Manager's Toolkit - Benefit Resources

Leave
Chancery Holidays for 2011	View
Chancery Holidays for 2010	View
Monthly Leave Form	View
Personal or Military Leave of Absence	View

FML - Family Medical Leave

Always contact the Office of Human Resources at 206-382-4570 or 800-261-4749 regarding any disability concerns or accommodation requests. Each situation must be treated individually and may intersect with Family Medical Leave and Workers' Compensation.

Family Medical Leave
Helpful Hints - WC/ADA/FML Chart	View
Employee Application for Family Medical Leave (FML)	View
Employer Response to Request for FML	View
Certification of Provider for FML	View
Provider Certification for Return to Work From FML	View

Workers' Compensation

The Archdiocese of Seattle self-insures for Workers' Compensation, and provides benefits for employees who are injured on the job or contract a work-related illness, disability or disease. Rules and regulations under the Industrial Insurance Laws (Title 41) of the State of Washington are observed.

Employees who are unable to work because of a work-related injury or disease will receive compensation for time lost determined in a manner consistent with the Washington State rules and regulations.

Employees may use sick leave and vacation leave hours to offset the pay difference while receiving time-loss benefits.

Workers’ Compensation claims administration has been turned over to a third party administrator called CCMSI. All completed Self-Insurer Accident Report (SIF-2) and Physicians Initial Report (PIR) forms should be sent directly to:

CCMSI
7900 E. Greenlake N., Suite 208
Seattle, WA 98103
PH: 206-517-5590
FAX: 206-517-5591

As a reminder, please remember to provide the employee who will be filing a work- related injury claim with "A Guide to Industrial Insurance Benefits for Employees of Self-Insured Business" booklet. Should you need additional booklets, please fax your request to (206) 382-4372 or email cristym@seattlearch.org.