Valeria Carlos Tavarez

Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.

Professional with significant experience in handling claims and ensuring efficient processing. Known for strong team collaboration and adaptability to changing needs. Skilled in problem-solving, customer service, and data analysis. Reliable and results-driven with focus on achieving organizational goals.

• 5. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery? No Yes.
• If so, estimate the beginning and ending dates for the period of incapacity:
• 6. Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced schedule because of the employee’s medical condition? No Yes.
• If so, are the treatments or the reduced number of hours of work medically necessary?
• No Yes.
• Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period:
• Estimate the part-time or reduced work schedule the employee needs, if any:
• Hour(s) per day; days per week from through
• 7. Will the condition cause episodic flare-ups periodically preventing the employee from performing his/her job functions? No Yes.
• Is it medically necessary for the employee to be absent from work during the flare-ups?
• No Yes. If so, explain:
• Based upon the patient’s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days):
• Frequency: times per week(s) month(s)
• Duration: hours or day(s) per episode
• ADDITIONAL INFORMATION: IDENTIFY QUESTION NUMBER WITH YOUR ADDITIONAL ANSWER.
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• Form WH-380-E Revised May 2015

• Signature of Health Care Provider Date
• PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT
• If submitted, it is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC 20210. DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT.
• Page 4
• Form WH-380-E Revised May 2015

• 1. Approximate date condition commenced:
• Probable duration of condition:
• Mark below as applicable:
• Was the patient admitted for an overnight stay in a hospital, hospice, or residential medical care facility?
• No Yes. If so, dates of admission:
• Date(s) you treated the patient for condition:
• Will the patient need to have treatment visits at least twice per year due to the condition? No Yes.
• Was medication, other than over-the-counter medication, prescribed? No Yes.
• Was the patient referred to other health care provider(s) for evaluation or treatment (e.g., physical therapist)?
• No Yes. If so, state the nature of such treatments and expected duration of treatment:
• 2. Is the medical condition pregnancy? No Yes. If so, expected delivery date:
• 3. Use the information provided by the employer in Section I to answer this question. If the employer fails to provide a list of the employee’s essential functions or a job description, answer these questions based upon the employee’s own description of his/her job functions.
• Is the employee unable to perform any of his/her job functions due to the condition: No Yes.
• If so, identify the job functions the employee is unable to perform:
• 4. Describe other relevant medical facts, if any, related to the condition for which the employee seeks leave (such medical facts may include symptoms, diagnosis, or any regimen of continuing treatment such as the use of specialized equipment):
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• Form WH-380-E Revised May 2015

• U.S. Department of Labor
• Wage and Hour Division
• OMB Control Number: 1235-0003
• Expires: 5/31/2018
• SECTION I: For Completion by the EMPLOYER
• INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. Please complete Section I before giving this form to your employee. Your response is voluntary. While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306-825.308. Employers must generally maintain records and documents relating to medical certifications, recertifications, or medical histories of employees created for FMLA purposes as confidential medical records in separate files/records from the usual personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies, and in accordance with 29 C.F.R. § 1635.9, if the Genetic Information Nondiscrimination Act applies.
• Employer name and contact: Fred Loya Insurance - Maria Molina, HR Manager Phone: (210)257-4509
• Employee’s job title: Support Staff
• Regular work schedule: M-F
• Employee’s essential job functions:
• Check if job description is attached:
• SECTION II: For Completion by the EMPLOYEE
• INSTRUCTIONS to the EMPLOYEE: Please complete Section II before giving this form to your medical provider. The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA leave due to your own serious health condition. If requested by your employer, your response is required to obtain or retain the benefit of FMLA protections. 29 U.S.C. §§ 2613, 2614(c)(3). Failure to provide a complete and sufficient medical certification may result in a denial of your FMLA request. 29 C.F.R. § 825.313. Your employer must give you at least 15 calendar days to return this form. 29 C.F.R. § 825.305(b).
• Your name: Valerie Taylor
• First Middle Last
• SECTION III: For Completion by the HEALTH CARE PROVIDER
• INSTRUCTIONS to the HEALTH CARE PROVIDER: Your patient has requested leave under the FMLA. Answer, fully and completely, all applicable parts. Several questions seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the patient. Be as specific as you can; terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage. Limit your responses to the condition for which the employee is seeking leave. Do not provide information about genetic tests, as defined in 29 C.F.R. § 1635.3(f), genetic services, as defined in 29 C.F.R. § 1635.3(e), or the manifestation of disease or disorder in the employee’s family members, 29 C.F.R. § 1635.3(b). Please be sure to sign the form on the last page.
• Provider’s name and business address:
• Type of practice / Medical specialty:
• Telephone: ( ) Fax: ( )
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• Form WH-380-E Revised May 2015

