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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.
For more details about AMT Warranty feel free to
visit: http://blog.amtrustgroup.com/policywire/3-helpful-tips-forsubmitting-a-paid-family-leave-claim