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Stephanie Haber

PFL Claim Forms Released

October 19, 2017

PFL Claim Forms

On October 17, the Workers’ Compensation Board released the highly anticipated Paid Family Leave claim forms to be used by eligible employees starting January 1, 2018. 

There is a separate claim form for each type of leave:

Download ShelterPoint specific PFL claim forms here if you are a ShelterPoint customer:

ShelterPoint PFL Claim Form  - Bonding

ShelterPoint PFL Claim Form – Providing Care

ShelterPoint PFL Claim Form – Military Exigencies


Download Generic PFL claim forms from the State of New York here:

PFL Claim Form  - Bonding

PFL Claim Form – Providing Care

PFL Claim Form – Military Exigencies

Even though the forms are now available:

  • Paid Family Leave claims cannot be processed until PFL becomes officially effective on January 1, 2018. 
  • No leave under PFL can begin prior to January 1, 2018

Eligible employees should send in their fully completed claim form along with the required certifications and supporting documents as listed on the respective claim forms to their employer’s NY Statutory Short-Term Disability (DBL) insurance carrier within 30 days of the leave event occurring.   Consequently, claim forms should NOT be submitted to your carrier prior to January 1, 2018.

For a self-employed person, advance carrier notice may be required.

If you have further questions, you can send them to us anytime 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

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