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NY Paid Family Leave Claims - Comforting hands

Statutory Benefits Center

NY Paid Family Leave Claims Overview

How Do I File a Claim for NY Paid Family Leave?

What you need when filing a Paid Family Leave claim, depends on the type of leave being taken. There is one claim form packet for each leave type under PFL: Bonding, Caregiver, Military Exigency, and COVID-19 Quarantine. Included with each packet are detailed instructions and checklists for completing and submitting the respective forms to your PFL insurance carrier, which is typically the same as your statutory disability (DBL) carrier.

 

 

Woman filing a claim

Claim Help

If you’re a ShelterPoint customer, visit our Claim Help section here to get started with your statutory NY benefit (DBL/PFL/COVID-19 Quarantine) claim with these online tools available 24/7:

  • Checklist with step-by-step instructions
  • Downloadable claim forms
  • Tips and instructions on filing your claim
  • Online claim submission
  • Check your claim status online
  • and much more!
Get started with your claim now.  

 

Download NY Paid Family Leave Claims Forms

 

Father bonding with baby


BONDING
To Bond with a newly

born, adopted, or

fostered child


DOWNLOAD FORM

 

Caring with grandma


CAREGIVER
To care for a family member

with a serious
health condition


DOWNLOAD FORM

 

Military Exigency


MILITARY EXIGENCY
To assist family members

due to another family

member's active military

duty or impending active

duty abroad

DOWNLOAD FORM

 

 

 

How Do I Know Which Form/s I Need to File for My Claim?

We’ve put together an easy chart to explain what forms you need and who you need to fill out those forms, depending on the type of leave taken.

 

PFL CLAIM TYPE BONDING CAREGIVER MILITARY EXIGENCY
PFL-1 form
Request for Paid Family Leave
Part A: completed by you and Part B: Completed by your employer. (They must complete their section & return to you within 3 business days)
PFL-2 form
Bonding certification
 
Completed by you
    
PFL-3 form
Release of personal health information		  

Completed by the “Care recipient”
(the family member you’re providing care for)*
  
PFL-4 form
Certification of care		  
 
Completed by you & the health care provider treating your family member
  
PFL-5 form
Military qualifying event certification		    
 
Completed by you & any applicable third party
Supporting Documentation
 
Proving your relationship with the child.  Ex. Birth certificate
  
 
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.

 

 
Regardless of the type of leave event, taking leave to bond with a new child, care for a seriously 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 specific 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 exactly what documentation is needed for your specific bonding situation.

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 for the care recipient’s 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.

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.
  • 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).

COVID-19 Quarantine Leave for Yourself

While Paid Family Leave is not designed to care for your own condition, there is one exception when it comes to COVID-19: 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.
Learn more about COVID-19 self-care and PFL forms here.  

COVID-19 Quarantine for a Minor Dependent Child

If you’re taking leave for your minor dependent child due to COVID-19 Quarantine/Isolation, you must submit the following:
  • DB/PFL-Child 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.


Why You Shouldn’t Submit Your Paid Family Leave Claim Forms Before Your Leave Starts

It may be tempting to get all your paperwork for Paid Family Leave submitted early and out of the way, especially when preparing for a big, life changing event like the birth of a new baby. But, there are some pretty important reasons why you shouldn’t submit your claims forms too early.

While you have to notify your employer at least 30 days in advance (more on that later), your insurance carrier doesn’t need to know in advance at all. You might think that by submitting your forms ahead of time, it saves you time and will help you get paid quicker once you are out on leave, but it actually has the opposite effect! Here’s why:

Your insurance carrier can’t give you a determination on your claim until your leave actually starts - even if you provide everything necessary and your forms are filled out perfectly. There are many factors that go into making a determination on your claim, and it’s possible that some of these factors could change if you submit your forms too early. A few of these important factors are:

  • your wages (PFL benefits are based on your wages 8 weeks prior to the date your leave begins)
  • the actual date your leave starts
  • the duration of leave, and whether you take it weekly or daily
  • whether you are using full days of Sick/Vacation/PTO during the requested leave period
  • your employment status at your same job (including whether you have worked the necessary length of time to be eligible for benefits - 26 weeks or 175 days).

“Life happens” and plans may change. So, the more time you have in between when your claim form is submitted and when your leave actually starts, the greater the likeliness that things may not go as anticipated.

For example, let’s say Elly is preparing for the birth of her new baby who is due on June 1. She knows she is going to take Paid Family Leave after the baby is born, so she fills out all her necessary PFL paperwork and submits it to her carrier in March. After receiving her claim, Elly’s carrier then sends her a letter letting her know that it’s too early to submit her claim, and to please fill out a new form with updated information and submit that new form once her leave actually starts. She’s now spending more time, doing double work by filling out the forms and sending them in twice, plus the added back-and-forth between Elly and her carrier may even delay her benefit payment.

Another thing to keep in mind is, Bonding Leave cannot begin until after the baby is already born. We all know babies are rarely born right on their due dates, thus changing the date on which the Paid Family Leave would actually start. This being an additional reason why it would be counterproductive to send your forms in too early.

