Claim Help - My Quarantine

 

Checklist to Get You Started

So you’re here because you yourself are under an official order of quarantine due to COVID-19 (Self-Care)? Need to care for your minor child who is under quarantine? (Go here for that information).

Follow this handy checklist to help make your claim as smooth as possible.


Your quarantine is considered a qualified quarantine – don’t file a claim unless you meet these criteria:

  1. Your employer has less than 100 employees (larger employers have to continue their employees salary and these DBL/PFL benefits do not apply! See the question for your benefit options if you work a larger employer in the Other FAQs section.)
  2. You are under an official “Order of Quarantine” issued by the by the state of New York, the department of health, local board of health, or other applicable governmental entity.
  3. You cannot perform your regular job responsibilities (or any alternative duties offered by your employer) due to the novel Coronavirus.
  4. You tested positive for COVID-19 but it was not a result of travel to a country designated by the CDC with a level 2 or 3 travel health notice, or to a state on NYS's travel advisory list. Click here for more details.

Check out this helpful infographic before you file your claim to make sure you’re eligible!

Your employer’s size further drives after how many days of quarantine you may qualify for Emergency DBL/PFL Quarantine benefits:

  • Your employer has 10 or less employees with less than $1m annual net income: your entire quarantine may qualify for special DBL/PFL quarantine benefits from day 1 assuming it started March 18 or later, or any additional days after your Federal benefits (effective April 1) end.
  • If your employer has 1-10 employees and more than $1m in annual net income or has 11-99 employees: your special DBL/PFL Quarantine benefits may begin on day 6 of your quarantine (your employer may provide paid sick leave for you during the first 5 days), assuming this time frame falls before the Federal Law began on April 1.
    • Otherwise, if your quarantine last longer than 14 days, you may qualify for special DBL/PFL quarantine benefits after your Federal benefits end.

If you are a health care provider, learn about the limits on benefits available to you here.

Type of Quarantine Employer Size (number of employees) Employer’s Annual Income Day of quarantine your NY Emergency DBL Quarantine Benefits kick-in* Additional Details
Self-Care lasting 14 calendar days or less.**  10 or less  Less than $1M  1  
 10 or less  More than $1M  6   Your Employer may provide Paid Sick Leave for you during the first 5 days.
 11-99  N/A  6
 100+  N/A  N/A  Employees at larger employers do not qualify for NY’s Emergency Quarantine Benefits. Check out the FAQ section to see what other options you may have.
 

*Quarantine days before 03/18/2020 are not compensated through NY’s Emergency DBL/PFL Quarantine Benefits.
With the Federal Law (“Families First Coronavirus Response Act”, short FFCRA) being in effect from 04/01/2020 to 12/31/2020, benefits under the NY emergency law will only be applicable to New Yorkers who either exceed the Federal law’s salary cap (they can then apply for supplemental benefits bridging between the Federal and State caps) or whose qualified quarantine lasts longer than 14 days. Learn more about how the two laws interact here.

**Employees who have been diagnosed with COVID-19 and are still out after 2 weeks of their employer’s sick pay, may be eligible for basic, standard DBL benefits (max benefit of $170/week of, if the employer has an enhanced DBL benefit level, at the respective coverage level of the policy in force).


You’re already under the qualified quarantine, and it started less than 30 days ago.

For Quarantine days between:
  1. March 18-31, 2020 – NY Law may be sole benefit option (this is when the NY law became effective, through the effective date of the Federal Law).
  2. April 1-December 31, 2020 – NY Law may be supplemental and extended benefit option in addition to the Federal Law. Learn more here.
  3. Since the Federal Law is currently set to end on December 31, starting January 2021, the NY Law may be your primary benefit again.

You are currently considered employed.

If you have been unemployed (including furloughed, temporarily laid off, or out of work because your employer is currently closed) when your qualified quarantine began and you are collecting unemployment benefits, you cannot collect both unemployment and DBL COVID-19 benefits. Click here for more information.

Everything is completed on your COVID-19 Quarantine claim forms.

COVID-19 Quarantine Leave for Yourself
If you’re taking leave for yourself due to COVID-19 Quarantine/Isolation you must submit the following:
  • DB/PFL-Self form sections 1-2, completed and signed by you
  • Part A of the PFL-1 form completed and signed by you
  • Section 3 of the DB/PFL form, and Part B of the PFL-1 form completed and signed by your employer.
    Your employer must complete their sections and return it back to you within 3 business days.
  • A mandatory or precautionary order of quarantine or isolation. See a sample here.Your claim is not complete without this official document. Read more details on how to obtain an order of quarantine here. We can’t process your claim without this official order, and if we don’t receive the order with your claim submission, your claim may be denied.

Everything is clearly legible.

If our examiners can’t clearly read your handwriting, this may require our team to reach out for clarification, which in turn may delay the processing of your claim.

You’ve included any other supporting documentation that may be required for your specific claim.

Your claim is not complete without the official mandatory or precautionary order of quarantine or isolation. If we don’t receive the order with your claim submission, your claim may be denied. If our examiners can’t clearly read your handwriting, this may require our team to reach out for clarification, which in turn may delay the processing of your claim.

