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Leave of Absence Guidelines Impact

Leave of Absence Guidelines

Faculty and staff may request time off work due to personal illness, birth or adoption of a child, or care of a qualified family member with a serious health condition. Department of Labor guidelines under the Family Medical Leave Act will be applied in eligible cases (see Benefits webpage on Family Medical Leave Act).

Faculty and staff who are absent from work due to medical reason for more than five (5) consecutive days or for surgery are required to provide a Medical Verification form to the Benefits Office (not the supervisor), with or without use of sick leave or annual leave. The purpose is to determine if the employee meets requirements to be placed on authorized medical leave of absence and/or if they are released to return to work status.

In addition, faculty and staff who have surgery or other procedures are required to submit medical information before returning to work. Any limitations must be listed.

The Medical Verification statement must provide information regarding the individual’s medical condition, diagnosis, prognosis, functional limitations, including anticipated duration and treatment plan, if any, and release to return to work date. The form must be completed by a licensed healthcare provider.

Faculty/staff will also be notified if they are eligible under the Family Medical Leave Act.

Medical leaves of more than five (5) consecutive days and any surgery require the following documentation:

  1. Request for Leave of Absence form (all benefit eligible staff/faculty)
    The form must be received prior to the expected last day of work. The forms must be signed by the employee and supervisor and submitted to the Benefits Office, 324 Hardway Hall.
    It is the responsibility of the employee and supervisor to ensure the Employee Leave Request forms are completed prior to the leave of absence. In emergency situations, submit as soon as reasonably possible.
  2. Monthly Work Record Forms (non-exempt employees)
    Must be submitted prior to the expected last day of  work.
  3. Employee Leave Request forms (12 month faculty and exempt staff)
    Must be submitted prior to the expected last day of work. Less than 12 month faculty will be paid according to the Faculty Sick Leave Policy 38. Faculty with an illness that lasts beyond fourteen (14) consecutive days will be removed from payroll on the 15th day.
  4. Staff and faculty who are members of the institutions Short Term Disability plan should contact the Benefits Office to obtain claim forms to apply for income benefits.
  5. Effective July 1, 2014, employees will be required to use all sick and annual leave during a medical leave of absence.
  6. Employees who are off payroll for an entire month will be billed for their share of health premiums (the employer share will continue to be paid by Fairmont State). Employees will also pay for other benefit plan coverage (Mt. Flex, optional and dependent life insurance, and disability premiums).