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Employer role in the paid family and medical leave review process

Leave administrators play a critical role in the paid family and medical leave approval and appeals process.

As representative for your employer to manage requests for paid leave, you’ll play an important role in the paid family and medical leave process. The Department of Family and Medical Leave will rely on you to provide important details about applications that list your employer, in order to verify the accuracy of these claims. Here’s how that process will work.

Table of Contents

Reviewing an application

You will receive an email letting you know that an employee at the company you represent has started an application for paid family or medical leave. You will get a second email when the employee submits the application. You will be able to view the details of the employee’s application by clicking on a link provided in the email.

When you receive this email notification, you will have 10 business days to review and respond to the information. If we do not hear from you or any other verified leaved administrator from your organization in that time, we will process the application using only the information the employee provided. 

The first thing to determine is whether you are the correct person to be evaluating this employee’s application. If you are not the correct person, notify your organization to ensure the appropriate person is notified of the application and take no further action.  If you are the correct person to review, you must verify that the information you provide during your assessment is true. 

Here is a list of information you may be asked to confirm or provide, as well as why we ask for this information. 

1. Other instances of paid and unpaid leave that the employee has taken in the past benefit year 

Most Massachusetts employees are eligible for up to 26 weeks of combined family and medical leave per benefit year. This combined leave may include: 

  • Up to 20 weeks of paid medical leave per benefit year to manage a personal serious health condition 

  • Up to 12 weeks of paid family leave per benefit year to care for a family member or to bond with a child, or 

  • Up to 26 weeks of paid family leave per benefit year to care for a family member who is a member of the armed forces. 

Paid family and medical leave is a Massachusetts-offered program. It works alongside federal programs like the Family and Medical leave act, and any independent leave programs offered by your employer. 

We ask if the employee has taken any other types of leave in the previous benefit year in order to confirm that they have not used more time than they are eligible for. 

Employees can take up to 12 weeks of leave to care for a family member with a serious health condition regardless of any leave taken prior to July 1, 2021 to care for a family member. In other words, leave taken to care for a family member prior to July 1, 2021 will not reduce the 12-week allotment under PFML to care for a family member with a serious health condition.

However, family leave to bond with a child and family leave for family members who are active service members taken between Jan 1-Jun 30 will reduce the 12-week allotment. In addition, for all types of leave, employees cannot exceed 26 weeks total in the benefit year.

Some examples:

  • If your employee took 8 weeks of family leave to bond with their child in 2021, they would only have 4 weeks of family leave available to them to care for a family member with a serious health condition.

  • If your employee has already taken 20 weeks of medical leave in 2021, they would only have 6 weeks of leave available to them to care for a family member with a serious health condition.

Paid family and medical leave is a Massachusetts program. It works alongside federal programs like the Family and Medical Leave Act, and any independent leave programs offered by your organization.
It is important for Leave Administrators to tell us if the employee has taken any other types of leave in the previous benefit year so the Department can confirm that they have not used more time than they are eligible for.

Learn more about other leaves and benefits

2. The employee’s earnings

To be eligible for Paid Family and Medical Leave, a employee must have earned at least $5,400 and at least 30 times their calculated weekly paid leave benefit amount in the last 4 completed quarters.

3. Work patterns and hours 

While most paid leave will be taken all at once, employees may also apply for paid leave on an intermittent or reduced schedule. An employee applying for intermittent or reduced leave must first confirm their leave schedule with their employer before beginning their application for paid leave.

4. Reporting potential fraud 

You will be asked if any of the information provided appears to be fraudulent. The Department takes fraud allegations seriously. Any application where the paid leave administrator has indicated that fraud might be taking place will be flagged for further review. 

Your employee’s application to care for a family member with a serious health condition requires the employee to confirm their relationship with the family member and the family member’s health care provider must fill out the Certification of your Family’s Member’s Serious Health Condition form. If upon review of the employee’s application you have reason to believe that this information is not accurate, you should contest the family relationship.

If a family relationship is contested the Department will ask the employee to submit documentation confirming their relationship to the family member requiring their care. This can include but is not limited to:

  • A copy of a legal certificate, such as a birth or marriage certificate, or a certificate of adoption or other court documents

  • An affidavit attesting to their relationship with the individual whose situation necessitates the employee’s leave and is a covered family member under PFML

5. Approving an employee's application

After your review of the information that the employee provided in their application, you will be asked whether you would approve or deny the application or leave it pending. You should use the open text field to explain your denial or pending designation of their application based on the law and your company’s existing policies.

While the Department ultimately approves or denies all applications, your recommendation will be taken into consideration as part of the Department’s decision. Note that if the employee is legally eligible to take paid family or medical leave, and if all aspects of the employee’s application are truthful and correct, the application will be approved.

If you have flagged the application for potential fraud, the Department will conduct a further review.

Additional Resources

Reaching a decision

When a decision has been made on a specific application that you reviewed, you will receive an email with a link to a PDF with the Department’s notice of decision.

When an employee is out on leave

During the time period(s) when employees are receiving Paid Family or Medical Leave benefits, employees can only work during the agreed upon schedule they established with you as part of their Paid Family and Medical leave application (continuous, reduced and/or intermittent). 

Employees cannot work for you, their employer, outside of the approved schedule without it resulting in a loss of benefits.

If an employee appeals a decision

Employees may appeal any aspect of a paid family or medical leave determination, including but not limited to: 

  • Denial of benefits

  • Leave modifications

  • Weekly benefit amounts

  • The duration of their leave

Employer Documentation Requirements

Employers must generally maintain records and documents relating to medical information, medical certifications, recertifications, or medical histories of employees in separate files/records from the usual personnel files and in accordance with any applicable laws and regulations.

Contact

Phone

For questions about benefits and eligibility: (833) 344-7365

Department of Family and Medical Leave - Hours of operation: Monday-Friday, 8 a.m - 5 p.m.

Fraud Reporting Hotline: (857) 366-7201

Department of Family and Medical Leave - Hours of operation: Monday-Friday, 8 a.m - 5 p.m.

For questions about contributions and exemptions: (617) 466-3950

Department of Revenue - Hours of operation: Monday-Friday, 8:30 a.m. - 4:30 p.m.

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