• October 27, 2015
• Valeria Moreno
• 9116 Geranium Dr
• El Paso, TX 79907
• Vmoreno1@fredloya.com
• Dear Valeria
• We are very sorry to hear about your current medical situation. We hope you have a speedy recovery and know that we are here to answer any questions you may have.
• I am attaching the following documents:
• Family Medical Leave Act (FMLA) information which explains your rights under FMLA
• FMLA Eligibility Notice
• FMLA doctor certification
• The doctor certification must be completed by your doctor and returned to us by 11/06/15. Please complete the continuation of coverage form as soon as possible and return to us via email or by fax to:
• Leaves@fredloya.com
• Or
• Fax to (210)521-8436
• Valeria, we will soon be in contact with you to ensure receipt of documentation and to discuss the next steps. If you have any questions please don’t hesitate to contact Maria Molina at 210-257-4509 immediately. Get well soon!
• Sincerely
• Maria Molina
• HR Manager
• (210)257-4509

• Basic Leave Entitlement
• FMLA provides covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons:
• For incapacity due to pregnancy, prenatal medical care or child birth;
• To care for the employee’s child after birth, or placement for adoption or foster care;
• To care for the employee’s spouse, son, daughter or parent, who has a serious health condition;
• For a serious health condition that makes the employee unable to perform the employee’s job
• Military Family Leave Entitlements
• Eligible employees whose spouse, son, daughter or parent is on covered active duty or call to covered active duty status may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings.
• FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered service member during a single 12-month period. A covered servicemember is: (1) a current member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation or therapy, or is otherwise in outpatient status, or is otherwise on the temporary disability retired list for a serious injury or illness
• ; or (2) a veteran who was discharged or released under conditions other than dishonorable at any time during the five-year period prior to the first date the eligible employee takes FMLA leave to care for the covered veteran, and who is undergoing medical treatment, recuperation, or therapy for a serious injury or illness.
• The FMLA definitions of “serious injury or illness” for current servicemembers and veterans are distinct from the FMLA definition of “serious health condition”.
• Benefits and Protections
• During FMLA leave, the employer must maintain the employee’s health coverage under any “group health plan” on the same terms as if the employee had continued to work. Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms.
• Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee’s leave.
• Eligibility Requirements
• Employees are eligible if they have worked for a covered employer for at least 12 months, have 1,250 hours of service in the previous 12 months
• and if at least 50 employees are employed by the employer within 75 miles.
• Special hours of service eligibility requirements apply to airline flight crew employees.
• Definition of Serious Health Condition
• A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee’s job, or prevents the qualified family member from participating in school or other daily activities.
• Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than 3 consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment.
• Use of Leave
• An employee does not need to use this leave entitlement in one block. Leave can be taken intermittently or on a reduced leave schedule when medically necessary. Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer’s operations. Leave due to qualifying exigencies may also be taken on an intermittent basis.
• Substitution of Paid Leave for Unpaid Leave
• Employees may choose or employers may require use of accrued paid leave while taking FMLA leave. In order to use paid leave for FMLA leave, employees must comply with the employer’s normal paid leave policies.
• Employee Responsibilities
• Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer’s normal call-in procedures.
• Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, or the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave.
• Employer Responsibilities
• Covered employers must inform employees requesting leave whether they are eligible under FMLA. If they are, the notice must specify any additional information required as well as the employees’ rights and responsibilities. If they are not eligible, the employer must provide a reason for the ineligibility.
• Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee’s leave entitlement. If the employer determines that the leave is not FMLA-protected, the employer must notify the employee.
• Unlawful Acts by Employers
• FMLA makes it unlawful for any employer to:
• Interfere with, restrain, or deny the exercise of any right provided under FMLA; and
• Discharge or discriminate against any person for opposing any practice made unlawful by FMLA or for involvement in any proceeding or inquiry relating to FMLA.
• Enforcement
• An employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit against an employer.
• FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights.
• FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered employers to post the text of this notice. Regulation 29 C.F.R. § 825.300(a) may require additional disclosures.
• For additional information:
• 1-866-4-USWAGE (1-866-487-9243) TTY: 1-877-889-5627
• Www.wagehour.dol.gov
• U.S Department of Labor Wage and Hour Division
• WHD Publication 1420 Revised February 2013

