Dear Doctor:

I confirm receipt of your recent medical note, dated XXX, as attached,
regarding this Employee wherein you have indicated:

“To whom it may concern: This patient was first seen on XXX. This
patient was totally disabled on INJURY/ILLNESS DATE and I estimate
through to DATE. Return to regular work on RTW DATE.

Additional Notes: Off work on the above dates due to medical reasons.
Will return to work on RTW DATE.”

It is important to know specific restrictions and abilities, if any, upon RTW.
When receiving Medical Notes, the Company considers the terminology “off work” to indicate being unable to work rather than attempt modified duties or step-up modified duties (i.e. 1-week no use, 1-week partial, etcetera) and medical notes will be clarified as needed

As this Employee may be eligible for Benefits (Short Term Disability or
otherwise) dependent upon his/her condition and reason for absence, please confirm the reason for the delay in Return-to-Work prior to RTW DATE. This Employee’s job classification is that of POSITION, specifically JOB TASKS. This job classification has been confirmed as (“Sedentary” as applicable) by WSIB.

The Company maintains a RTW Plan for Modified Duties as necessary that include worksite assistance, additional time for stretch / flex breaks and working at one’s own pace with no overly repetitive activity.

Your timely response on this item is most appreciated.

Sincerely,

THE COMPANY
YOUR NAME

cc: HR / Payroll File

Benefits Adjudicator