Since the New York Paid Family Leave (PFL) program is new and unprecedented in the country in terms of the amount and scope of benefits, there are bound to be some bumps in the road when it comes to filing PFL claims. To help minimize the frustrations of employees filing claims for PFL, we have provided three simple tips to help make the claims process easier and more efficient.

1. Determine who will submit the claim.

Having the employer and employee on the same page when it comes to the paid family leave claims submission process will help avoid things falling through the cracks. Whether it is the employer or employee submitting the claim, each scenario comes with its advantages and disadvantages. Being aware of these can help avoid claim submission pitfalls.

Employee
According to the regulations, filing the PFL claim is the employee’s responsibility because of the potential for the collection of sensitive personal health information (PHI).

• Advantage: The employee is responsible for completing all paperwork.

• Disadvantage: The employer may not have a copy of paperwork for reference if the employee is questioning the status of the claim.

Employer
The employer is allowed to continue existing human resources practices and submit the claims and required documentation.

• Advantage: The employer has visibility of the date that the claim was submitted.

• Disadvantage: The employer assumes responsibility for the claim submission and status tracking.

2. Fill out all claim forms completely.

It sounds easy enough, but it is often a cause of delays in the claims process. Having claim forms completely filled out as well as submitting all of the required documentation will keep things moving along. Without the completed claim information, the claim for paid family leave can remain in limbo and the employee must send in the required documentation before the review process takes place. Below is the list of claim forms that may need to be completed, depending on the type of PFL claim filed:

• PFL-1: Universal form for all leave types
• PFL-1: Part B is the employer’s portion to complete
• PFL-2: Bonding
• PFL-3 and 4: Caring for an ill family member
• PFL-5: Military exigency

Remember, making sure to “dot all the i’s and cross the t’s” on your forms will help avoid any delays in the claims process.

3. Know the claim timelines. 

Once a completed claim is received with all required forms and documentation, the carrier has 18 days to review and pay an approved claim. If a completed claim is received at least 18 days before the event, the carrier will pay approved claims within five days of the leave event: for example, a pre-scheduled surgery or pre-planned military event.

Being prepared is the key to success

Making sure to have all your “ducks in a row” when it comes to the PFL claims process benefits both agents and business owners alike. That’s where partnering with a leader in New York disability benefits can really pay off. AmTrust offers a strong and reliable support system that can help you (and your clients) understand and comply with the new policy and claims process.

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This material is for informational purposes only, summarizes coverages and services that may be available in a policy, and is not legal or business advice. Neither AmTrust Financial Services, Inc. nor any of its subsidiaries or affiliates represents or warrants that the information contained herein is appropriate or suitable for any specific business or legal purpose. Readers seeking resolution of specific questions should consult their business and/or legal advisors. Individual coverage may vary and may not be available in all states. Claim examples are general and for illustrative purposes only. Any available coverage for a claim will be determined based on the facts and circumstances of the claim as well as the terms and conditions of the policy, including any applicable exclusions or deductibles. In the event of a conflict with the material herein, the terms and conditions of any issued policy will control.