Request for Paid and/or Unpaid Medical Leave
Dear ___,:
I am sorry to hear that your health condition may require additional continuous absence from work. I am sending you this letter to provide information regarding benefit resources and your employment status during leave. At the same time, the attached 'medical leave' form must be filled out by your treating health practitioner and returned to the company.
Let me first explain to you that we are faced with a problem. During the first year of employment, this insurance applies for a maximum period of ( ) weeks leave per annum.
During your absence I encourage you to remain in a paid status if you have the necessary accruals. You may use accrued sick leave or if necessary, vacation accruals. If your sick and vacation accruals are near exhaustion, or in this case, due to minimum time at this office, I still need your health practitioner to complete a brief form (herewith attached) for submission to the office.
If you need to continue to be absent and do not have paid leave, (e.g., accruals are exhausted); our department will authorize unpaid leave. The duration of authorized unpaid medical leave is according to the period necessary for recovery and may be authorized for up to a () month period.
The information on the attached "Sick Leave Form" is required from the treating health practitioner for the department to authorize leave. As mentioned earlier, the completed form must be returned to me by DATE (set date to obtain the completed form no less than one week from date of letter). The period of the leave requested by the treating health practitioner should correlate to your medical recovery requirements.
If you have any questions, you can contact me at any time at the office or at home.
We wish you back to health very soon.
Sincerely,