Handling Requests
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Request Process

You should have Paid Family Leave request forms available to employees upon request. You can get these from your insurer or go to the Paid Family Leave forms page on this website. There are different form packages for the specific types of leave employees can request.

  1. Notice: Employees must provide you with 30 days’ advance notice of their intent to use Paid Family Leave, if it’s foreseeable. If the event is not foreseeable, the employee must notify you as soon as possible.
  2. Employer Portion: When an employee is preparing to take Paid Family Leave, they will request that you complete Part B of the Request for Paid Family Leave (Form PFL-1) and return it to them. This includes providing the employee's last 8 weeks of gross wages and calculating the employee's average weekly wage.
    • You must complete and return the form to your employee within three business days. Make a copy of this form for your records.
  3. Submit: Employees are responsible for submitting their requests directly to the insurer.
  4. Pay or Deny: The insurance carrier must pay or deny the employee’s request within 18 calendar days of receiving the completed request for Paid Family Leave, or the employee's first day of leave, which ever is later. 
    • Insurance carriers do not have a specific legal requirement to notify an employer about whether an employee’s request for Paid Family Leave is approved or denied, but employers may be in contact with their insurance carriers to develop a process for this.

Calculating an Employee's AWW

An employee’s average weekly wage (AWW) is computed by adding his or her wages for the eight weeks prior to the start of Paid Family Leave, and dividing the total by eight.

 

Wage Benefit Calculator

 

For a sole proprietor who has opted into Paid Family Leave, the average weekly wage will be the last 52 weeks of income divided by 52.

Payment of Benefits

Paid Family Leave benefits are paid to employees by the insurance carrier or employer, if self-insured. 

If the employer has an internal policy that provides the employee with full wages while the employee is on Paid Family Leave, the employer can pay the employee up front and then request reimbursement from the insurance carrier, up to the amount of the Paid Family Leave benefit.

Alternatively, the employer can supplement the employee’s Paid Family Leave benefit up to the amount provided under the internal policy.  In either situation, if the employer will be requesting reimbursement from the insurance carrier, the employer must indicate on the Request For Paid Family Leave (Form PFL-1, Part B, Question 10) that it is paying the employee their full wages and requesting reimbursement from the insurance carrier. If the employer fails to select “Yes” for requesting reimbursement from the insurance carrier, it will waive its right to reimbursement.

Complaints

If your employee disagrees with a claims decision, you should direct them to your insurer or www.nyspfla.com to request a review by a neutral arbitrator.

Arbitration for Paid Family Leave is handled by NAM (National Arbitration and Mediation).

If the insurance carrier denies or partially denies an employee’s request for Paid Family Leave, the insurance carrier (or employer, if self-insured) must provide the employee with the reason for denial and information about requesting arbitration. An employee can also visit the arbitrator’s website at www.nyspfla.com.

An employee may also request arbitration for any other PFL claim-related disputes, such as timeliness of the carrier’s payment or denial. In most cases, insurers must pay or deny a request within 18 days of receiving a completed request, or the employee’s first day of leave, whichever is later.

Health Insurance

Employers must continue to provide health insurance on the same terms as if the employee had continued to work while they are on Paid Family Leave. If employees regularly contribute to the cost of their health insurance, they must continue to pay their portion of the cost while on leave. 

Preventing Fraud

As an employer, you play a key role in preventing insurance fraud. Once you complete the portion of the Request for Paid Family Leave (Form PFL-1), you affirm your employee’s hours worked and wages, among other elements, which helps insurers confirm that the employee is eligible for Paid Family Leave benefits.

Contact PFL Helpline

For more information, call the Paid Family Leave toll-free helpline Monday-Friday, 8:30am – 4:30pm EST.

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