Claim Help - NY Paid Family Leave (PFL)

 

Checklist to Get You Started

So, you’re here because you’re going on leave to bond with your new child, need to care for a family member with a serious health condition that is NOT related to a COVID-19 quarantine order (click here if it is), or need to take care of things due to a military exigency.

Ready to submit your PFL claim?

Then download the claim form from the right (or if you’re browsing on a mobile phone – from the bottom)

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


You’re already out on your Leave.

Please do not file before you’re out on leave, such as filing before giving birth, or in anticipation of any other type of Leave you will need to take.

Your first full day of Leave was no longer than 30 days ago.

If took your first full day of Leave more than 30 days ago, you may lose out on some benefits. If you file your claim more than 6 months after the first day of your Leave, you are no longer eligible for PFL benefits.

You are currently employed or have not been unemployed.

If you have been unemployed (including furloughed, temporarily laid off, or out of work because your employer is currently closed) and you are eligible for/collecting unemployment benefits, you cannot collect both unemployment and PFL.

Everything is completed.

Whether taking leave to bond with a new child, care for an ill family member, or spend time with a loved one as a result of a military leave event, you will need to complete and submit the general “Request for Paid Family Leave” form (PFL-1):
  • complete Part A of the PFL-1 form,
  • give it to your employer to complete Part B. Your employer must complete their section and return it back to you within 3 business days.
In addition to the completed PFL-1 form, you are responsible for obtaining and submitting the necessary certifications and supporting documents to show the need for your Leave.

Bonding Leave
For bonding leave, you will need to submit the following:
  • PFL-1 completed by both you and your employer
  • PFL-2 (Bonding certification) completed by you
  • Supporting documentation proving the relationship between the claimant (you) and child, such as the birth certificate. Form PFL-2 has a checklist to help you identify what exact documentation is needed for your specific bonding situation
See more details about supporting documentation and timing of your claim in this bonding claims roadmap here.

Caregiver Leave
For leave to care for a seriously ill family member, you will need to submit the following:
  • PFL-1 completed by both you and your employer
  • PFL-3 (Release of personal health information) completed by the “care recipient,” i.e., the family member you’re providing care for (this is filed with their health care provider, so the provider can complete the PFL-4 form. Do not file form PFL-3 with your insurance carrier)
  • PFL-4 (health care provider’s certification of care) completed by you and the health care provider treating your family member
See more details about supporting documentation and timing of your claim in this caregiver claims roadmap here.

Military Exigency Leave
For leave as a result of a qualifying military leave event, you will need to submit the following:
  • PFL-1 completed by both you and your employer
  • A PFL-5 (Military qualifying event certification) completed by you and – if applicable – any third party
  • Supporting documents evidencing the military member’s status (covered active duty, impending call/order to covered duty, or Rest and Recuperation document) and the need for leave (such as meeting announcement for informational military briefing; appointment with a school official, doctor, attorney or financial advisor; or a bill for services for the handling of legal or financial affairs)
See more details about supporting documentation and timing of your claim in this military claims roadmap here.

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.


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 you child’s birth certificate yet, please don’t send what’s been completed so far and the birth certificate 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.

 

Fill Out Your Forms

 

PFL Claim Type

PFL-1 form

Request for Paid Family Leave

PFL-2 form

Bonding certification

PFL-3 form

Release of personal health information

PFL-4 form

Certification of care

PFL-5 form

Military qualifying event certification

Supporting Documentation

Bonding

Part A: completed by you

&

Part B:
Completed by your employer. (They must complete their section & return to you within 3 business days)

Completed by you

 

 

 

Proving your relationship with the child.  Ex. Birth certificate

Caregiver

 

Completed by the “Care recipient” (the family member you’re providing care for)*

Completed by you & the heath care provider treating your family member

 

 

Military Exigency

 

 

 

Completed by you & any applicable third party

Documents evidencing military members status and the need for leave

 

*This is filed with their health care provider, so the provider can fill out the PFL-4 form. Do not file PFL-3 form with your insurance carrier.

 

 

 

 

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:

PFL 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 provide a status.
Regardless of your submission method, you will receive mail from us either in form of the first payment, a request for more information, or 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 after about a calendar week after we receive your properly and fully completed claim.

PFL regulations require a determination be made on your claim after 18 days – but the clock on that time limit doesn’t start until your fully completed claim packet and all required documentation has been received. Thereafter, benefits are payable every 2 weeks.

See what this really means for your claim payment schedule. We have a simple timeline for you in this helpful infographic.

Tip: You can track your payment status, when your next check is scheduled, and much more in our claim portal. Your first payment includes your claim number, which you’ll need to log in.

Manage your claim 24/7 online or via our App!
Once you receive your claim#, sign into our claim portal for around-the-clock access to:
  • Find out if you are eligible for benefit payments
  • View your current claim status and see if you need to take any action to assure continued processing of your claim
  • Upload additional forms and documents
  • See when your next check will be sent
  • And much more!
Registration is fast and easy – you just need your:
  • Claim number
  • Social Security Number
  • Valid email address

Online Claims Portal: Shelterpoint.com/claimportal

Claim Portal App:
  

Generally speaking, claims are paid bi-weekly. However, it’s your responsibility to keep us and your employer updated. This includes if you return to work early, or your Leave plans change.

Still have questions?

Check our frequently asked questions “ABCs of PFL” to learn more about eligibility, benefit amount, etc.

 

 

Our PFL Experts are happy to help. Contact them anytime at: customerservice@shelterpoint.com

Download icon   PFL 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:

Bonding Leave
Caregiver Leave (Providing Care)
Military Exigency


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

 

Check status icon  Check My Claim Status

Manage your claim 24/7 online or via our App!
Once you receive your claim#, sign into our claim portal for around-the-clock access to:

  • Find out if you are eligible for benefit payments
  • View your current claim status and see if you need to take any action to assure continued processing of your claim
  • Upload additional forms and documents
  • See when your next check will be sent
  • And much more!

Registration is fast and easy - we just need your:

  • Claim number
  • Social Security number
  • Valid email address

Monitor icon   Online Claims Portal:
Shelterpoint.com/claimportal

Mobile icon  Claim Portal App:
Download Mobile App now!

  

 

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

All policies are administered by ShelterPoint Life and underwritten by either ShelterPoint Life, a NY-domiciled carrier, or ShelterPoint Insurance, a FL-domiciled carrier depending on the state. Contact Underwriting for details.
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