 

Bookmark icon
PFL Expert Tip:

You can’t take DBL and PFL at the same time. So, if you’re taking Paid Family Leave directly following a DBL claim, make sure the dates of leave are not the same on the respective claim forms you submit!


How to Prepare For Your Leave Without Submitting Forms Too Early

 

Our best advice for those who want to prepare for their leave is to download and print out all the forms you need ahead of time. You can even fill out the basic information that’s not going to change, like your name, address etc. But then hold off until you actually start your leave to fill in the leave specific information and submit it to your carrier - keeping in mind that claims must be submitted to your insurance carrier within 30 days after your first day of leave taken.

And don’t forget, before you go out on PFL and can fill out a claim form, you must provide a 30-day notice to your employer for any foreseeable leave. If the leave is not foreseeable, you must give notice to your employer as soon as ”practicable,” typically within a day or two. This notice should be in writing and identify which of the 3 qualifying events you will be taking leave for and the anticipated timing and duration.

Paid Family Leave Weekly Benefit Estimator

image

Get an idea of your
potential PFL benefit amount,  and calculate your average weekly wage by using our easy

Paid Family Leave
Weekly Benefit Estimator


This tool walks you through step-by-step,
and does all the math for you!


Want more details on Paid Family Leave Benefits? Visit this NY Paid Family Leave Benefits page for everything you need to know about calculating benefits/average weekly wage, and maximum benefit duration.


10 Quick Tips for Using NY Paid Family Leave

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You need to provide your employer with a 30-day written notice for foreseeable events (like birth or regular, scheduled treatments). If you can’t provide this notice due to the sudden nature of the event (an accident, heart attack, or short-notice deployment, for example), you’re still entitled to take leave, but must notify your employer as soon as reasonably possible.

 

If you take intermittent leave, your employer has the right to require you to provide notice before each day of leave — even if it’s a regular schedule.

 

There is no “waiting period.” (once eligibility is met)

 

Once on leave, you’ll receive a monetary PFL benefit (partial income replacement) from your employer’s DBL/PFL insurance carrier.

 

You can’t take DBL and PFL at the same time, i.e., receive benefits from both concurrently. They must be taken in sequence.


If you qualify for both DBL and PFL, the combined duration cannot exceed 26 weeks in a consecutive 52-week period (whether those benefits are for the same or different qualifying events). Read more about how DBL and PFL compare.

 

Your employer can’t require you to use up your accumulated PTO (sick/vacation days) before letting you go out on Paid Family Leave (unless it’s also an approved FMLA leave).

 

You can, however, choose to use your accrued PTO during your Paid Family Leave, and receive your full salary as opposed to the percentage provided by PFL. If you do this:

1. You won’t be able to collect both PTO and monetary PFL benefits simultaneously;

2. PFL will only provide job protection in this case.

 

If the business you work for has 50+ employees, it has to honor Family Medical Leave Act (FMLA) — which means your PFL benefits must be coordinated and used concurrently with FMLA benefits. Learn more about PFL vs. FMLA here.

 

Paid Family Leave provides more than just monetary benefits — it provides job security similar to unpaid leave with FMLA but regardless of employer size. So,

1. When returning from PFL, you’re entitled to return to your same or comparable position;

2. If your employer declines to reinstate you when you return from PFL, you have the right to report this to NY State.

 

If you have health insurance through your employer, it is continued at your usual coverage level and contribution amount as if you weren’t on leave.

 

The ABCs of PFL

Our in-depth guide provides everything you need to know about Paid Family Leave in New York. Here’s what you’ll find inside this 34-page guide:

  • PFL basics
  • Eligibility
  • Benefit eligibility and qualification period details
  • Benefits
  • Claims
  • Premium
  • Example withholdings
  • Employer responsibilities
  • How PFL compares to DBL & FMLA
  • Tips from your PFL Experts
  • …And much more!
Download your copy now

 

 

ABCs of PFL brochure cover

Paid Family Leave And COVID-19

As the impact of COVID-19 (the illness caused by the novel Coronavirus) continues to grow and puts so many of us at risk, we have created a COVID-19 Resource Center for important updates and information – including how New York’s “Emergency COVID-19 Paid Sick Leave Law” impacts New York Paid Family Leave.


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NY Paid Family Leave Claims FAQs

Whose responsibility is it to file a paid family leave claim? The employer or the employee?

It’s the responsibility of the employee to complete and submit their PFL claim. Along with the forms, the employee will need to include required supplemental documentation related to the type of leave they are taking.

However, Part B of the PFL-1 form, must be filled out by the employer and returned to the employee within 3 business days.

The employee will then send their form and accompanying documentation directly to their Paid Family Leave insurance carrier. We provide ShelterPoint-specific claim forms with our address and contact information prefilled for our customers.

If an employee doesn’t give the 30 days’ notice to their employer, can their claim be denied or reduced?

Yes. Since this is required by the law, it could have some impact on your benefit payment. The 30 days’ notice is only applicable for “foreseeable” qualifying events, such as:
  • An expected birth, or placement for adoption or foster care
  • Planned medical treatment for a serious health condition of a family member
  • Planned medical treatment for a serious injury or illness of a covered service member
  • Other known military exigencies
In some instances, 30 days’ notice is not possible — as with a medical emergency, sudden changes in circumstances, or premature birth. In these cases, notice must be given to the employer as soon as practicable given the circumstances of the event.

