Stephanie Haber
/ Categories: Claims

Paid Family Leave Claims

December 05, 2017

PFL Claims

The long awaited Paid Family Leave (PFL) claim forms were released by the Workers’ Compensation Board (WCB).  In this post we are going to focus on what to submit for a PFL claim.  Read this post if you’re looking for more information on claim eligibility (whether you’re eligible to request paid leave under PFL), or go here to find out what the benefits are or what to expect when out on PFL.

But don’t forget, before you go out on PFL and can fill out a claim form, you must provide a 30-day notice to your employer for any foreseeable leave.  If the leave is not foreseeable, you must give notice to your employer as soon as ”practicable,” typically within a day or two. This notice should be in writing and identify which of the 3 qualifying events you will be taking leave for and the anticipated timing and duration.

It is your responsibility as the employee taking leave to file the PFL claim with your DBL insurance carrier. Depending on the type of leave, there are some parts of the form that your employer or other parties will need to fill out before you can send it in. 

Even though the claim forms are now available, they cannot be processed until after 01/01/18 when Paid Family Leave becomes effective.  Therefore, no claims can start prior to 01/01/18, even those bonding claims for 2017 events.  You will need to submit your fully completed claim packets (including forms, certifications, and supporting documents) to your DBL insurance carrier within 30 days of your first day of leave taken. 

There is one claim form packet for each leave type under PFL: Bonding, Caregiver, or Military Exigency.  Included with each packet are detailed instructions and checklists for completing and submitting to your NY statutory disability (DBL) carrier. But the actual forms vary based on the type of leave.

Whether taking leave to bond with a new child, care for an ill family member, or spend time with a loved one as a result of a military leave event, you will need to complete and submit the general “Request for Paid Family Leave” form (PFL-1):

  • complete Part A of the PFL-1 form,
  • give it to your employer to complete Part B.   Your employer must complete their section and return it back to you within 3 business days

In addition to the completed PFL-1 form, you are responsible for obtaining and submitting the necessary certifications and supporting documents to show the need for your leave.

Let’s take a look at each type of leave in more detail, including example claim road maps that you can download below:

Bonding Leave

For bonding leave,  you will need to submit the following:

  • PFL-1 completed by both you and your employer
  • PFL-2 (Bonding certification) completed by you
  • Supporting documentation proving the relationship between the claimant (you) and child, such as the birth certificate. Form PFL-2 has a checklist to help you identify what exact documentation is needed for your specific bonding situation


bonding claims road map

Click here to download above image as a PDF!


Caregiver Leave

For leave to care for a seriously ill family member, you will need to submit the following:

  • PFL-1 completed by both you and your employer
  • PFL-3 (Release of personal health information) completed by the “care recipient”, i.e., the family member you’re providing care for (this is filed with their health care provider, so the provider can complete the PFL-4 form. Do not file form PFL-3 with your insurance carrier)
  • PFL-4 (Health care provider’s certification of care) completed by you and the health care provider treating your family member

PFL claim caregiver

Click here to download above image as a PDF!


Military Exigency Leave

For leave as a result of a qualifying military leave event, you will need to submit the following:

  • PFL-1 completed by both you and your employer
  • A PFL-5 (Military qualifying event certification) completed by you and – if applicable – any third party
  • Supporting documents evidencing the military member’s status (covered active duty, impending call/order to covered duty, or Rest and Recuperation document) and the need for leave (such as meeting announcement for informational military briefing; appointment with a school official, doctor, attorney or financial advisor; or a bill for services for the handling of legal or financial affairs)


PFL claims military

Click here to download above image as a PDF!


A few other things to note about taking PFL claims:

  • Your employer can’t require you to use your accrued Personal Time Off (PTO) before letting you go out on Paid Family Leave, unless it’s also FMLA-approved leave and part of your employer’s FMLA practices
  • Your employer can’t deny a valid request for PFL, but remember you will need to give your employer 30 days’ notice for foreseeable leave
  • If your circumstances would qualify you for Paid Family Leave, but you don’t use PFL, your employer could still dock your “PFL time bank” for the time you are out
  • You have the right to report your employer to the New York State Worker’s Compensation Board if they decline to reinstate you upon your return from Paid Family Leave


The PFL Experts at ShelterPoint are here to help with any questions you may have about NY’s Paid Family Leave.  Contact them anytime at:



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

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