal resignation with the date of resignation included. A copy must be included with the PAR/Separations Packet.

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1. Check box 3., Separations

2. Last Workday: The last day the employee was physically at work. 3. Effective Date: Date of Separation and date of Action in the system. 4. Reason for Separation: Select from a dropdown list. Our example “Resigned- Personal Reasons”. 5. Ensure all leave benefits and balances are current and correct. 6. Comments: Ensure to include comments to support the Separation. 7. Signatures: Must be signed by a Supervisor/Manager or Division Director (or Designee).

The PAR cannot be completed by and signed by the same person.

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PAR for Personal Reasons

Resignation Letters

• Resignation letters or documentation may vary within DPS. However, resignation documentation must include: • Copy of the Resignation Letter or e-mail with a physical signature by the employee.

OR • If the copy is NOT signed by the employee, a letter must be sent to the employee

stating that the work location is accepting/acknowledging the memo, email or verbal resignation with the date of resignation included.

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EXAMPLE OF RESIGNATION DOCUMENTATION

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Links to Policy and Forms

Common Errors to Avoid • Incorrect section completed on the PAR. • Incorrect names and Personnel ID numbers. • Incorrect Position Classification. • On the PAR the Completed by and signatures the same person (has to be a different person). • Last Day Worked doesn’t match CATS_DA. • Reason for Separation doesn’t match the attached document. • No memo, e-mail, verbal approval document attached for resignation. • Comments does not match documentation (ex: Reason: Personal Reasons; comments state Better

Employment). • Not signed by Supervisor/Mgr. or Division Director or Designee.

Notes:

Policy

Forms

https://weare.ncdps.gov/Index2.cfm?a=003324,0033

https://weare.ncdps.gov/index2.cmf?a=003322,002675





https://weare.ncdps.gov/index2.cmf?a=003322,002675

Leave of Absence (LOA) and Separations

Documents

Transcript of Leave of Absence (LOA) and Separations