LOA Toolkit: Employee Role


If you are an employee requesting or currently on leave, your role includes:

Notify both your manager and The Hartford (888.980.9382) at least 30 days in advance for planned leaves. For unforeseen leave, please provide notification on the first day of the absence or within the next two business days.

Read all leave documentation provided to you by The Hartford (sent after leave is requested).

Complete Form 4782 for a personal leave of absence.  Obtain manager approval and submit form to Employee Benefits.

Complete all paperwork within five days, preferably sooner. This will prevent delays in processing, pay, and potential job protection.

Documentation: You may be required to provide certification documents from your physician. Delay in providing required documents may impact the timing of your leave approval, pay, benefits, and job protection.

Respond as quickly as possible to The Hartford’s requests for medical certification (from the doctor) and completion of your leave documentation.

It’s essential that you follow up with your doctor (or their nurse) to ensure they have submitted your certification. To avoid delays, we suggest you encourage them to file their certification online.

Delayed responses can adversely impact the processing of your claim and getting paid on time, particularly if leave pay is administered by the state.

California Employees: Note that disability claims should be sent to EDD, if applicable, as they administer some of the leave offered by the state. Refer to pay during leave

Non-California Employees: Submit Short Term Disability claims to The Hartford. Refer to pay during leave.

Monitor your leave of absence status regularly on The Hartford website.

You must notify The Hartford and EBSC regarding changes in your leave status, and/or intermittent absences.

Please remember to stay in contact with EBSC.

Scheduling your Return to Work (RTW)

Please contact EBSC at least two business days prior to your RTW date to confirm.

If you’re on disability leave, you must provide the Employee Benefits team with RTW medical certification form signed by your doctor. As such, we suggest that you schedule a doctor appointment two to five business days prior to your planned RTW.

Please fax (310.563.7930) or email  RTW certification at least two business days before your return to work.