Change of FMLA Leave Administrator to Sedgwick
This document outlines the transition of Verizon's FMLA and leave administration to Sedgwick. It includes instructions for filing claims and eligibility requirements for Family and Medical Leave. Important contact information and resources are provided for employees seeking assistance.
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How do I fill this out?
To fill out this form, begin by ensuring you meet the eligibility criteria. Next, gather necessary documentation regarding your claim. Follow the outlined steps for submission to ensure timely processing.

How to fill out the Change of FMLA Leave Administrator to Sedgwick?
1
Verify your eligibility for FMLA leave.
2
Gather required documents and information.
3
Complete the appropriate forms from Sedgwick.
4
Submit your claims according to their instructions.
5
Await confirmation and any necessary follow-up actions.
Who needs the Change of FMLA Leave Administrator to Sedgwick?
1
Employees planning to take family medical leave.
2
Employees needing to care for a relative with a serious condition.
3
Employees who have recently welcomed a child through birth or adoption.
4
Service members’ family members seeking leave for qualifying exigencies.
5
Employees who have incurred a serious health condition.
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What are the instructions for submitting this form?
To submit your leave request form, you have various options. For electronic submissions, fax your completed form to (859) 264-4384. Alternatively, you can also reach out to Sedgwick via email for assistance at support@sedgwick.com.
What are the important dates for this form in 2024 and 2025?
Important dates for filing FMLA requests transition to Sedgwick beginning February 1, 2020. Ensure submissions are made in accordance with these dates to avoid any complications. Future updates and adjustments to these timelines will be communicated accordingly.

What is the purpose of this form?
The purpose of this form is to facilitate the request for Family and Medical Leave under the updated administration by Sedgwick. It provides necessary guidelines and procedures for eligible employees to follow when seeking leave. Understanding the requirements will ensure compliance and successful leave approval.

Tell me about this form and its components and fields line-by-line.

- 1. Employee Information: Includes details such as name, contact, and employee ID.
- 2. Claim Type: Indicates the type of leave being requested.
- 3. Duration of Leave: Specifies the start and end dates for the requested leave.
- 4. Supporting Documents: Requires documentation to substantiate the leave request.
- 5. Signature: Space for the employee's signature to validate the request.
What happens if I fail to submit this form?
Failure to submit this form may result in denial of leave requests, leading to potential job-related consequences. Missing deadlines can jeopardize your eligibility for FMLA benefits. It is critical to ensure timely and complete submissions.
- Denial of Leave: Without submission, you risk losing entitlement to FMLA.
- Job Protection Loss: Failure to file can impact job security during medical leave.
- Financial Implications: Unpaid leave may apply if claims are not processed.
- Legal Repercussions: Not following protocol could lead to potential legal issues.
- Complications in Future Requests: Previous denials may complicate future leave applications.
How do I know when to use this form?

- 1. Personal Health Conditions: For leave requests due to your own serious health issues.
- 2. Family Health Needs: To care for a family member who is ill.
- 3. Birth or Adoption: When taking leave for childbirth or adopting a child.
- 4. Military Leave: For exigencies related to a military family member.
- 5. Serious Injury Care: To care for service members or veterans with serious injuries.
Frequently Asked Questions
How do I initiate a claim?
To initiate a claim, contact your supervisor to notify them of your leave request.
What do I do if I encounter issues with the PDF?
If you face difficulties, use the support feature on PrintFriendly for assistance.
Can I save my edits?
Yes, after editing, you can download the modified PDF for your records.
What should I do after submitting my claim?
After submission, keep an eye out for communication from Sedgwick regarding your claim status.
How can I reach Sedgwick for questions about my claim?
You can contact Sedgwick directly through the contact information provided in this document.
Is there a time limit for filing claims?
Yes, be mindful of the deadlines outlined for filing your claim.
Are there options for expedited processing?
Contact Sedgwick for any options regarding expedited claim processing.
What happens if my claim is denied?
You will be notified of the reasons, and you may appeal the decision if eligible.
Where can I find additional resources?
Additional resources can be found on the About You section mentioned in this document.
How often can I apply for FMLA leave?
You can apply for FMLA leave up to once per calendar year, subject to eligibility.
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