How it works

The paid family medical leave benefits-claims process involves the participation of multiple parties. This page identifies those parties and their respective responsibilities. It also sketches a timeline for navigating the benefits-claims process.

Roles and responsibilities

The following parties participate in a claim for paid family medical leave benefits:

Claimants

Claimants are responsible for determining their eligibility and coordinating leave with their employer and healthcare provider. Claimants may optionally estimate the benefits for which they are eligible.

Claimants must formally request paid family medical leave benefits by filing a claim with [State name] [Department name]. They can either file a claim online, which is preferred, or use a paper form.

Finally, claimants must coordinate with their healthcare provider in order to provide [State name] [Department name] with medical and/or diagnostic information related to their claim.

Healthcare providers

Healthcare providers are responsible for providing medical and diagnostic information relevant to their patient’s (or their patient’s caretaker’s) claim for paid family medical leave benefits. More information is available on the healthcare providers page.

Employers

Employers are responsible for helping the [State name] [Department name] validate their employee’s claim for paid family medical leave benefits. More information is available on the employers page.

Timeline

Filing online

Party Action Estimated time
Claimant Estimates the benefits for which they qualify 1 hour
Claimant Files online 1 hour
[State name] Does things 18 days

Appeals

Claimants have the right to appeal any decision regarding their claims to PFML benefits. Appeals should be submitted in writing to:

PFML Appeals Coordinator
123 Main St.
Springfield, ST, 20210

800-555-5555

Each case will be assigned to a Referee (Hearing Officer) at the Board of Review. The Referee will schedule a hearing, at which time you may state your argument in detail. You may bring witnesses or someone to represent you. You should bring any documents or other evidence that will support your claim. The Board of Review is an impartial authority not under the direction of [State name].