Section 702-1-VII - [Effective 1/1/2025] Review of claims for benefitsA. The Administrator shall review a complete application and issue a determination to the covered individual. The review of the claim shall begin no later than the close of the 10 business days within which the employer is required to provide information to the Administrator. During those 10 business days, the Administrator will not begin the review if the employer has not yet provided requested information.B. If an applicant is not approved to obtain benefits, the Administrator shall notify the applicant and the employer and state the reason or reasons for the denial in the notification. The Administrator's notice shall also inform the applicant that they are entitled to request a reconsideration of the Administrator's decision by notifying the Administrator in writing within 15 business days from the date the notification is issued.C. If the applicant is approved to obtain benefits, the Administrator shall notify the applicant and the employer as to the benefit amount, the amount of time for which the applicant has been approved to take paid family or medical leave, and the qualifying reason, along with information on when benefits will be paid, and contact information of the Administrator. The Administrator shall also inform the applicant that they are entitled to request a reconsideration of the decision if they do so in writing within 15 business days from the date the notification is issued.D. If the applicant requests reconsideration, the Administrator shall review the request and the applicant's original application, using a separate reviewer from the initial consideration. The Administrator shall notify the employer of the applicant's request for reconsideration. The Administrator shall notify the applicant and employer in writing of the outcome of the reconsideration request. If reconsideration results in denial of benefits, the Administrator shall state the reason for the denial. If the applicant is aggrieved by the result of the reconsideration, the applicant may appeal the reconsideration decision pursuant to Section XV within 15 business days from the date the decision is issued. An applicant is not aggrieved if all requested benefits were approved.E. If an applicant's claim is approved, the employer(s) from which they are taking leave will receive notification of the claim approval along with the approved timeframe of leave within 5 business days of the approval date.F. All notifications from the Administrator to applicants and employers will be in writing, which may include email or electronic portal notifications.12-702 C.M.R. ch. 1, § VII