This is the second entry in what will be an occasional series about my navigation of the District of Columbia’s universal paid family and medical leave program. You can find the first entry here.
Getting your application ready
Like every interaction with the government here, applying for leave requires filling out a series of forms. In the District of Columbia, whether you’re taking personal medical, family, or parental leave, you have to fill out the “general claim form,” or PFL-1, which is used to identify you in the District’s primitive payroll database to determine your daily or weekly benefit amount. Then you need to complete additional forms, depending on the type of leave you’re taking:
- for parental leave: PFL-2, the “parental leave claim form”
- for personal medical leave: PFL-MMC, the “medical leave medical certification form”
- for family leave: PFL-3, the “family leave claim form,” PFL-FMC, the “family leave medical certification” form, and PFL-FR, the “certification of family relationship.”
PFL-2 and PFL-3 are the only forms you can complete on your own, (PFL-2 requires just a copy of a birth certificate or hospital admission form). The other forms require at least some information from a “licensed healthcare professional.” This need not be a doctor, but they do need to provide information about their state license and the “Primary ICD-10 Code for Health Condition.” I assume most healthcare providers in DC are familiar with these forms by now, but you may need to be patient if you’re seeing a doctor elsewhere, since in my experience doctors are not especially attentive form-fillers.
Once you’ve completed the required paper forms to your satisfaction, you can initiate the online application process here. This is a fairly tedious process that essentially involves copying the data from the paper forms into online fields. At the end of this process, you are also required to upload scanned copies of the paper forms — the online system is completely duplicative of the offline system.
Timing your application
Here’s where things get tricky and it’s important to understand the rules very precisely. You are eligible to apply for leave only after a “qualifying event” has taken place. But each kind of leave defines qualifying events slightly differently.
- In the case of parental leave, the qualifying event is the birth of a biological child or placement of an adopted child;
- In the case of family leave, the qualifying event is the diagnosis or occurrence of a serious health condition that requires care or companionship;
- In the case of personal medical leave, the qualifying event is “hav[ing] a serious health condition that prevents you from working, attending school, or performing regular activities of daily living.”
What’s important to know in timing your application is that there’s a 7-day waiting period before you can receive benefits for your first (but only your first) leave period during your benefit year (the 52 weeks that begin when you file your first application for leave).
In order to get the most value from the program, you must understand how these rules interact.
First and foremost, you always want to get your benefit year started as soon as possible, in order to restart your benefit year as soon as possible, even if you do not collect any money on the claim, due to the 7-day waiting period that resets at the beginning of each benefit year. Take the case of two covered employees who find themselves pregnant on January 1, 2022, with a due date of October 1. While they can prepare their parental leave documents in advance, they’re ineligible to submit a parental leave claim until the day the qualifying event occurs (the baby is born).
However, in consultation with their healthcare provider, the pregnant partner can immediately file an “intermittent” personal medical leave claim to indicate days they won’t be able to work while they “need to take leave from work in order to attend prenatal care appointments with medical providers.” According to a random-but-reputable-looking schedule of visits I pulled up, a normal pregnancy should have “about” 15 visits over 40 weeks. By filing an “intermittent” leave claim immediately alongside an anticipated schedule of visits, the pregnant worker can start her “overall” leave clock January 1 (or as soon as they’re able to collect the required paperwork). To be clear: the first 7 days of that leave won’t be paid, due to the 7-day waiting period. But by triggering the start of her benefit year and “running down” those 7 days as soon as possible, she can bring forward her individual benefit year reset date and begin receiving benefits the date her eligible parental leave claim is submitted.
What about the non-pregnant partner? Rather than personal medical leave, they need to file a claim for family leave, to “provide care and companionship” to the pregnant partner during those visits. This, too, will start the benefit year clock and the non-pregnant partner can start to run down their own 7 day waiting period.
Either or both of their employers may allow them to use sick or vacation time to be paid for those unpaid days of leave, or simply take them as unpaid time off.
Assume the pregnancy proceeds as uneventfully as any pregnancy can and the happy day arrives October 1, 2022. What now? Hopefully somebody brought a laptop to the hospital, and the weary companion uploads an image or scan of an admission form and submits both of their claims for parental leave. With their 7-day waiting periods already passed, they can begin to receive paid parental leave immediately.
Note a few important things here:
- There’s no requirement for leave to begin immediately. It can begin anytime up to 52 weeks after the qualifying event, so they can take turns taking leave in virtually any configuration.
