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- How Benefits are Paid or Adjusted
- How to File a Claim
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How Benefits are Paid or Adjusted
How Benefits are Paid
When your claim is received, the PFL office will notify you of your weekly benefit amount and request any additional information needed to determine your eligibility. If you meet all requirements, a check will be mailed to you from a central payment center. The majority of claims are processed and payments issued within 14 days of receipt of Part A, the HIPAA authorization on page two, Part B or Part C of the claimants and the doctor's Part D of the claim. The first seven days of your claim is a waiting period for which no benefits are paid with the exception that you may be transitioning from a DI pregnancy claim into a PFL bonding claim.
If you are eligible for further benefits, either additional payments will be sent automatically or a continued claim certification form for the next period will be enclosed. Usually the certification periods are for two weeks; however, the period will vary under certain circumstances. You will be paid 1/7 of your weekly benefit amount for each calendar day you are eligible and bonding or providing care unless benefits are reduced for some reason. (See “BENEFIT REDUCTIONS” below.) Benefits paid by the PFL program will be reported to the Internal Revenue Service and EDD will send you a 1099G in January of the following year. For more specific tax information, contact the Internal Revenue Service.
Benefit Reductions
Under certain circumstances, you may not be eligible for a period of your claim or you may be eligible only for partial benefits. The PFL office will determine whether or not benefits must be reduced. The types of income shown in the following list should be reported to PFL even though they may not always affect your benefits. Failure to report your income could result in an overpayment, penalties, and a false statement disqualification.
- Sick leave pay
- Paid time off
- Adoption pay
- Self-employment income
- Military pay
- Commissions
- Wages, including modified duty wages
- Residuals
- Part-time work income
- Bonuses
- Workers' Compensation benefits
- Insurance settlements
- Holiday pay
- In addition, your benefits may be reduced because of a prior Unemployment Insurance, Paid Family Leave, DI overpayment or for delinquent court-ordered support payments.
Benefit Interruption and Termination
A “Notice of Final Payment” will be issued when records show you have:
- Been paid to doctor’s estimated date and care will no longer be required. If you are still providing care, ask your doctor to complete and mail the “Physician’s Supplementary Certificate” enclosed with the Notice of Final Payment.
- Returned to your job. If you return to work and need to provide care again, immediately submit a new claim form and report the dates you provided care.
