Discontinuation of Coverage Form - Digital | WWC

Under the Family and Medical Leave Act of 1993 (FMLA) and any applicable state or local laws, an eligible employee may take up to 12 workweeks of job-protected leave during any 12-month period for family and medical reasons if they work for covered employers. Upon return, an employer must restore the employee’s original job or an equivalent position with the same pay, benefits, and other terms and conditions of employment they had before leave. However, once an employee has used up their entitled leave, associated job protections may end unless otherwise extended. Therefore, it is vital for employers to notify eligible employees when their leave has been exhausted.

Employers may use our attorney-reviewed Discontinuation of Coverage Form to notify an employee when their 12 weeks of job-protected leave have expired. The form allows an employer to provide an employee on leave with official notice one week before their scheduled return to work. Included is a section to inform an employee of their rights and responsibilities under FMLA and State Family and Medical Leave. Finally, confirmation of form delivery, specifying the method and verification of delivery is included.

Features & Benefits Include:

• A digital form to let an eligible employee know that their 12 weeks of FMLA or State Family and Medical Leave have expired;
• Attorney-reviewed to ensure compliance with the FMLA and applicable state and local laws;
• Printable, fill-in-the-blanks digital format for physical or electronic recordkeeping;
• A detailed instruction sheet explaining how & when to use the form and how long to retain it.

Our attorney-reviewed form is designed to help employers:

• Notify an eligible employee when their 12 weeks of job-protected leave is exhausted.
• Communicate to an employee their rights and responsibilities under FMLA and State Family and Medical Leave.

Guarantee

• If you are not completely satisfied, you can cancel your order within thirty (30) days of receipt for a full refund.