- However, you are only eligible for paid leave for a qualifying event for the 52 weeks after that event. So while there might be advantages to delaying your parental leave claim to take turns with the newborn, don’t get too clever with it and run into that 52-week wall and lose benefits you would have been eligible for.
- In the words of the paid family leave office, “the limit on the number of weeks for each kind of leave resets separately.” This is an important qualification, since it means the happy couple can’t take two 8-week parental leave periods for the same qualifying event (one beginning October 1, 2022, and the second beginning when their benefit year resets January 1, 2023).
- I believe you would have to file a second parental leave claim (and run down a second 7-day waiting period) if you crossed the benefit year threshold, which might be slightly inconvenient but since you’d be submitting identical forms for an identical qualifying event, and already have your account set up, probably not terribly so.
While the rules don’t let you double-dip on any individual kind of leave, pulling your benefit year reset date forward does let you use the different kinds of leave more flexibly. Assume our happy parents both begin their 8 weeks of paid leave on the delivery date of October 1, 2022. They won’t be eligible for additional parental leave until 52 weeks later, on October 1, 2023. But because their benefit year began January 1, 2022, on New Years Day they’re each immediately eligible for 6 more weeks each of personal medical and family caregiving leave (and remember — they have a new member of the family to care for!).
My family leave submission
Since I’m applying for family leave, I needed to submit PFL-1 and PFL-FR, which I completed myself, and PFL-FMC, which had to be completed by my family member’s medical provider. When I had all three documents in hand, I groaned. The doctor had dated their signature with the procedure date, rather than the date the form was signed. Hoping for the best, I replicated the forms into the online fields, uploaded scanned copies, and crossed my fingers.
The good news is that my monetary determination came through immediately, and was precisely correct. As a self-employed person “opted in” to the paid family leave program, I submit my quarterly income through the Department of Employment Services archaic wage reporting system. Archaic or not, the Office of Paid Family Leave was ability to immediately pull up my last 5 quarters of income, identify the 4 highest-earning quarters, and calculate my weekly and daily benefit. So far so good.
In addition to my monetary determination, I immediately received an “Employer Notice.” For employees, this notice goes to their employer to alert them that an employee has filed a paid family leave claim. This is yet another relic of placing the paid leave program under the control of the same people who run the unemployment insurance program. In the case of unemployment insurance, the employer is asked to confirm that an employee was involuntarily fired; in the case of paid family leave, it’s to confirm their “regular workweek” so the department can properly divide their “weekly benefit” into a “daily benefit.” It’s completely unnecessary in the case of employees, but in the case of the self-employed it reaches the level of absurd. Still, completing the “response” was fairly painless, although it required creating yet another account, this time on the “employer” side.
Obstacle, and resolution
About a week after submitting, my groan proved justified. Someone in the office of paid family leave e-mailed me to point out that the doctor’s signature was future-dated:
“The PFL-FMC form you submitted does not contain the correct date of completion by the health care provider that completed the form. Since the date of diagnosis is more than a year ago we need a current qualifying event date. Typically, paid family leave claims are filed after a qualifying event has ocurred, not before. Therefore, the correct date of completion on the PFL-FMC form will allow us to process the claim for future dates. Without it, the qualifying event date you selected at the time of filing does not match the supporting documentation.”
She was right! Since the procedure hasn’t occurred yet, it couldn’t be an eligible qualifying event, and since the diagnosis was over a year ago, neither can it.
Gamely, I played dumb, and simply replied, “what information/document do you need?”
Fortunately, the claims examiner chose to play along, and replied “The date the PFL-FMC form was completed by the health care provider needs to be corrected to the date on which the form was completed, not a future date.”
After following some pretty simple instructions included in her e-mail, I submitted the corrected form, again through the online portal. Another week went by, and suddenly another slew of e-mails landed in my box, the most important of which was “QUALIFYING DETERMINATION.” I’d passed the test.
My leave starts on Monday and is scheduled to run about 3 weeks. While I won’t be paid for the first 7 days of that period, by kicking off my benefit year as soon as possible, I’m pulling forward my benefit year reset for all three forms of leave. If I need to take additional family or medical leave in the next year, I will have run down my waiting period and be eligible for immediate benefits, and if not, I’ll be eligible for the full 6 or 8 weeks of family and medical leave in just 52 short weeks.
In the next entry in this occasional series, I’ll report back on what the reporting requirements are once you start to receive benefits, the payment schedule, and any other paperwork requirements once a claim is in effect.