Or. Admin. Code § 471-070-1205

Current through Register Vol. 63, No. 12, December 1, 2024

Section 471-070-1205 - Benefits: Weekly Claims

(1) A claimant taking Paid Family and Medical Leave Insurance (PFMLI) benefits on an intermittent leave schedule or for more than one qualifying purpose as described in OAR 471-070-1430, must file a weekly claim in order to receive PFMLI benefits for that week.

(2) For a weekly claim to be approved, the weekly claim must be complete and include, but is not limited to, the following information:

(a) The dates of the work week being claimed;

(b) The number of work days of leave taken for each leave type specified under 657B.020;

(c) The number of days worked during the work week;

(d) Claimant's eligibility to receive workers' compensation time loss benefits under ORS chapter 656 or Unemployment Insurance benefits under ORS chapter 657 for the work week;

(e) Any changes to current employment, including any new employment or employment that has ended since the benefit application or last weekly claim; and

(f) A written or electronically signed statement declaring under oath that the information provided in support of the weekly claim is true and correct to the best of the claimant's knowledge.

(3) The weekly claim must be submitted only after that work week has ended and no later than 30 calendar days following the end of the work week in which the family, medical, or safe leave was taken. Weekly claims submitted after 30 calendar days will be denied, except in cases where a claimant can demonstrate a weekly claim was submitted late for reasons that constitute good cause under section (5) of this rule.

(4) For claimants taking intermittent leave, the number of days of leave eligible in a work week may not exceed the average number of work days worked per week, as provided under ORS 471-070-1100(1)(c)(C) or OAR 471-070-1210(2), minus the number of days actually worked during the work week.

Example: Eddie submits an application for benefits that states their average work week consists of four work days. The weekly benefit amount is $875.00. Eddie submits their first weekly claim and reports three days worked and three days of leave, for a total combination of six days of work and leave reported. Eddie will only be paid for one of the three days of leave reported on the weekly claim report as Eddie worked three days out of a four day work week. The benefit amount paid for the first week of leave to Eddie is $218.75 [($875.00 weekly benefit amount divided by 4 work days) x 1 day of payable leave].

(5) Good cause exists when a claimant establishes by satisfactory evidence submitted to the department that factors or circumstances beyond the claimant's control prevented the claimant from submitting a weekly claim within the required timeframe under section (3) of this rule. Good cause for the late submission of a weekly claim is determined at the discretion of the department and includes, but is not limited to, the following:

(a) A serious health condition that results in an unanticipated and prolonged period of incapacity and that prevents a claimant from timely filing a weekly claim; or

(b) A demonstrated inability to reasonably access a means to file a weekly claim in a timely manner, such as an inability to file a weekly claim due to a natural disaster or a significant and prolonged department system outage.

(6) If the department determines the claimant demonstrated good cause for late submission of a weekly claim, the department may accept the weekly claim up to one year after the leave was taken.

Or. Admin. Code § 471-070-1205

ED 5-2023, adopt filed 07/31/2023, effective 8/1/2023; ED 5-2024, amend filed 07/30/2024, effective 8/1/2024

Statutory/Other Authority: ORS 657B.340

Statutes/Other Implemented: ORS 657B.020, 657B.090 & Chapter 20 Oregon Laws 2024