If the qualifying event is foreseeable, and the employee fails to provide the 30 days’ notice to their employer, the insurance carrier could file a “partial denial” on the claim.

What does “partial denial” mean?

A partial denial is when all, or some of the employee’s time allowed under PFL may become reduced – meaning they wouldn’t be approved for the full 12-weeks. Their benefit payment amount remains the same, just the time available for the employee to use on leave is less. There are few reasons why this would occur:
  • The employee has reached their benefit maximum of 26 weeks in a 52-week period.
    • Example: an employee has already taken 20 weeks of Disability, so that leaves them only 6 weeks to use their Paid Family Leave.
  • The employee gave late or no notice to their employer for foreseeable leave (30 days in advance notice is required).
    • Example: The employee only gave 10 days’ notice of PFL for their bonding leave, so their Paid Family Leave time may be denied, or may be reduced by 20 days.
  • The employee filed their claim too late with their PFL insurance carrier (must be filed within 30 days after the first day of leave).
    • Example: An employee started their Paid Family Leave on March 1, but didn’t file their claim until April 10. The claim may be denied, or reduced by 11 days.

How long does it take for a claim to be approved or denied?

Paid Family Leave forms and all relevant documentation must be submitted to the PFL carrier within 30 days after the first day of leave. Paid Family Leave insurance carriers have 18 days to accept or deny a fully completed claim.

How soon does an employee have to inform that they will be taking PFL?

An employee must provide the employer with at least 30 days advance notice before the planned paid leave if the qualifying event is foreseeable, such as

  • an expected birth, placement for adoption or foster care;
  • planned medical treatment for a serious health condition of a family member;
  • the planned medical treatment for a serious injury or illness of a covered service member or other known military exigency.
If a 30-day advance notice is not practicable (due to, for example, lack of knowledge, a change in circumstances, or a medical emergency), notice must be given as soon as practicable under the facts and circumstances of the qualifying event, ideally within the time required by the employer’s usual and customary notice internal policy.

Does a claim have to get filled out for each day off?

No. Not unless there is a 3 month gap.

Are the claim forms customized with ShelterPoint’s contact information, so the employee knows where to send the forms?

In a way, yes. We have claim forms available for download above. There are two types of claim form packets available for each type of qualifying leave: The generic forms provided by NY State, and a ShelterPoint-specific form. These ShelterPoint-specific versions are the NY State forms but ShelterPoint’s mailing address is prefilled in the insurance carrier section. If you’re a ShelterPoint policyholder you can use these “custom” claim forms.

It might be helpful (for you and your employees), to add ShelterPoint’s (or whoever your PFL insurance carrier is) contact information in the same places you post your PFL information. You can use this great resource from NY State to get started — there’s even a place where you can add your company’s contact for all things PFL, as well as ShelterPoint’s contact information. This way there may be fewer questions about where to send the forms when your employees apply for benefits.

Does ShelterPoint have an online claim portal?

Yes! Visit: https://www.shelterpoint.com/claimportal

ShelterPoint claimants can sign up online for around-the-clock access to:
  • View current claim status and see if any action needs to be taken to assure continued processing of claim.
  • Check the history of the benefit payments we’ve issued to you.
  • See which forms we sent you and which forms we’ve received back from you.
  • See important notifications regarding your claim.
  • Sign up for alerts via email when you need to take action to keep your claim payments going.
  • Sign up to receive claim forms electronically.
Registration is fast and easy – you just need your
  1. claim number
  2. Social Security #
  3. valid email address

How does it work if leave crosses over two different calendar years?

The benefit amount that is in effect at the time the leave began applies to the full duration of the paid leave for that event, even if a new calendar year with increased benefit levels falls within that period.

For example, if your leave started in December of 2020, and ended in February of 2021, you would have 10 weeks total, and benefits would be paid at the 2020 level for the entire duration of your leave.

 

 

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At ShelterPoint, we stay on top of all the latest news, updates, and information about Paid Family & Medical Leave,
 so we can pass it on to you. Sign-up for updates now to stay in the know!

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The ShelterPoint family of companies operates under the “ShelterPoint” name strictly as a marketing name, and no legal significance is expressed or implied. The ShelterPoint family of companies consists of ShelterPoint Life Insurance Company, a NY-domiciled carrier, and its wholly-owned subsidiary ShelterPoint Insurance Company, a FL-domiciled carrier, depending on the state. ShelterPoint is a registered service mark.

Underwritten by:
ShelterPoint Life Insurance Company (principal office in Garden City, NY) in: NY
ShelterPoint only offers Paid Family Leave in form of a rider to DBL.
Policy Form# SPL DB0922 F

This page is for informational purposes only and is not intended to provide legal counsel. Please consult with an appropriate professional for legal and compliance advice. Any Paid Family Leave information is based on the applicable statutes and may change if guidance is issued by the State of New York.

 

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