Claims Examiner Entry
Resume:
Gary Kenyon
Hampton, NH 03842
********@*****.***
Re: Leave Number 5733089
Dear Gary Kenyon:
I’m Aliyah Abdulah, Integrated Claims Examiner and I have completed a review of your leave documentation for your own health condition. Designation/Determination Information
Because your leave will be unscheduled, it is not possible to provide the hours, days, or weeks that will be counted against your FMLA entitlement at this time. You have the right to request this information once in a 30-day period, if leave was taken in the respective 30-day period.
For the duration of this leave to date, the following number of weeks will be counted against your FMLA leave entitlement: 1.20 weeks. Additionally, below is a listing of the absences that you have taken during the last 8 weeks and their designation under federal, state, or employer-authorized policies:
You are approved for the following:
Intermittent 07/27/2022 for 8.00 hours: Family and Medical Leave Act - Approved, Massachusetts Paid Family Medical Leave - Approved Intermittent 08/24/2022 for 8.00 hours: Family and Medical Leave Act - Approved, Massachusetts Paid Family Medical Leave - Approved Intermittent 08/25/2022 for 8.00 hours: Family and Medical Leave Act - Approved, Massachusetts Paid Family Medical Leave - Approved Intermittent 08/31/2022 for 8.00 hours: Family and Medical Leave Act - Approved, Massachusetts Paid Family Medical Leave - Approved Intermittent 09/15/2022 for 8.00 hours: Family and Medical Leave Act - Approved, Massachusetts Paid Family Medical Leave - Approved Intermittent 09/21/2022 for 8.00 hours: Family and Medical Leave Act - Approved, Intermittent 09/21/2022 for 8.00 hours: Family and Medical Leave Act - Approved, Massachusetts Paid Family Medical Leave - Approved Based on the most recently received medical certification, the estimated frequency and duration for intermittent absences related to this condition are as follows: Absence for medical treatment: None certified
Absence due to incapacity: Frequency of 3 events per 1 Month(s), Duration of 3 Day(s) per event
Certification Information
Your certification is valid from 07/27/2022 through 09/21/2022. Need To Extend Your Leave?
If you’re returning to work on a different date than your scheduled return to work date, make sure to
Contact me by phone at 800-***-**** Extension 52391 or email at ******.*******@*********.*** and let me know what is going on. Submit a new CHCP form at least 2 business days prior to the effective date of any such changes.
If your leave is greater than 60 calendar days, you may be required to furnish me with periodic reports of your status and intent to return to work. Keep in mind – Failure to provide additional supporting documentation in a timely manner to extend your leave may result in a delay of the claim extension and/or a disruption of pay!
What to Do to Return to Work
If the circumstances of your leave change and you are able to return to work earlier than the date indicated in this letter:
Notify your Employer at least 2 business days prior to the date you intend to report for work.
Contact me by phone at 800-***-**** Extension 52391 or email ******.*******@*********.*** at least 2 business days prior to the date you intend to report for work.
If the leave is for your own illness, you will need to provide your manager a return-to-work note in accordance with Rochester Electronics, LLC’s policy on the date you report for work. Failure to do so may delay your ability to return to work. If you have a disability or impairment that substantially limits one or more major life activities and want to consider a work accommodation for your return to work, please contact Alyssa Stevenson at 978-***-**** x3426 / **********@*******.*** or Odalis Ramirez at 978-***-**** x3478 / ********@*******.***. Need More Information?
If you need anything, check on your claim status, extend your leave or just ask a question, log in to www.matrixabsence.com and interact with RITA (Your Personal Leave Assistant), check out the Matrix eServices mobile app (search “Matrix eServices”), or contact me at the phone number or email address below.
Matrix Absence Management, Inc.
2421 W. Peoria Avenue, Suite 200
Phoenix, AZ 85029
Confidential Fax: 866-***-****
Phone: 800-***-**** Extension 52391
Email: ******.*******@*********.***
Aliyah Abdulah, Integrated Claims Examiner
Matrix Absence Management, Inc. on behalf of
Human Resources Department, Rochester Electronics, LLC Enclosed:
Employee Instructions for Reporting Intermittent Time Off of Work (if applicable) Matrix Absence Management – IAR Instructions (new platform) – 6/8/2015 INSTRUCTIONS FOR REPORTING INTERMITTENT TIME OFF FROM WORK FOR INTERMITTENT LEAVES ONLY
In addition to your employer’s regular absence management policy, intermittent time off from work relating to your leave must be reported to Matrix Absence Management on a timely basis, within the guidelines set by your employer. You may report time off to Matrix by the following methods:
• Through your Matrix eServices Account on the web
• Through your Matrix eServices Account on your IOS or Android mobile device
• By Calling the Matrix Interactive Voice Response System (IVR) NOTE: If the time you request for leave is not approved you will receive a letter from Matrix explaining the reason(s). You will not receive a letter if your time is approved. Creating a Matrix eServices Account
1. On the Web: go to www.matrixabsence.com and Select “Create an Account”. 2. On your Mobile Device download Matrix eServices Mobile App from Google Play or the ITunes App Store. Select
“Create an Account” from the login screen.
3. Enter your: Last Name, Date of Birth, Last four (4) digits of your Social Security Number and Home Zip Code. 4. Create your User Name and Password (A personal email address is recommended for User Name). Reporting Intermittent Absence Time on the Web
1. Login to Matrix eServices (www.matrixabsence.com) using your username and password. 2. Select the option to Report Intermittent Absence. 3. From the list of leaves, select the leave you are reporting time against. 4. Enter the Start Date and End Date of your absence. 5. Enter the Total Time Off for that day -- EXAMPLE: 2 hours off in the morning and 1 hour in the afternoon, absence for that day must be entered as a total of 3 hours off. Save entry and record the System Confirmation Number for future reference NOTE: Contact your Integrated Claims Examiner for special situations, adjustments or corrections. Report Intermittent Absence Time using your Mobile Device 1. Login to the Matrix eServices Mobile App and select the appropriate claim to report intermittent time. 2. From the list of leaves, select the leave you are reporting time against. 3. Select the option to Report Intermittent Absence/Report more time off. 4. Enter the Start Date and End Date of your absence. 5. Enter the Total Time Off for that day -- EXAMPLE: 2 hours off in the morning and 1 hour in the afternoon, absence for that day must be entered as a total of 3 hours off. Save entry and record the System Confirmation Number for future reference. NOTE: Contact your Integrated Claims Examiner for special situations, adjustments or corrections. Reporting intermittent time by calling the Matrix Interactive Voice Response System (IVR) 1. You can report your intermittent absences by calling the number provided by your employer or by calling 1-888-***-****.
2. Identify yourself by providing your Date of Birth (DOB) and last four (4) digits of your Social Security Number. 3. Select the option to report Intermittent Time Off. 4. Select the leave you are reporting this time against. 5. Enter the Start Date and End Date of your absence. 6. Enter the Start Time of your absence.
7. Enter the Total Hours absent for that day -- EXAMPLE: 2 hours off in the morning and 1 hour in the afternoon, absence for that day must be entered as a total of 3 hours off. 8. Save entry and record the System Confirmation Number for future reference. NOTE: Contact your Integrated Claims Examiner for special situations, adjustments or corrections.
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