Paid Leave Oregon Claims

How Do I File a Claim for Paid Leave Oregon?

When it comes to applying for Paid Leave in Oregon, the requirements can vary based on who is providing your coverage, and the type of leave you intend to take. Don’t worry," we’re here to help you through the process. To get started, it’s important to have a conversation with your employer to determine who is responsible for your Paid Leave coverage: the State, your employer through a self-insured plan, or an Equivalent Plan carrier like ShelterPoint Insurance Company (ShelterPoint). If your employer has told you that your Paid Leave coverage is provided by ShelterPoint in the form of a Paid Family & Medical Leave (PFML) policy, you’re in the right place. We’ve gathered all the necessary information to guide you through the claim filing process, and we’re here to make it as simple and hassle-free as possible for you.

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A female mechanic working on a car in a garage

How Do I know if I’m Eligible to Apply for Benefits?

If you meet the following criteria, you may request paid leave benefits:

You are an eligible employee who experienced a qualifying event – learn more about qualifying events and leave types here
You earned at least $1,000 in wages in the base year, or alternate base year, from an employer who has to provide Paid Leave coverage and don’t fall into a class of excluded employees – learn more here
You contributed through paycheck deductions (or your employer sponsored your portion of the required contributions) during the base year or alternate base year.

How Do I know Which Form(s) I Need to File for
My Claim With ShelterPoint?

We’ve put together the chart below to illustrate what’s included in the leave-specific claim packets. The forms included and who needs to complete those forms, depends on the type of leave taken:

Medical Leave packet
Bonding Leave packet
Caregiver Leave packet
Safe Leave packet

Medical Leave packet

Counter

Component of Claim Packet	Who this form should go to
Claimant Statement
Employer Statement
HIPPA Authorization
Medical Certification - Self Care
ACH/Direct Deposit Form

Bonding Leave packet

Counter

Component of Claim Packet	Who this form should go to
Claimant Statement
Employer Statement
Bonding Certification
ACH/Direct Deposit Form

Caregiver Leave packet

Counter

Component of Claim Packet	Who this form should go to
Claimant Statement
Employer Statement
HIPPA Authorization
Medical Certification – Family Care
ACH/Direct Deposit Form

Safe Leave packet

Counter

Component of Claim Packet	Who this form should go to
Claimant Statement
Employer Statement
Safe Leave Certification
ACH/Direct Deposit Form

= Required to be submitted to ShelterPoint

= For provider

= Optional (if elected to be submitted to ShelterPoint)

A few things to keep in mind:

Each claim form packet includes a checklist with guidance on claim-specific information you will need to collect and what documentation is required to support your claim. This checklist is for your convenience and won’t need to be sent in with your claim.
The claimant statement and employer statement apply to all leave types and are required regardless of qualifying event.
If you wish to receive your benefit payments via direct deposit, please complete the ACH/Direct Deposit form.
The remaining forms vary by type of leave.
While the HIPAA form (if applicable to your leave) does not need to be submitted to us, it is an important form to ensure smooth processing of your claim: It gives the health care provider permission to release medical information to ShelterPoint. So please be sure to supply any applicable providers with a HIPAA release.

Download your Paid Leave Oregon Claim Form Packet

A father sitting with his newborn baby using a laptop

BONDING

To Bond with a newly born,
adopted, or fostered child

DOWNLOAD FORM

A woman caring for and hugging her grandmother

CAREGIVER

To care for a family member
with a serious health condition

DOWNLOAD FORM

A person sitting on a couch with a broken foot

SELF-CARE
(MEDICAL LEAVE)

Manage and/or recover from your own serious health condition

DOWNLOAD FORM

Distraught woman sitting on a couch covering her face

SAFE-LEAVE

Safe Leave for myself or my child due to domestic violence, harassment, sexual assault, bias crime, or stalking

DOWNLOAD FORM

**Child for the purposes of safe leave means an individual under the age of 18 as described in ORS 657B.010(6) – or over the age of 18 as an adult dependent substantially limited by a physical or mental impairment as defined by ORS 659A.104.

How and Where to Submit your ShelterPoint Claim

You can submit your new claim or updates on existing claim to:

By email: claimforms@shelterpoint.com

By mail:

ShelterPoint Life Insurance Company
Attn: OR PFML Claims
1225 Franklin Ave, Suite 475
Garden City, NY 11530

By fax: Fax 516-504-6414

By web upload: ShelterPoint Online Claim Submission

For the quickest processing time possible, please make sure the fully completed claim package is sent through only one method, and only one time! Submitting through different methods, multiple times or in separate pieces will likely delay the claims processing time.

