Takeaways from PFML Claims Round Table

Today we were fortunate to have Bill Alpine, Executive Director and Lisa Shepard, Senior Manager, Benefit Operations, Program Integrity, and Appeals from the Department of Paid Family and Medical leave join us as guest speakers at our round table.  We covered a lot of ground in an hour, but here were the most important things that I took away from the discussion:

  • As of last week, the Department has had about 15,000 claimants, and they’ve paid about $80MM in PFML claims.
  • They have 45 employees on staff.
  • Total paid claims are running a bit lower than expectations.
  • Employers should update their company policies to add language about the PFML plan and how it operates.
  • If employers have questions or concerns about claimants or the request for information, they call the Department at 833-344-PFML.
  • A common claims issue happens when a new mother applies for bonding leave first, before applying for medical leave.  Things are much more smooth if she applies for medical leave first and then bonding leave.  In this situation, no new elimination period is needed, and the mother can attach the bonding leave to the medical leave with a phone call to the Department.
  • The most common reason a claim is denied is because there is no match with the employee to the employer, no wages showing up in the system for the employee, an incorrect Social Security number, or an incorrect employer identification number.
  • All denials can be appealed, and the appeal begins with a phone call.  It’s rare that an appeal requires a hearing because more often than not, the denial was something simple like the issues noted above.  These can be easily rectified.
  • You may have seen the emails from the state, but if you are using the state plan (not a private plan), you will need to re-authenticate your leave administrator on Mass Tax Connect.  This should be done before May 11.
  • Employers can find the end date for a claim on the approval letter, but be aware extensions for claims can be requested.
  • Employees who think they need an extension beyond the initial approval date should contact the Department 2 weeks PRIOR to the end date to let them know an extension is requested.  They should not wait until the ending date to call.
  • We still have no guidance from the IRS about the tax treatment of PFML claims.

Here is a timeline for a PFML claim with the state, assuming that all of the proper documentation is submitted:

  • The waiting, or elimination period is 7 days.
  • The employer has up to 10 days to respond to the request for information.
  • The claims team has up to 14 days to approve the claim.
  • The regulations state that the Department will not pay a claim until 14 days after the claim is approved.

If you add up those days, an employee could be looking at up to 45 days before a check is mailed to them, although it could be faster.  This is good information to share with claimants to establish realistic expectations.

If you have questions about PFML, or if you’d like to join us for an upcoming round table event, give us a call at 866-724-0008 or click the link below.

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