02.24.2021
Confidential – Internal Use Only | ©2021 Walmart Inc
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Date of vaccine
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Name of issuing provider
If you’re an hourly associate in New York, New Jersey, or Hawaii, you’ll need to submit medical documentation from a
licensed medical provider that has treated you for a diagnosis or symptoms of COVID-19 to qualify for your state’s
short-term disability benefits.
If you’re a New York hourly, salaried, or driver associate, you may also qualify for New York Paid Family Leave benefits.
You’ll need a licensed health care provider who’s treating your family member to complete a form, which Lincoln will
provide. You’ll also need to complete a Release of Personal Health Information form; which Lincoln will also provide. To
start the process, file for a leave of absence with Sedgwick, who will notify Lincoln of your request.
If you’re advised to self-quarantine, New Jersey and Hawaii hourly associates may also be eligible to receive state
disability benefits. You and your licensed health care provider will need to complete a form, which Lincoln will provide to
you.
• In New Jersey, the definition of “sickness” now includes known or suspected exposure to illness as well as in-home
care or treatment for yourself or a family member. You’ll need to provide a notice of determination from a health
care provider, or public health authority that you or a family member’s presence in the community will put others at
risk; and a recommendation, direction or order from the health care provider or public health authority that you or
your family member be isolated or quarantined as the result of exposure.
• Paid Family Leave in New Jersey is administered by the state. You’ll need to contact Sedgwick to file for a leave of
absence and contact the state to learn about eligibility for paid family care.
• In Hawaii, you’ll need a doctor’s note stating that you are ill or quarantined because of COVID-19.
13.
If I take a leave of absence for COVID-19, will I get paid? If so, when?
If you choose to self-quarantine, , you may use available PTO/Protected PTO or sick time, but you are not required to.
You may also use your personal time if you have no PTO or Protected PTO available. If you don’t have any paid time off
available, your self-quarantine will be unpaid. If you’re required to quarantine, failed the Walmart Health Screening, been
diagnosed with COVID-19, or have experienced side effects from the COVID-19 vaccine, you may be eligible for up to
two weeks of pay. Visit MySedgwick at One.Walmart.com/LOA
to file your leave as soon as possible if you’re going to be
out for more than three days.
If you qualify for paid leave benefits, Sedgwick will coordinate your pay. Your payments will be processed through
Walmart Payroll and you’ll be paid on regular paydays. When your leave is complete, you’re required to report your return
to work to Sedgwick.
14.
What if I’m mandated to quarantine and then get diagnosed with COVID-19?
The maximum pay benefit is two work weeks with Level 2, Level 3, and/or adverse reaction to COVID-19 vaccine leave
combined, per continuous leave event. If you’ve been diagnosed with COVID-19 and aren’t able to return to work after
that time, you may be eligible for additional pay replacement for up to 26 weeks.
15.
How is pay calculated?
Please refer to the COVID-19 Emergency Leave Policy by visiting the People Policies page on One.Walmart.com.
16.
Do I need to report my return to work upon completion of my Leave of Absence?
Yes. All associates must report their return to work (RTW) date via mySedgwick or Sedgwick’s Integrated Voice
Response (IVR) within four days leading up to their RTW to avoid delay with pay and systems access.