Short/Long Term Disability

Completing a Leave/Irregular Workweek Form

When do I need to fill out a Leave/Irregular Workweek Form?

When an injury/illness lasts more than 10 days, a Leave/Irregular Workweek Form must be completed. The LIWF is completed in order to properly code sick leaves and Long Term Disability leaves. In most cases, you will submit several LIWFs as an employees moves through this process.

In addition to completing the LIWF, is there anything else I need to do?

YES! Keep detailed records of hours worked. It is very important to keep detailed records if an employee is able to work modified hours during their salary continuance period, since all hours worked will extend the salary continuance period. 

If you need assistance calculating a salary continuance period please contact the Benefits Department at extension 85562.  Benefits Administration will request confirmation of the first day sick and any hours worked since the first day sick in order to calculate their salary continuance period. This information will then be relayed back to the department.

Coding Examples for a Leave/Irregular Workweek Form

Long Term Disability (LTD) Application Process
(Start 8 weeks prior to end of employee's salary continuance period (STD))

What is the Supervisor's role in the LTD application process?

In application for Long Term Disability benefits is made through Manulife Financial.

The application consists of four statements listed below:
  • Employee Statement - completed by employee
  • Physician Statement - completed by employee's Physician (arranged by employee)
  • Supervisor Statement - completed by employee's Supervisor
  • Employer Statement - completed by Benefits Administration
For LTD leaves, the Supervisor must complete the Supervisor Statement which will be sent to you approximately 8 weeks following the first sick day. The Supervisor Statement is to be completed and then sent back to Benefits Administration at SSB 5100.

Benefits Administration will send the Employee Statement and Physician Statement directly to the employee with a guide and letter outlining their next steps. Benefits Administration will complete the Employer Statement. 

All statements should be submitted approximately 8 weeks prior to the anticipated expiration of their salary continuance period.

Please contact a member of our HR team if you have any questions or require assistance.