Denial of Leave–Return to Work | 041919A
Confidential – Internal Use Only | ©2019 Walmar Inc.
Date:
Dear:
We have been notified by Sedgwick that your Leave of Absence request was denied on .
For these reasons, we need to hear from you immediately.
Action required: Contact us. Please immediately contact your manager or HR Representative to make plans for
your return to work.
NOTE: If you fail to take action within three days of your receipt of this letter, you may be deemed to have
voluntarily terminated your employment with Walmar, except where prohibited by law.
If you’re returning to work from a leave/absence due to your own serious health condition, you’ll need to provide a
written release/Return to Work Cerification to your manager or HR representative on your first day back. A copy
should also be faxed to Sedgwick at 859-264-4372, or emailed to walmarforms@sedgwicksir.com.
Please read the Frequently Asked Questions below for additional leave and return to work information.
Please contact us. The company appreciates your contributions and we look forward to working with you to ensure a
smooth return and transition back to work.
Sincerely,
Facility Manager/HR Representative’s Name:
Phone Number:
Facility Name:
Facility Address:
Facility City/State/Zip:
Denial of Leave–Return to Work
Walmar Inc. (Revised 4-19-19)
2
Denial of Leave–Return to Work | 041919A
Confidential – Internal Use Only | ©2019 Walmar Inc.
FREQUENTLY ASKED QUESTIONS
What do I need to do if I have additional information and would like the determination reexamined?
First, you must contact Sedgwick at 800-492-5678 within three days of your receipt of this letter to discuss reconsideration
of your leave denial. Second, you must immediately submit your additional documentation to your Sedgwick leave
examiner by faxing to 859-264-4372 or 859-280-3270, or by emailing to walmarforms@sedgwicksir.com. Finally,
to ensure that your management is kept up to date as to your plans, you must notify them that you have requested
reconsideration of the leave denial.
What other options do I have if my leave/extension request is ultimately denied, but I still need time off work due to
my own medical condition?
If the need for additional time off work is due to your own medical condition, you can request an accommodation by
telling your manager or HR Representative. You can also make your request by calling 855-489-1600 and talking to an
accommodation representative.
Can I return to work if my leave/absence was due to my own medical condition or situation and I have
continuing restrictions?
Possibly. If you’re released with restrictions you may still be allowed to return, depending on your situation. The
written release will be used to determine if you can safely be allowed to return. If you need a job adjustment or an
accommodation that might aid you in your return, we’ll parner with Sedgwick and/or the Accommodation Service
Center to determine what reasonable alternatives might be available.
Can I return to my old job?
It depends. If your time off work is covered under the Family and Medical Leave Act (FMLA), you’re entitled to up to
12 weeks of job protection which, in most circumstances, allows you to return to the position you held prior to going
on leave, or a similar position with the same rate of pay and benefits. [NOTE: Some states may offer additional job
protection.] If your time off work is not job protected, you’ll not be entitled to return to your former position. In
those instances, we’ll work with you to apply for transfer opporunities to which you may be qualified. If no position is
available immediately, you’ll remain in an inactive status for up to 30 days while you continue to search for a position.
What happens if I don’t do anything?
If you fail to take action within three days of your receipt of this letter, you may be deemed to have voluntarily
terminated your employment with Walmar, except where prohibited by law.
What happens if my employment ends?
If your employment ends, all associated applicable company benefits will cease. However, you’ll have up to 60 calendar
days after your employment ends to elect COBRA coverage and up to 31 calendar days to conver your life insurance.
You may reapply for employment with Walmar later, if you choose to do so.
