Current through Register Vol. 47, No. 17, September 10, 2024
1. A claimant
who receives family and medical leave insurance benefits they are not entitled
to receive shall be liable for repayment of the amount overpaid, unless
otherwise relieved pursuant to section 6.3.7. Circumstances giving rise to a
benefits overpayment include, but are not limited to a(n):
A. Division miscalculation that occurs
without any fault from the claimant or is caused by a claimant's omission,
willful misrepresentation, or fraud;
B. Determination by the Division that the
claimant does not qualify for family and medical leave insurance benefits
because they are not localized in Colorado pursuant to the in-state status
provisions of 7 CCR 1107-1, are not a covered individual, do not have a
qualifying condition, or are disqualified from receiving family and medical
leave insurance benefits because of a willful false statement or
misrepresentation pursuant to C.R.S. §
8-13.3-513;
C. Claimant's failure to notify the Division
of an event that causes benefit payments to change pursuant to 7 CCR 1107-3,
Section 3.10.1;
D. Claimant who has
not taken a leave of absence from the employment from which they are receiving
family and medical leave insurance benefits;
E. Claimant who is receiving family and
medical leave insurance benefits, continuous or intermittent, during a period
of unemployment, except as described in 7 CCR 1107-3 Section 3.4.1.A;
F. Claimant receiving family and medical
leave insurance benefits for an absence from work that is caused by
circumstances that would entitle the claimant to temporary indemnity benefits
under the Colorado Workers' Compensation Act in violation of 7 CCR 1107-4,
Section 4.3;
G. Claimant receiving
family and medical leave insurance benefits during any week the individual
receives unemployment benefits for the same job pursuant to the Colorado
Employment Security Act in violation of 7 CCR 1107-4, Section 4.4;
H. Claimant receiving family and medical
leave insurance benefits when their family and medical insurance leave benefits
have been exhausted;
I. Employer
who incorrectly reports wages for the claimant, causing the claimant to receive
family and medical leave insurance benefits in an amount greater than their
actual wages would provide;
J.
Self-employed individual who reports inflated wages on their own behalf,
causing the claimant to receive family and medical leave insurance benefits in
an amount greater than their actual wages would provide; or
K. Health care provider who fails to meet the
definition of "health care provider" as defined by C.R.S. §
8-13.3-503(13),
has provided a diagnosis, treatment, or leave certification outside of their
licensed or certified scope of practice, or has a license or certification that
has been suspended or revoked at the time the provider completes documentation
regarding the individual's need for family and medical
leave.
2. Benefit
overpayments may be identified through any lawful means, including but not
limited to Division audits, Division investigations, or external
tips.
3. The Division will notify
claimants of any determination of benefit overpayment by sending the claimant a
determination letter to the claimant's correct address. If the claimant has
provided an email address, the Division shall send the determination via email,
and such delivery via email will satisfy the requirement to send the
determination letter to the claimant's correct address.
4. The claimant may appeal a determination of
benefit overpayment as detailed in 7 CCR 1107-9.
5. Any outstanding benefit overpayment owed
to the Fund by the claimant is subject to recovery pursuant to 7 CCR 1107-8,
Section 8.8.
6. Any outstanding
balance past due shall accrue interest pursuant to 7 CCR 1107-8, Section
8.9
7. At its discretion, the
Division may waive, in whole or in part, any amount of benefit overpayment owed
to the Fund where such recovery would be against equity and good conscience,
unless the overpayment resulted from the individual's willful misrepresentation
or willful failure to disclose a material fact to the Division.
