Washington State Paid Family Leave Insurance Form

Qualifying serious health conditions and authorized healthcare providers are described below.

Washington state paid family leave insurance form. Need help or want to request the paper application. How much time you can take and when you can take it. Washington state s paid family and medical leave washington workers will have up to 12 weeks of paid family or medical leave starting in 2020. Contact the paid family and medical leave team.

For the most up to date information head over to our website at www paidleave wa gov. Contact us at paidleave esd wa gov or by phone at 833 717 2273. Beginning in 2020 it allows most employees to receive up to 12 weeks of paid leave for. You can apply for paid family and medical leave online or with a paper application.

Some people may qualify for up to 16 or 18 weeks of paid leave. You don t have to use your leave all at once. For example if the child was born feb. 1 2020 until feb.

Paid family and medical leave is a new benefit for washington workers and lets you take up to 12 weeks of paid time off when you need it most. This form is used to certify a serious health condition in order to qualify for paid family and medical leave. Your patient may be applying due to their own serious health condition or to care for a family member with a serious health condition. I authorize paid family and medical leave to use the information on this form to determine my eligibility for paid family or medical leave benefits and i attest that i am applying for paid leave due to my own serious health condition or to take care of a family member with a serious health condition.

It applies to just about every business and employee in washington. The paid family and medical leave program is a new state run insurance benefit passed by the legislature in 2017. Learn more and apply. Most washington workers are eligible for up to 12 weeks of paid family and medical leave a year.

Paid family and medical leave is a new state insurance program in washington that provides paid leave for people when they need to care for themselves or a family member after childbirth or a serious illness or injury or for certain military connected events. The paid family and medical leave program is a mandatory statewide insurance program administered by the employment security department esd which provides paid family and medical leave to eligible employees.