• The Family and Medical Leave Act (FMLA) entitles an eligible employee to take up to 12 workweeks of job-protected unpaid leave for the birth or placement of a son or daughter, to bond with a newborn or newly placed son or daughter, or to care for a son or daughter with a serious health condition. See 29 USC 2612(a)(1).
• This Fact Sheet provides guidance on an employee’s entitlement to FMLA leave to bond with or care for a child to whom the employee stands “in loco parentis.” You may also wish to review Fact Sheet #28C on FMLA leave to care for a parent on the basis of an in loco parentis relationship.
• FMLA definition of “son or daughter”
• The FMLA defines a “son or daughter” as a biological, adopted, or foster child, a stepchild, a legal ward, or a child of a person standing in loco parentis. See 29 USC 2611(12). The broad definition of “son or daughter” is intended to reflect the reality that many children in the United States live with a parent other than their biological father and mother. Under the FMLA, an employee who actually has day-to-day responsibility for caring for a child may be entitled to leave even if the employee does not have a biological or legal relationship to the child.
• The definition of “son or daughter” is limited to children under the age of 18 or 18 years of age or older and incapable of self-care because of a mental or physical disability. See 29 USC 2612(12). The FMLA military leave provisions have specific definitions of son or daughter that are unique to those provisions. See 29 C.F.R. § 825.122(g), (h).
• What does in loco parentis mean under FMLA?
• In loco parentis is commonly understood to refer to a relationship in which a person has put himself or herself in the situation of a parent by assuming and discharging the obligations of a parent to a child with whom he or she has no legal or biological connection. It exists when an individual intends to take on the role of a parent.
• Under the FMLA, persons who are in loco parentis include those with day-to-day responsibilities to care for or financially support a child. Courts have indicated some factors to be considered in determining in loco parentis status include:
• The age of the child;
• The degree to which the child is dependent on the person;
• The amount of financial support, if any, provided; and
• The extent to which duties commonly associated with parenthood are exercised.
• The fact that a child has a biological parent in the home, or has both a mother and a father, does not prevent an employee from standing in loco parentis to that child. The FMLA does not restrict the number of parents a child may have. The specific facts of each situation will determine whether an employee stands in loco parentis to a child.
• Examples of in loco parentis
• Examples of situations in which FMLA leave may be based on an in loco parentis relationship include:
• A grandfather may take leave to care for a grandchild whom he has assumed ongoing responsibility for raising if the child has a serious health condition.
• An aunt who assumes responsibility for caring for a child after the death of the child’s parents may take leave to care for the child if the child has a serious health condition.
• A person who will co-parent a same-sex partner’s biological child may take leave for the birth of the child and for bonding.
• What may be required to document an in loco parentis relationship?
• The employer’s right to documentation of family relationship is the same for an individual who asserts an in loco parentis relationship as it is for a biological, adoptive, foster or step parent. Such documentation may take the form of a simple statement asserting the relationship. For an individual who stands in loco parentis to a child, such statement may include, for example, the name of the child and a statement of the employee’s in loco parentis relationship to the child. An employee should provide sufficient information to make the employer aware of the in loco parentis relationship. See 29 CFR § 825.122.
• In loco parentis status and other FMLA requirements
• In loco parentis status under the FMLA does not change the law’s other requirements, such as those regarding coverage, eligibility, and qualifying reasons for leave. All requirements must be met for FMLA protections to apply. An employee asserting a right to FMLA leave for birth, bonding, or to care for a child for whom he or she stands in loco parentis may be required to provide notice of the need for leave and to submit medical certification of a serious health condition consistent with the FMLA regulations.
• Where to Obtain Additional Information
• For additional information about the FMLA, visit the Wage and Hour Division Website, http://www.wagehour.dol.gov and/or call our toll-free helpline, 1-866-4-USWAGE (1-866-487-9243) available 8 a.m. to 5 p.m. in your time zone.
• This publication is for general information and is not to be considered in the same light as official statements of position contained in the regulations.
• U.S. Department of Labor
• Frances Perkins Building
• 200 Constitution Avenue, NW
• Washington, DC 20210
• 1-866-4-USWAGE
• TTY: 1-866-487-9243
• Contact Us