Please keep the following in mind to optimize the processing of your ShelterPoint claims submission:

Updates for already established claims must include the claim # on any correspondence!
Please don’t submit the same document via different methods – it won’t speed up processing as all incoming channels lead to the same queue.
Forms must be fully & legibly completed and signed & dated to be valid.
Any missing, illegible, or incomplete information may delay claims processing or result in denial of benefits.

Paid Leave Oregon Claims FAQs

When should I notify my employer about the leave?

If you know that you will need to take Paid Leave, you need to let your employer know at least 30 days in advance. Of course, things can happen unexpectedly. In that case, you will need to give your employer verbal notice within 24 hours of starting your leave and follow up with a written notice within 3 days from when your leave starts.

How soon can I expect to hear about a decision on my claim?

Paid Leave Oregon regulations grant carriers 14 calendar days from receipt of a claim to make a decision on the claim or request additional information.

How often will I receive benefit payments?

Payments are issued weekly for continuous claims. If you are taking intermittent leave, payment frequency may vary depending on the exact leave dates requested.

We strongly recommend signing up for Direct Deposit of benefit payments via ACH for timely receipt of payments. The form is included in your claim packet. Be sure to include it with your initial claim submission to assure direct deposits from the start.

Are Paid Leave Oregon benefits taxable?

While we do not provide any tax advice and ask that you direct those questions to your qualified tax professional, the industry generally understands taxability as follows:

Family Leave benefits (bonding, family care, safe leave) are considered non-wage income. Benefits paid totaling $600.00 or more will be reported on form 1099-MISC, which will be mailed by January 31 of the following calendar year.
Medical Leave (self-care and safe leave for the employee’s own medical care/treatment due to domestic violence) benefits are considered sick pay, which makes them taxable based on the ratio of employer contributions to total employer and employee contributions.

How can I appeal a decision?

In case your benefits are denied, the denial includes the Appeal Notice Rights and Request for Appeal form. You have 60 calendar days (or as soon as practicable for good cause) to submit an appeal if you have additional information that may change our determination.

Should you receive a denial notification, please send the Request for Appeal form to ShelterPoint within the above timeframe so that we can review the decision and any additional information that has been submitted. It may be an easy issue to resolve. For example, you may receive a denial notification because some of the information needed to determine the claim status and/or amount may be missing. If ShelterPoint denies the claim again after all the required claim documents are complete and are in good order, you have the right to appeal to the State.

Learn More About ShelterPoint

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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 (see our Geographic & Jurisdictional Notice here). ShelterPoint is a registered service mark.

The information in this document is based on our knowledge of the OR [Chapter 657B of the Oregon Revised Statutes and the policies of the Oregon Employment Department under OAR 471-070-0010 et seq.] and regulations, and may change as regulations evolve or the Oregon Employment Department issues guidance regarding the regulations. It is for illustrative purposes only, providing a general overview of the Paid Leave Oregon program. It is not a contract. ShelterPoint Insurance Company policies are subject to Underwriting approval. Please refer to the policy for terms under which it may be continued or cancelled, and for policy exclusions and limitations. In the event of conflicting information with the policy, the policy will take precedence over what is shown in this material. Available in Oregon only. Underwritten by: ShelterPoint Insurance Company, a FL-domiciled carrier, Policy Form # SPI PFMLP 0123 OR

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All policies are underwritten and administered by either ShelterPoint Life Insurance Company (principal office in Garden City, NY), or ShelterPoint Insurance Company, a FL-domiciled carrier, depending on the state. Contact Underwriting for details.
Policies for Private Plans of Statutory Benefit Programs are underwritten by ShelterPoint Life Insurance Company (principal office in Garden City, NY) in NY, NJ, CT, MA, CO; and underwritten by ShelterPoint Insurance Company (a FL-domiciled carrier) in OR. Click here to view availability by state.
For information about which company is licensed in your state, please visit our Geographic & Jurisdictional Notice.

Statutory Benefits Center

Paid Leave Oregon Claims

How Do I File a Claim for Paid Leave Oregon?

How Do I know if I’m Eligible to Apply for Benefits?

How Do I know Which Form(s) I Need to File for My Claim With ShelterPoint?

Medical Leave packet

Bonding Leave packet

Caregiver Leave packet

Safe Leave packet

Download your Paid Leave Oregon Claim Form Packet

How and Where to Submit your ShelterPoint Claim

Please keep the following in mind to optimize the processing of your ShelterPoint claims submission:

Paid Leave Oregon Claims FAQs

When should I notify my employer about the leave?

How soon can I expect to hear about a decision on my claim?

How often will I receive benefit payments?

Are Paid Leave Oregon benefits taxable?

How can I appeal a decision?

Statutory benefit programs are what we do.

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With decades of experience in helping keep people INSURED,

rest ASSURED: you have found the specialists you can turn to.

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How Do I know Which Form(s) I Need to File for
My Claim With ShelterPoint?