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:
- The person claiming benefits, also known as the claimant.
- The claimant’s healthcare provider.
- The claimant’s employer.
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.
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 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 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.
|Claimant||Estimates the benefits for which they qualify||1 hour|
|Claimant||Files online||1 hour|
|[State name]||Does things||18 days|
Claimants have the right to appeal any decision regarding their claims to PFML benefits. Appeals should be submitted in writing to:
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].