New York Codes, Rules and Regulations
Title 12 - DEPARTMENT OF LABOR
Chapter V - Workers' Compensation
Subchapter H - Disability Benefits
Article 2 - Rules Under Disability Benefits Law
Part 380 - Paid Family Leave
Subpart 380-5 - Payment and Denials
Section 380-5.3 - Prefiling request for paid family leave

Universal Citation: 12 NY Comp Codes Rules and Regs § 380-5.3

Current through Register Vol. 45, No. 52, December 27, 2023

(a) A carrier or self-insured employer may receive a request for paid family leave in advance of the happening of a foreseeable qualifying event as identified in Subpart 380-3 of this Part, in which one or more pieces of required information, contained in part A of the request for paid family leave (currently form PFL-1) or as set forth in sections 380-4.2, 380-4.3, and 380-4.4 of this Part, is missing. The request for paid family leave shall indicate that it is being submitted in advance of the qualifying event. Such missing information must be supplied upon the happening of the qualifying event.

(b) When a carrier or self-insured employer receives a request for paid family leave under this section, the carrier or self-insured employer shall not deny the claim for incomplete claim package. The carrier or self-insured employer shall provide the employee within five business days:

(1) a notice indicating the employee's claim is pending until all missing information is received upon the happening of the qualifying event;

(2) each piece of required information, as identified in sections 380-4.2, 380-4.3, and 380-4.4 of this Part, which is missing from the employee's request for paid family leave (currently PFL-1); and

(3) instructions outlining the preferred method in which the employee shall submit the missing pieces of required information upon the happening of the qualifying event, including a contact office or person's name, mailing address, email, and contact phone number;

(4) once the carrier or self-insured employer receives all missing pieces of required information, the carrier or self-insured employer must pay the claim or deny the completed claim within 18 days, and shall provide the employee within 3 business days a confirmation of receipt of a complete claim. A carrier may not deny a claim on the grounds of incompleteness after issuing such a confirmation.

(c) If the claim is the responsibility of the board as a result of the employer's lack of paid family leave coverage, a prefiled request for paid family leave may take more than five business days.

Adopted New York State Register July 19, 2017/Volume XXXIX, Issue 29, eff. 7/19/2017

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