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Leaves of Absence

What You Need to Know 

The Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA) are laws that provide eligible employees up to 12 weeks of job protected unpaid leave in a 12-month period for:

  • Care of oneself or one’s family member with a serious health condition
  • Disability due to pregnancy, child birth, or related medical condition (does not apply to CFRA)
  • Bonding/caring for a new born baby, or adopted or foster child
  • Military Family Leave

Eligibility – To be eligible for FMLA/CFRA you must have worked for the City for at least 12 months, and worked at least 1,250 hours during the 12 months immediately preceding the start of the leave of absence. If you are not eligible for FMLA/CFRA and you are pregnant, you are likely still eligible for Pregnancy Disability Leave.

To Request Leave – Fill out Request for Family Medical Leave Form and send to Human Resources via interoffice mail, FAX to (415) 485-3191, or scan and send to

During your leave – While you are on leave, you are encouraged to stay in touch with your supervisor or manager, particularly if there are any foreseeable changes to your return to work date.

Returning to work – Before returning to work from medical leave, you may be required to provide a medical release from your healthcare provider (your return to work certification should include any and all limitations, if any).  You may also be eligible for modified duty or reasonable accommodation if you are returning to work with limitations. Modified duty is a temporary modification to the work assignment to help you transition back to regular duty.

For more information, please read the City's FMLA/CFRA Policy and review this Medical Leave Summary.

Family and Medical Leave Process

When absence is foreseeable, provide your supervisor with 30 days’ notice before taking a medical leave of absence under FMLA/CFRA. Foreseeable leaves of absence include pre-scheduled surgery and time off for child birth, and/or to bond with a new child. Complete the Request for Family and Medical Leave form. Should you need a leave of absence suddenly to care for yourself or a family member, you must notify your supervisor or HR as soon as practicable.

The FMLA/CFRA Medical Certification Form must certify that the absence is required for a ‘serious health condition’ of the employee or the employee’s family member.

It must include:

  • Start date of the condition
  • The expected duration of absence
  • The anticipated return to work date
  • Signature of the health care provider

The certification must not include diagnosis, but must detail the required time away from work. The medical certification is private and confidential and should be submitted directly to Human Resources Department, within 15 days of your request for leave.

Intermittent leave may be taken as the condition requires. However, the treating practitioner must provide specific information regarding frequency and duration of intermittent leave. If leave is for medical appointments, specific dates and times must be provided by the healthcare practitioner.

You will receive from Human Resources a notice of approval, provisional approval, or denial via US mail within a few days after they have received the medical certification from you. The letter will include contact information for you to call or email with any questions or concerns about your leave of absence.

While FMLA, CFRA and PDL provide job-protection and maintenance of benefits to eligible employees, the protected time off is unpaid. Therefore you must use your own leave accruals while on an FMLA/CFRA or PDL and, if eligible, integrate supplemental income such as State Disability Insurance (SDI) and/or Paid Family Leave (PFL).  Both SDI and PFL are administered by the State of California Employment Development Department (EDD).

Participation in SDI/PFL is determined by bargaining unit and is an employee-paid benefit.  Currently, only members of SEIU, SEIU-Child Care, WCE and PEU Local 1 Confidential contribute to SDI.   However, employees who do not contribute through their City employment may have SDI “credit” based on any employment prior to or outside of your employment with the City of San Rafael.

During the time you are on FMLA/CFRA or PDL, the City-paid portion of health (flex dollar contribution) and other benefits (dental, vision, life, LTD) will continue and any employee portion will be deducted from your paycheck. If you run out of accrued paid time off while on any protected leave, you will be placed on Leave Without Pay, during which time you will continue to receive the City’s contribution towards your benefits and must make a payment arrangement with Human Resources to pay directly for the balance due for any employee portion of your premiums.

Unpaid Leave of Absence After Protected FMLA/CFRA or PDL

There are times when employees must remain on unpaid medical leave beyond protected FMLA/CFRA. In this case, in order to maintain your benefits coverage, you must pay the full premium contributions for yourself and any enrolled dependents. Payments are made directly to Human Resources. It is your responsibility to work with HR to make a payment arrangement or make temporary changes to your benefits enrollment. Failure to make timely premium payments can result in the termination of your benefits, which may not be reinstated until you return to work or during Open Enrollment.

  1. The most important part of your responsibilities while on leave is to remain in communication with your department, particularly if there is a foreseeable change to your return date whether you plan to return sooner or later than first expected.
  2. If there is an extension to your return date send in the appropriate Medical Certification Form before your original expected return date arrives, preferably a week or two before so that your department can further plan for coverage of your usual duties.
  3. If you apply for and receive SDI/PFL, contact Payroll immediately at (415) 485-3453 to integrate funds with your paycheck by coordinating buy back of leave accruals used while on FMLA/CFRA or PDL protected status.

Understanding the Difference Between Job Protection and How You are Paid

There are two aspects of leave that are important to understand: job protection and non-work income replacement. How you are paid depends on your own leave balances (sick, vacation, etc.), as well as your eligibility for income replacement through:

  • Worker's Compensation (WC), if the injury occurred on the Job - See the City's Workers Compensation Policy or contact Rhonda Castellucci at (415) 485-3474 for specific Workers Compensation related questions.
  • California’s State Disability Insurance (SDI), if illness or injury is not job related
  • Paid Family Leave (PFL), for illness or injury of family member
  • Long Term Disability (LTD) - Check your MOU for more information. You must be disabled for 90 days before benefits may be payable.

State Disability (SDI) - SDI provides affordable, short-term (up to one year) benefit to eligible workers who suffer a loss of wages when unable to work due to a non-work-related illness or injury, or due to pregnancy or childbirth. SDI does not pay for the first 7 calendar days of the disability. If SDI approves your claim, you will receive up to 55% of your weekly salary for a maximum of 52 weeks. Benefits may be generated within 15 to 21 days after submitting the SDI claim, assuming all the necessary information is provided.

Paid Family Leave (PFL) – PFL was established for workers who suffer a loss of wages when they need to take time off from work to care for a seriously ill child, spouse, parent, registered domestic partner, or to bond with a new child. It pays up to six weeks of benefits.

Participation in SDI/PFL is determined by bargaining unit and is an employee-paid benefit.  Currently, only members of SEIU, SEIU-Child Care, WCE and PEU Local 1 Confidential contribute to SDI.   However, employees who do not contribute through their City employment may have SDI “credit” based on any employment prior to or outside of your employment with the City of San Rafael.

Tutorials on How to Register and File a Claim for SDI or PFL

Other Questions? Ask EDD.

Long Term Disability (LTD) - This insurance is administered through CIGNA and pays benefits only if you are unable to work for 90 days or more. LTD pays up to a maximum percentage of pre-disability income as established in your MOU. Benefits may be reduced by other payments you receive, such as SDI, sick leave or other salary continuation.

Integration of Disability Benefits

Integration is a method of combining your paid time off (accruals) with disability benefits during a medical leave of absence. State Disability Insurance (SDI), Paid Family Leave (PFL), and Workers' Compensation (for non-safety employees) all provide partial wage replacement during a medical leave of absence. It is unlawful to receive disability benefits AND a full paycheck. Your total compensation (paycheck + disability) CANNOT exceed 100% of your standard base salary.

Employee Responsibilities

As soon as you receive a notice of benefits for SDI and/or PFL (statement and/or debit card), you must provide a copy of your statement to Payroll for the purpose of integrating funds with leave accruals. *Typically you will receive a new statement biweekly or monthly, so this will be a recurring responsibility during your leave of absence. *

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