All pieces are submitted together at the same time.

If you submit pieces of your claim in separate emails or under separate cover through the mail, each email would be like a separate, incomplete claim submission!

For example, if you haven’t gotten back the Employer’s Statement section from your employer yet, please don’t send what’s been completed so far and the Employer Statement separately later. This will not help get your claim in line sooner and will actually have the opposite effect.

So, please make sure you send everything together at one time, regardless of submission method.

If you chose to submit via email, you can snap a picture of each page and attach multiple files to 1 email.

When submitting by email, your message is less than 10MB.


Only submit your claim through one method.

Please do not submit your claim multiple ways, like email and fax. This would log your claim twice and your claim would compete with itself. Pick one and done!

This is the best way to submit your initial claim. We advise you to go through this Checklist section before you upload your files.

Upload Now

 

In short: Please make sure everything is completed, legible, and submitted together at one time.

Claims are processed in the order they are received, and cannot be reviewed by an examiner unless everything is complete. So, if you are missing a portion in your submission, your claim cannot go into the processing queue until you submit everything that’s needed. This may result in delays processing your claim as we must request the missing information and allow time for the missing information to be returned, prior to issuing a decision.

 

Submitting Your Claim

Claims are processed and reviewed in the order they are received and logged. To help save time on getting your claim “in line” to be reviewed, we recommend you email or fax it, as it then won’t need the additional step of being digitized on our end:

Email: claimforms@shelterpoint.com

Fax: 516-504-6414

You can also mail your completed claim package to:

COVID-19 Quarantine Claims
ShelterPoint Life
1225 Franklin Ave, Ste., 475
Garden City, NY 11530

 

 

 

What Happens Next?

We get a lot of questions about what happens next. Here’s our collection of FAQs:

Claims will be processed in the order they are received. Once your claim is logged/digitized into our system, you will receive your claim# (via paper mail) - please be patient, this usually takes a couple of business days.

Once you have a claim number assigned, we can view it in our system – and you can track the status of your claim yourself 24/7 using our online claimant portal.
Regardless of your submission method, you will receive mail from us either in the form of the first payment, a request for more information, or a denial notice. This communication will include your claim number.

For the majority of claims, you can generally expect to receive this after about a calendar week after we receive your claim.
If your claim has not made it into our system yet, we won’t be able to look up the claim number for you and we won’t be able to give you a confirmation or tell you your claim number if you call us immediately after submitting your claim. Please allow 2 full business days for your claim to get registered. At this point your claim gets assigned a claim number.
If something is missing we will send a request to you in writing via paper mail. For the majority of claims, you can generally expect this after about a week after we receive your claim. We may reach out via email if you provided your contact information to us on your claim form.

If we have everything we need to review your claim, and it is payable, you should receive your benefit payment in the form of a check, along with any other supplemental updates requested.

 

 

 

My Claim is approved – now what?

If we have everything we need to review your claim, and it is payable, you will receive mail from us including a check for your first benefit payment. For the majority of claims, you can generally expect to receive this in about 10 calendar days after we receive your properly and fully completed claim.

Regulations require (if your claim is properly completed with all required statements) that your first payment should be made within 18 days of receipt.

 

 

 

Other FAQs

No. If you have been unemployed (including furloughed, temporarily laid off, or out of work because your employer is currently closed) when your qualified quarantine began and you are collecting unemployment benefits, you cannot collect both unemployment and DBL COVID-19 benefits. Click here for more information.
If your claim was previously denied for a missing quarantine order and you have since received the required documentation, you can send it to us and we will reopen your claim for review.
If you file your claim late, benefits may be denied for any period of disability prior to 2 weeks before it was filed – unless you can demonstrate that it was impossible to file sooner. And if your claim is filed later than 26 weeks after your disability began, you are not eligible for benefits at all. (Exception: Minors, mentally or physically incompetent people with no guardian may have a longer period in which to file a claim.)
No, special Emergency DBL/PFL Quarantine benefits do not apply. However, you still have these options if the quarantine is for yourself, the employee (“self-care”):
  1. Larger employers have to continue their employee’s salary for at least 14 days.
  2. If your quarantine lasts longer than 14, you may apply for regular DBL (State Disability) benefits thereafter until your quarantine is over, using the regular DBL claim form. The maximum statutory DBL benefit is $170/week, or, if your employer provides an enhanced DBL benefit level, at the respective coverage level of your employer’s policy. In this case, a copy of the official Order of Quarantine is not required to file your claim.

 

 

Still have questions?
Our DBL/PFL Experts are happy to help. Contact them anytime at: customerservice@shelterpoint.com

Download icon   COVID-19 Related Claim Forms

To help best serve you, we ask you to make our self-service online tools your first stop for service and support questions:

Employees with official "Order of Quarantine"
Care for minor dependent subject to official "Order of Quarantine"

Upload icon   Online Claim Submission

This is the best way to submit your initial claim. We advise you to go through the checklist section on the left before you upload your files.

Upload Now

 

 

 

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ShelterPoint Life Insurance Company, formerly The First Rehabilitation Life Insurance Company of America.

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