When an employee has a foreseeable situation, he/she should provide Human Resources with 30 days advance notice of the intention to use Paid Family Leave. If the event is not foreseeable, the employee must notify Human Resources as soon as practical.
Human Resources will provide the employee with a claim form package for the employee to complete and submit to the insurance company within 3 days of their first day of paid leave. The insurance carrier will process the claim and issue a determination to the employee.
Please contact Deborah Lugo, Manager of Benefits Administration, at 718-817-4933 or email@example.com to receive the claim materials.
When filing a Paid Family Leave claim, the employee must submit supporting documentation to the insurance carrier, as detailed below:
Childbirth/Foster Care Placement/Adoption
All leaves to bond with a child requires an employee complete PFL-2.
The documentation required to support the application for a claim for Paid Family Leave to bond with a newly-born child depends on whether the applicant is the birth mother or the second parent.
The birth mother must submit a birth certificate, if available, or documentation of pregnancy or birth from a health care provider. The document must include the mother’s name and the child’s due date or birth date. The second parent must submit, if available, a birth certificate naming them as a parent. If a birth certificate naming the second parent is not available, the second parent may submit a Voluntary Acknowledgment of Paternity or a Court Order of Filiation naming them as a parent.
If those documents are not available, the second parent can submit birth documentation from the birth mother’s health care provider and either a marriage certificate or evidence of a civil union or domestic partnership to demonstrate the relationship to the birth mother.
If none of these documents are available, the second parent may submit other documentary evidence of parental relationship to the child, to be evaluated on a case-by-case basis by the carrier.
In addition to PFL-2, leave to bond with a fostered child requires the submission of a letter of placement issued by a county or city department of social services or local voluntary agency. If a second parent is not named in documentation, a copy of the document plus a document verifying the relation to the parent named in the foster care placement will be needed.
A claim for Paid Family Leave to bond with an adopted child requires a court document finalizing adoption or, for Paid Family Leave taken before the adoption is complete, a document showing that the adoption process is underway. Examples of proof of a pending adoption include a signed statement from an attorney, adoption agency or adoption-related social service provider that the employee is in the process of adopting a child.
If the second parent is not named in that document, they must also file documentation verifying the relationship to the parent named in the adoption.
Serious Health Condition
An employee is required to complete the employee section of PFL-4 and to provide and ask the recipient of the intended care to have their healthcare provider complete the remainder of PFL-4. In addition, the recipient of the care must complete Form PFL-3, which is kept on file with the recipient’s health care provider.
An authorization for personal health disclosure form is required by the HIPAA Privacy Rule and must be completed by the care recipient and retained on file with the health care provider in order to submit the required medical information.
Active Military Duty Deployment
A claim for Paid Family Leave to assist loved ones when a family member is deployed abroad on active military duty generally requires either a PFL-5 “Military Qualifying Event” certification or a US Department of Labor “Certificate of Qualifying Exigency for Military Family Leave.” Those forms include (1) military documentation of the family member’s deployment or impending deployment (active duty orders or other notice from the military) and (2) documentation of the reason for leave.