• U.S. Department of Labor
• Wage and Hour Division
• OMB Control Number: 1235-0003
• Expires: 5/31/2018
• In general, to be eligible an employee must have worked for an employer for at least 12 months, meet the hours of service requirement in the 12 months preceding the leave, and work at a site with at least 50 employees within 75 miles. While use of this form by employers is optional, a fully completed Form WH-381 provides employees with the information required by 29 C.F.R. § 825.300(b), which must be provided within five business days of the employee notifying the employer of the need for FMLA leave. Part B provides employees with information regarding their rights and responsibilities for taking FMLA leave, as required by 29 C.F.R. § 825.300(b), (c).
• [Part A – NOTICE OF ELIGIBILITY]
• TO: Valeria Moreno
• Employee
• FROM: Maria Molina, HR Manager
• Employer Representative
• DATE: 10/27/2015
• On 10/23/2015 you informed us that you needed leave beginning on 11/13/15 for:
• The birth of a child, or placement of a child with you for adoption or foster care;
• Your own serious health condition;
• Because you are needed to care for your spouse, child, parent due to his/her serious health condition.
• Because of a qualifying exigency arising out of the fact that your spouse, son or daughter, parent is on covered active duty or call to covered active duty status with the Armed Forces.
• Because you are the spouse, son or daughter, parent, next of kin of a covered servicemember with a serious injury or illness.
• This Notice is to inform you that you:
• Are eligible for FMLA leave (See Part B below for Rights and Responsibilities)
• Are not eligible for FMLA leave, because (only one reason need be checked, although you may not be eligible for other reasons):
• You have not met the FMLA’s 12-month length of service requirement. As of the first date of requested leave, you will have worked approximately months towards this requirement.
• You have not met the FMLA’s hours of service requirement.
• You do not work and/or report to a site with 50 or more employees within 75-miles.
• If you have any questions, contact Maria Molina, HR Manager @ 210-257-4509 or view the FMLA poster located in Break Room.
• [PART B-RIGHTS AND RESPONSIBILITIES FOR TAKING FMLA LEAVE]
• As explained in Part A, you meet the eligibility requirements for taking FMLA leave and still have FMLA leave available in the applicable 12-month period. However, in order for us to determine whether your absence qualifies as FMLA leave, you must return the following information to us by 11/09/2015. (If a certification is requested, employers must allow at least 15 calendar days from receipt of this notice; additional time may be required in some circumstances.) If sufficient information is not provided in a timely manner, your leave may be denied.
• Sufficient certification to support your request for FMLA leave. A certification form that sets forth the information necessary to support your request is/is not enclosed.
• Sufficient documentation to establish the required relationship between you and your family member.
• Other information needed (such as documentation for military family leave):
• No additional information requested
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• Form WH-381 Revised February 2013