Alex Corrado
/ Categories: Claims

Top 3 Must See — Q&A on Paid Family Leave Claims

March 27, 2018

PFL claims

For our next installment of “Top 3 Must See,” we’re looking at three common questions about Paid Family Leave claims. Here are the answers to your real questions.

 

1. Whose responsibility is it to file a Paid Family Leave claim? The employer or the employee?

It’s the responsibility of the employee to complete and submit their PFL claim. Along with the forms, the employee will need to include required supplemental documentation related to the type of leave they are taking.

However, Part B of the PFL-1 form, must be filled out by the employer and returned to the employee within 3 business days.

The employee will then send their form and accompanying documentation directly to their Paid Family Leave insurance carrier. We provide ShelterPoint-specific claim forms with our address and contact information prefilled for our customers.

PFL Expert Tip: Sending in forms/documentation too early may be counterproductive.  Read this to find out why.

While employers are not responsible for filing PFL claims, they can provide forms for their employees. If you are an employer, make sure you have the required postings and written information for your employees. (Learn more about that here).

 

2. If an employee doesn’t give the 30 days’ notice to their employer, can their claim be denied or reduced?

Yes.  Since this is required by the law, it could have some impacts on your benefit payment.  The 30 days’ notice is only applicable for “foreseeable” qualifying events, such as:

  • An expected birth, or placement for adoption or foster care
  • Planned medical treatment for a serious health condition of a family member
  • Planned medical treatment for a serious injury or illness of a covered service member
  • Other known military exigencies

In some instances, 30 days’ notice is not possible — as with a medical emergency, sudden changes in circumstances, or premature birth. In these cases, notice must be given to the employer as soon as practicable given the circumstances of the event.  

If the qualifying event is foreseeable, and the employee fails to provide the 30 days’ notice to their employer, the insurance carrier could file a “partial denial” on the claim.

So, what does “partial denial mean?”

A partial denial is when all, or some of the employee’s time allowed under PFL may become reduced – meaning they wouldn’t be approved for the full 8-weeks of time in 2018.  Their benefit payment amount remains the same, just the time available for the employee to use on leave is less.  There are few reasons why this would occur:

  • The employee has reached their benefit maximum of 26 weeks in a 52-week period
    • Example: an employee has already taken 20 weeks of Disability, so that leaves them only 6 weeks to use their Paid Family Leave
  • The employee gave late or no notice to their employer for foreseeable leave (30 days in advance notice is required)
    • Example: The employee only gave 10 days notice of PFL for their bonding leave, so their Paid Family Leave time may be denied, or may be reduced by 20 days
  • The employee filed their claim too late with their PFL insurance carrier (must be filed within 30 days after the first day of leave)
    • Example: An employee started their Paid Family Leave on March 1, but didn’t file their claim until April 10.The claim may be denied, or reduced by 11 days.

 

3. How long does it take for a claim to be approved or denied?

Paid Family Leave forms and all relevant documentation must be submitted to the PFL carrier within 30 days after the first day of leave. Paid Family Leave insurance carriers have 18 days to accept or deny a fully completed claim. 

 

Have more questions about claims, or other Paid Family Leave topics? Check back soon to see if we cover your question in our next installment, or ask our PFL experts at pflquestions@shelterpoint.com.

 


This blog post is for informational purposes only and is not intended to provide legal counsel. Please consult with an appropriate professional for legal and compliance advice. Any PFL information is as of the blog post’s date stamp; it is based on the applicable statutes and regulation,  and may change as regulations evolve or NY State issues guidance regarding Paid Family Leave regulations. Have more questions? Email us at pflquestions@shelterpoint.com
Previous Article Why You Shouldn’t Submit Your PFL Claim Forms Before Your Leave
Next Article PFL Update: NY State Average Weekly Wage for 2019 Benefits
Print
2366 Rate this article:
No rating

Name:
Email:
Subject:
Message:
x

Get the latest Paid Family Leave New York updates delivered to your inbox!