1
What do we do if the claim fails eligibility?
Escalate claim to the unworkable queue.
What do you do if you get this error? “Episodic Frequency and Duration are required and cannot be zero.”
You must capture the frequency.
When discussing the work pattern with the claimant, they stated their hours worked per week are incorrect. What do you do?
Create an action requested task to PI with claimants hours. Advise claimant of process (claim will be placed in review and another ER will be sent out before claim will be reapproved with corrected hours)
Claimant calls in asking for payment status and you see exempt Employer What do you tell the claimant?
It looks like your employer has a private plan and is exempt from the PFML Program which is why your payments have been cancelled.
claimant calls and states that they need to record a few weeks of leave. They want to report that they were out of work 9/30-10/28 8 hours each day. you already confirmed frequency and work pattern at 24 hours 7 days a week for frequency, and they work 40 hours a week M-F 8 hours each day. What would you ask the claimant next.
asks the claimant the specific dates he missed and how many hours
If a claim is for intermittent leave, but the cert shows a continuous leave what do we do?
Call the claimant to verify the leave type, but do not RFI. Update the frequency to 7 times a week for 24 hours
Claimant calls in asking why their start date was changed, what do you advise the caller?
Your date was changed to reflect the first reported and approved actual
How would you explain the waiting week to a new caller?
The waiting week begins on the first reported and approved actual and is seven consecutive days from that day.
What does paid mean when referring to payments?
When the payment has successfully passed internal DFML review and is being sent to the customer for payment.
What is the one thing we never use when recording actuals via the wizard or calendar?
The “all day” button
What 2 things you must discuss with each claimant prior to reporting actuals
Work pattern and frequency
Claimant calls and states “I have not received payment for January 5th”. What do you do?
After reviewing the claim and noticing the date was recorded, approved, and not within the waiting week. Explain to the claimant that their date is reported and approved and Create an action requested to PI and explain we are missing payments
The claimant states they have reported less than 8 hours before. What would be the only reason we are allowed less than 8 hours to be reported?
-Last of the availability
the hours are older than 30 days
I can be cracked, made, told, and played. What am I?
a Joke
I have branches, but no fruit, trunk or leaves What am I?
a Bank
What runs all around the back yard, yet never moves?
A fence
If a claimant calls in and states My end date on my new approval letter is changed What's is going on?
The claim was place in review and once we approved it the last reported day that was approved triggered as your end date. But no worries
If the claimant has an over payment. They can return the monies to us but where and with what?
A claimant can always remit payments via check to the address below regardless of whether an overpayment exists in the Absence Paid Leave case or not. Checks from DFML should not be voided when returned.
Department of Family and Medical Leave
100 Cambridge Street
Boston, MA 02114
Note: The claimant’s NTN# must be written on the check for verification purposes.
When looking at an overpayment where can you find a break down on where the over payment is for?
Meaning what caused the overpayment
Associated dues
What can take up the room with out using space?
Light
What begins wit T ends with T and has T in it?
Tea Pot
The claimant’s frequency is 5 hours twice per week. This is their first-time reporting hours and report the following days January 5th for 8 hours and January 8th for 4 hours.
Assuming you verified that the frequency matches the certification doc, the days are within work pattern and the claimant has the time available.
A. How do you decision these dates?
B. What do you advise the claimant?
A. January 5th: you can either Report and approve 5 hours and report and the deny the additional 3 hour. Or you can deny the entire 8 hours (over frequency)
January 4th: Record and Approve the dates
B. Advise the claimant That they're frequency only allows 5 hours per day, but they can speak to their doctor to have the frequency updated if they need more than the 5 hours daily
When hours need to be manually approved and you receive the error "denied decisions across all leave plans" what should you check prior to asking for assistance?
-Is there an alert for cert periods
-Are the cert periods filled in
-Availability
-Other claims
What is the one thing we never use when reporting actuals via wizard or calendar?
The all day button
What has a heart but doesn't beat?
An artichoke