12-702-1 Me. Code R. § VI

Current through 2024-51, December 18, 2024

Section 702-1-VI - [Effective 1/1/2025] Process for Application and Approval of Benefits

A. To request paid family and medical leave benefits, an applicant shall submit an application for benefits in a manner approved by the Department. An application may be submitted online. The applicant must submit all information and documentation requested by the Administrator that is reasonably necessary to determine eligibility for leave. Requested information and documentation may include, as applicable to the type of leave requested:

1. Proof of personal identity;

2. Identifying information about all employers participating in the Fund from which the applicant is seeking leave;

3. Proof of identity of family member if the applicant is applying for paid family leave;

4. Information regarding the existence of a significant personal bond, if the applicant is applying for family leave to care for an individual with a serious health condition with whom the applicant has a relationship as described in 26 M.R.S. § 850-A(19)(G). A significant personal bond is one that, when examined under the totality of the circumstances, is like a family relationship, regardless of biological or legal relationship. This bond may be demonstrated by, but is not limited to the following factors, with no single factor being determinative:

a. Shared personal financial responsibility, including shared leases, common ownership of real or personal property, joint liability for bills or beneficiary designations;

b. Emergency contact designation of the employee by the other individual in the relationship or the emergency contact designation of the other individual in the relationship by the employee;

c. The expectation to provide care because of the relationship or the prior provision of care;

d. Cohabitation and its duration and purpose;

e. Geographic proximity; and

f. Any other factor that demonstrates the existence of a family-like relationship.

5. Reason for leave;

6. Proposed scheduling of leave, including the first day of missed work and the expected duration of leave;

7. A waiver signed by the employer that the proposed schedule of leave is not an undue hardship, if applicable;

8. Documentation, to include the anticipated duration of leave, from a health care provider of the applicant's own serious health condition if seeking medical leave;

9. Documentation, to include the anticipated duration of leave, from a health care provider of the family member's serious health condition if seeking family leave; and

10. Other information and documentation reasonably requested by the Administrator.

B. The application will contain an Authorization Statement, which, if signed by the applicant or, in the case of applications for leave to care for a family member with a serious health condition, the applicant's family member, authorizes the Administrator to obtain medical information from the relevant health care provider as part of the verification process to obtain paid family or medical leave benefits. Applicants and their family members are not obligated to sign the Authorization Statement; however, if they decline to do so, the applicant is responsible for providing all required medical information from the relevant health care provider, and processing of the application may be delayed by any delay or failure to provide such information.

C. An application for safe leave must include a signed statement that the applicant meets the requirements for safe leave set forth in the Act.

D. A completed application must include a signed statement attesting that the information provided in support of the application for paid family or medical leave benefits is true and correct to the best of the applicant's knowledge.

E. A failure to provide reasonably necessary information or documentation may result in a delay in processing or denial of the application. Before denying a claim for incomplete information, the Administrator must provide the applicant an opportunity to provide the outstanding information. If such information is not provided within 10 business days of the Administrator's request, the application may be denied. The Administrator may deny an application for incomplete information only if such information is reasonably necessary to determine whether the applicant is eligible for benefits under the Act, and the extent and timing of such benefits.

F. A complete application for paid family or medical leave benefits may be submitted to the Administrator no more than 60 days prior to the start of family and medical leave and no more than 90 days after the start date of family leave and medical leave.

G. The 90-day application deadline may be waived if the Administrator finds good cause exists. Good cause for the late submission of an application is at the discretion of the Administrator.

H. The Administrator shall notify the employer in writing of an applicant's claim to obtain paid family or medical leave within 5 business days after a claim was filed. If there is an agreement as to the scheduling of leave, as mentioned in Section V B(5), the application will be processed immediately. If there is no agreement as to the scheduling of leave, as mentioned in Section V B(5), the application will go through an employer review as follows. Within 10 business days, the employer must submit any additional facts or information regarding the applicant's eligibility it wishes the Administrator to consider, and if the employer has determined that the proposed scheduling of the leave constitutes an undue hardship, the employer must also provide documentation supporting its determination pursuant to section V. Failure to claim an undue hardship during this time period shall be deemed a determination that the proposed schedule does not constitute an undue hardship. The Administrator shall review all determinations of undue hardship pursuant to section V. If the Administrator finds that the employer's determination is reasonable and the application would otherwise be approved, the Administrator shall impose a reasonable schedule provided by the employer. The employee shall be notified in writing by Administrator of the finding of undue hardship and the new provided schedule. If the Administrator finds that the employer's determination of undue hardship is not reasonable, the Administrator shall notify the employer in writing, and the application shall be processed in accordance with these rules with the employee's requested schedule. The employer or employee may appeal the Administrator's finding in this section pursuant to section XV within 15 business days from the date the decision is issued.

12-702 C.M.R. ch. 1, § VI