Current through Register Vol. 47, No. 17, September 10, 2024
1. Unless
otherwise indicated, terms used here that are defined in the Act have the same
definition as they do under the Act.
2. "Benefit Overpayment" means a payment in
excess of the amount authorized by the Act and its implementing
regulations.
3. "Claimant" has the
same definition as 7 CCR 1107-3, Section 3.2.7.
4. "Correct Address" has the same definition
as 7 CCR 1107-8, Section 8.2.6.
5.
"Determination" has the same meaning as defined in 7 CCR 1107-9, Section
9.2.7.
6. "Equity and Good
Conscience" means fairness as applied to each individual case after considering
the totality of the circumstances. When determining whether an individual or
entity shall pay an amount owed to the Fund (e.g. benefit overpayment, fines or
interest), the Division or private plan administrator may consider the
following factors to determine equity and good conscience, including, but not
limited to:
A. The individual's financial
condition required that the amount owed be spent on reasonable and necessary
living expenses;
B. The
individual's household income is below 200% of the federal poverty income
guidelines;
C. The individual or
entity lacks the ability to pay the amount owed based on prior income level,
current income and assets, and future earnings potential;
D. Requiring repayment will cause
extraordinary financial hardship by depriving the individual of the ability to
provide for basic necessities that cannot be deferred such as food, shelter,
clothing, utilities, and medical costs;
E. The individual detrimentally changed their
position in reliance on the receipt of the overpaid benefits including, but not
limited to, entering into a financial and/or contractual obligation that they
would not have entered except for the receipt of the overpaid
benefits;
F. The individual
relinquished a valuable right in reliance on the receipt of the overpaid
benefits, including the receipt of other governmental benefits for which they
would have been entitled except for the receipt of the overpaid benefits.
Although the individual is not required to apply for governmental benefits and
be rejected from receiving them, they may be required to prove eligibility for
such benefits by establishing their economic situation at the time family and
medical leave insurance benefits were received as well as the requirements for
receiving said benefits;
G. The
individual's knowledge or lack of knowledge regarding an employer's incorrect
reporting of wages; and/or
H. The
individual's knowledge or lack of knowledge with regard to a provider who fails
to meet the definition of health care provider, or who has provided a diagnosis
or treatment outside of their licensed scope of practice, or has a license that
has been suspended or revoked at the time the provider completes documentation
regarding the individual's need for family and medical leave.
7. "Fees" means any additional
charge by a private plan added to an outstanding amount owed.
8. "Party" or "Parties" means a claimant,
employee, employer, or individual electing coverage involved in a
proceeding.
9. "Qualifying
Condition" means a reason for leave described at C.R.S. §
8-13.3-504(2).
