EXAMPLE 1. Claim Filing. Claimant A files a first claim for Family Temporary Disability Insurance benefits to provide care for a seriously ill family member which is received on September 20, 2007, and postmarked September 15, 2007. Claimant A indicates family care leave beginning June 30, 2007. The department determines Claimant A does not have good cause for exceeding the 41 day filing period and under Section 3301(e) of the code gives the claim an effective date of July 29, 2007. Claimant A is paid Family Temporary Disability Insurance benefits based on July 29, 2007. Claimant A appeals the department's denial of benefits for the days from June 30 through July 28, 2007. The department has not determined that Claimant A was initially eligible for those days. Therefore, pending decision on the appeal, Claimant A is not entitled to receive benefits for any day prior to July 29, 2007. The days following July 29, 2007 are not affected by the back dating issue raised by Claimant A's appeal, and Claimant A is entitled to continued payment of Family Temporary Disability Insurance benefits for the days following July 29, 2007.
(Note: The received and postmark dates for Family Temporary Disability Insurance claims are established by utilizing a five day processing standard for the automated claim form. On the day that the department receives a Family Temporary Disability Insurance claim, an automated procedure establishes the FTDI claim date as of the five days preceding receipt of the completed claim. For example, if the department receives a completed FTDI claim on July 15, 2007 the automated procedure establishes an FTDI claim date as of July 10, 2007.)
EXAMPLE 2. Claim Filing. Claimant B files a first claim for Family Temporary Disability Insurance benefits to bond with a new child born on May 19, 2007. Claimant B previously received Disability Insurance benefits during her pregnancy with this child. Claimant B submits her application for Family Temporary Disability Insurance benefits which was received September 20, 2007 and postmarked September 15, 2007. Claimant B is requesting to begin her Family Temporary Disability Insurance claim on June 30, 2007. The department determines that Claimant B does not have good cause for exceeding the 41 day filing period and under Section 3301(e) of the code gives the claim an effective date of August 5, 2007. Claimant B is paid benefits based on August 5, 2007. Claimant B appeals the department's denial of benefits for the days between June 30, 2007 to August 4, 2007. The department has not determined that Claimant B was initially eligible for those days. Therefore, Claimant B is not entitled to receive benefits for any day prior to August 5, 2007, pending decision on the appeal. The days following August 5, 2007 are not affected by the backdating issue raised by Claimant B's appeal and she is entitled to receive continued benefits after August 5, 2007.
(Note: The received and postmark dates for Family Temporary Disability Insurance claims are established by utilizing a five day processing standard for the automated claim form. On the day that the department receives a Family Temporary Disability Insurance claim, an automated procedure establishes the FTDI claim date as of the five days preceding receipt of the completed claim. For example, if the department receives a completed FTDI claim on July 15, 2007 the automated procedure establishes an FTDI claim date as of July 10, 2007.)
EXAMPLE 3. Claim Filing. The department determines Claimant D is initially eligible for Family Temporary Disability Insurance benefits. Claimant D receives benefits for 28 days, but does not return the continued claim for the next period of payment until after the 20-day filing period. The department determines that Claimant D does not have good cause for late filing and holds Claimant D ineligible because the claim was not filed timely in accordance with Section 2706-3 of these regulations. Claimant D files an appeal. Since the department has determined that Claimant D was initially eligible, Claimant D is entitled to receive benefits for the disallowed period pending decision on the appeal.
EXAMPLE 4. Late Medical Extension. The department determines Claimant E is initially eligible for Family Temporary Disability Insurance benefits to care for his ill father with chronic renal failure. Claimant E receives benefits for 25 days, however, Claimant E continues to provide care beyond the 25 days that were initially certified by the physician. Claimant E does not return his medical extension form until after the 20-days commenced from the date the medical extension form was issued. The department determines that Claimant E does not have good cause for late filing and holds Claimant E ineligible because the medical extension was not received timely in accordance with Section 2706-3 of these regulations. Claimant E files an appeal. Since the department has determined that Claimant E was initially eligible, Claimant E is entitled to receive Family Temporary Disability Insurance benefits for the disallowed period pending decision on the appeal.
EXAMPLE 5. Reconsideration of Determination. Claimant F files a first claim for Family Temporary Disability Insurance benefits to care for a seriously ill mother with cancer. The Department pays Family Temporary Disability Insurance benefits to Claimant F for 20 days and subsequently discovers that Claimant F is being paid temporary disability indemnity under workers' compensation for the same period and weekly rate as the Claimant's Family Temporary Disability Insurance benefits. The department reconsiders the determination and determines that Claimant F is ineligible under Section 3303.1 of the code for the period of family care leave because of the duplication of benefits. Claimant F appeals. Since under subdivision (a) of Section 2707.5 of the code the department may reconsider any benefit determination prior to filing an appeal, the initial determination was not final and claimant F is not entitled to receive Family Temporary Disability Insurance benefits pending decision on the appeal.
EXAMPLE 6. Reconsideration of Computation. Claimant G files for and is paid Family Temporary Disability Insurance benefits. While Claimant G is in continued claim status, the department recomputes Claimant G's claim and determines under Section 2652 of the code that Claimant G does not have sufficient qualifying wages in the disability base period to have a valid claim. Claimant G appeals. Since, under subdivision (b) of Section 2707.5 of the code the department may re-compute a claim within one year from the beginning date of a disability benefit period, the initial computation was not final, and Claimant G is not entitled to receive Family Temporary Disability Insurance benefits pending decision on the appeal.
EXAMPLE 7. Receipt of Duplicate Benefits. Claimant H is found eligible for Family Temporary Disability Insurance benefits due to bonding with a new child. Prior to filing a claim for Family Temporary Disability Insurance benefits, Claimant H was scheduled for surgery due to carpal tunnel syndrome. The scheduled surgery is performed during the period that Claimant H filed for Family Temporary Disability Insurance benefits. Beginning with the date of the surgery and for the following four weeks, Claimant H is paid temporary disability indemnity under workers' compensation at a rate in excess of Claimant H's weekly Family Temporary Disability Insurance benefit amount. The Department denies Claimant H for four weeks under Section 3303.1 of the code. Claimant H appeals. Since Claimant H is not eligible to receive Family Temporary Disability Insurance benefits during the four weeks of receiving temporary disability indemnity under workers' compensation, Claimant H is not entitled to receive Family Temporary Disability Insurance benefits for the four weeks pending decision on the appeal.
Cal. Code Regs. Tit. 22, §§ 2706-7
2. Change without regulatory effect amending subsection (b) filed 6-22-2010 pursuant to section 100, title 1, California Code of Regulations (Register 2010, No. 26).
3. Change without regulatory effect amending subsection (c)(1) filed 1-10-2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 2).
4. Change without regulatory effect amending subsections (b) and (k)(1) and amending NOTE filed 3-1-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 9).
Note: Authority cited: Sections 305, 306, 2706 and 3300, Unemployment Insurance Code. Reference: Sections 1335, 1336, 2706 and 2707.2, Unemployment Insurance Code.
2. Change without regulatory effect amending subsection (b) filed 6-22-2010 pursuant to section 100, title 1, California Code of Regulations (Register 2010, No. 26).
3. Change without regulatory effect amending subsection (c)(1) filed 1/10/2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 2).
4. Change without regulatory effect amending subsections (b) and (k)(1) and amending Note filed 3-1-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 9).