Time Away From Work Service Center

PO Box 14674
Lexington, KY 40512-4674

March 28, 2020

Phone: (855) 858-7557
Fax: (888) 999-7573
Ana Cortez
6338 16Th Pl S
West Palm Beach, FL 33415

Time Away From Work Service Center

PO BOX 14674

Sedgwick Claims Management Services, Inc.

Phone: (855) 858-7557

Fax: (888) 999-7573
Lexington, KY 40512-4674

March 28, 2020

Ana D Cortez
6338 16Th Pl S
West Palm Beach, FL 33415

RE: Approval of Continuous Leave

Case Number: C003120606500087AA

Dear Ana D Cortez:

On March 12, 2020, the Time Away From Work Service Center was notified of your request to take a leave of
absence due to a serious health condition that makes you unable to perform the essential functions of your
job.

We have reviewed your request for Continuous leave and have approved your leave under the Federal Family
and Medical Leave Act (FMLA) from March 6, 2020 through March 23, 2020. Your absences under this leave
will be counted against your FMLA entitlement. Provided that there is no deviation from your anticipated
leave schedule, the following number of weeks will be counted against your leave entitlement: 2.40 weeks.
Also, we have reviewed your request for leave and have approved your leave under General Medical Leave
(GML). Your absences from March 6, 2020 through March 23, 2020 under this leave will be counted against
your GML entitlement. Provided there is no deviation from your anticipated leave schedule, the following
number of weeks will be counted against your leave entitlement: 2.40 weeks

You are required to notify the Time Away from Work Service Center as soon as practicable if the
circumstances of your leave change, are extended, or were initially unknown. As this approval will expire on
March 23, 2020 you will need to provide an updated and fully completed medical certification form prior to
the expiration date above. Once this form is received, the Time Away from Work Service Center will reassess
this claim. You will be provided notification regarding the approval or denial of the extension within 5
business days. Failure to provide updated information supporting the need for ongoing leave may result in
the denial of FMLA/GML coverage.

1. This approval will expire on 03/23/2020, and you will need to provide an updated and fully completed
certification form prior to the expiration date if an extension is needed.

2. If your leave is for a continuous period and is due to your own serious health condition, you will be
required to present a completed Return To Work Release Form to be restored to active status at the end of
your leave. If such documentation is not received, your return to work may be delayed until the
documentation is provided.

3. If your leave is for a continuous period of time to care for a family member please contact the Time
Away From Work Service Center at the number listed below on the date you return to work.

Sedgwick Claims Management Services, Inc.

!C00945183.222-6065!
Please notify us as soon as practicable if the circumstances of your leave change, are extended, or were
initially unknown. Since this approval will expire on March 23, 2020, you will need to provide an updated and
fully completed certification form prior to the expiration date above. Once the updated and fully completed
certification form is received, the Time Away From Work Service Center will reassess this claim. You will be
provided notification regarding the approval or denial of the extension within 5 business days. Failure to
provide updated information supporting the need for ongoing leave may result in the denial of coverage.

Please be advised:
 You may be eligible to use accrued PTO during your FMLA absence. Please contact your supervisor to
discuss this option.
 Employees are not permitted to work for a business entity in any capacity while on a continuous
leave of absence.
 Once an intermittent absence is reported on an approved leave, it will be reviewed and you will be
contacted within 2 business days if additional information is needed or the absence cannot be
designated as FMLA. If your absences repeatedly exceed the approved frequency and/or duration
guidelines provided by your health care provider, you will be required to provide additional
documentation regarding the change in your circumstances. Failure to provide sufficient information
to support the need for additional leave may result in the denial of FMLA coverage for absences in
excess of the approved frequency and/or duration. Additionally, your leave of absence will require
recertification every 6 months in connection with an absence. Your failure to recertify your claim
will result in closure and any time taken may be subject to denial of coverage under FMLA
coverage.

Medical information you have shared is considered confidential under the Family and Medical Leave Act
(FMLA) and the Americans with Disabilities Act (ADA). This information is only shared when necessary on a
need-to-know basis with your employer, the Time Away From Work Service Center, or outside medical
professionals retained to review your leave request in an effort to assist in your return to work and to verify
your eligibility for leave. Return to work information (e.g., restrictions) will be shared with your supervisor or
Human Resources Department as necessary on a need-to-know basis.

The Americans with Disability Act Amendments Act (ADAAA) – If your leave request is for your own serious
health condition, and you would like to discuss an accommodation in addition to this request for leave,
please contact your facility’s Human Resources department as soon as possible.

For additional information please find a link to a short video:

https://play.vidyard.com/MzFaTbiy2TNYU4CUprZVsY

You can check for detailed information about the status of this leave 24 hours a day, 7 days a week through
our Interactive Voice Response (IVR) system at (855) 858-7557, or through the ViaOne Express portal, by
logging into www.HCAhrAnswers.com, clicking on “My Time Away From Work” and then selecting “TAFW
Service Center - Report or Check on a Claim.” If your facility does not use HCA hrAnswers, log into
HCArewards.com and click “Time Away From Work.”

If you have questions or I can assist in any way, you may reach me at the Time Away From Work Service
Center at (855) 858-7557, Monday through Friday 6:00 a.m. – 7:00 p.m. (CST).

Sincerely,

Kristen P.
Sedgwick Claims Management Services, Inc.

!C00945183.222-6065!
Leave Advocate
Phone: (855) 858-7557
Fax: (888) 999-7573

Sedgwick Claims Management Services, Inc.

!C00945183.222-6065!