Application for Benefits Verification, Amendment or Extension of Leave Period and Paid Leave

Benefits (1) Application for Benefits Verification. For each request for payment associated with intermittent leave, the covered individual must verify with the Department the hours of leave taken each week in order to receive benefit payments. (2) Amendment of Benefits. Following an approval of an application for benefits, if there is a change in relevant circumstances that would justify an extension, reduction, or other modification of the period of leave or the amount of benefits, the covered individual and the employer or covered business entity, if any, shall have an affirmative obligation to notify the Department within seven calendar days of said change using the forms prescribed by the Department. (3) The Department shall provide contemporaneous notice to the individual and to the employer of any report of a change in relevant circumstance including, but not limited to, the date on which the change occurred. (4) Extension of Benefits. If a covered individual seeks an extension of benefits, the covered individual must file an application to request an extension using forms prescribed by the Department. (a) A request for an extension must be filed 14 calendar days prior to the expiration of the original approved leave; provided, however, that the Director may allow a late filed request for extension for good cause shown. (b) A request for an extension must include all information required by the Department, including the following: 1. the reason for the extension; 2. the requested duration of the extended leave; 3. the date on which the covered individual provided notice for the request for extension to the employer (if applicable); and 4. a newly completed or updated health care certification for individual or family leave that otherwise satisfies the requirements of 458 CMR 2.08(5). (c) The Department shall notify an employer or covered business entity of a request for an extension not more than five business days following its receipt of a completed request form. The Department shall provide to the employer or covered business entity: 1. the requested duration for the extension; 2. whether the newly requested leave is continuous or intermittent; 3. any additional certification from a health care provider; and 4. any other information or record the Department deems relevant to verifying and otherwise processing the application for benefits. (d) The covered business entity or employer shall, within ten business days from the date of the notice, provide to the Department all relevant information or records requested by the Department, which may include the following: 2.09: continued (4) The approval for payment of benefits notice shall include: (a) The reason for the approved leave benefits; (b) The duration of the approved leave benefits; (c) For intermittent leaves, the frequency and duration of the leave benefits; ( d) The expiration of the approved leave benefits; and (e) The weekly benefit amount. (5) A denial of payment of benefits notice shall include: (a) The reason for the denial of leave benefits; and (b) A description of the individual's appeal rights under 458 CMR 2. 14. (6) Where the Department finds that a covered individual has failed to provide the Department with notice of a relevant change in circumstances which would have reduced the amount of benefits paid, the covered individual shall be responsible to reimburse the Department the amount overpaid within 30 calendar days of a request made by the Department. 2. 10: Application for Benefits Verification, Amendment or Extension of Leave Period and Paid Leave Benefits ( 1) Application for Benefits Verification. For each request for payment associated with intermittent leave, the covered individual must verify with the Department the hours of leave taken each week in order to receive benefit payments. (2) Amendment of Benefits. Following an approval of an application for benefits, ifthere is a change in relevant circumstances that would justify an extension, reduction, or other modification of the period of leave or the amount of benefits, the covered individual and the employer or covered business entity, if any, shall have an affirmative obligation to notify the Department within seven calendar days of said change using the forms prescribed by the Department. (3) The Department shall provide contemporaneous notice to the individual and to the employer of any report of a change in relevant circumstance including, but not limited to, the date on which the change occurred. (4) Extension of Benefits. If a covered individual seeks an extension of benefits, the covered individual must file an application to request an extension using forms prescribed by the Department. (a) A request for an extension must be filed 14 calendar days prior to the expiration of the original approved leave; provided, however, that the Director may allow a late filed request for extension for good cause shown. (b) A request for an extension must include all information required by the Department, including the following: 1 . the reason for the extension; 2. the requested duration of the extended leave; 3. the date on which the covered individual provided notice for the request for extension to the employer (if applicable); and 4. a newly completed or updated health care certification for individual or family leave that otherwise satisfies the requirements of 458 CMR 2.08(5). (c) The Department shall notify an employer or covered business entity of a request for an extension not more than five business days following its receipt of a completed request form. The Department shall provide to the employer or covered business entity: 1 . the requested duration for the extension; 2. whether the newly requested leave is continuous or intermittent; 3. any additional certification from a health care provider; and 4. any other information or record the Department deems relevant to verifying and otherwise processing the application for benefits. (d) The covered business entity or employer shall, within ten business days from the date of the notice, provide to the Department all relevant information or records requested by the Department, which may include the following: 1. Whether the covered individual will receive any paid leave benefits from the employer or covered business entity during the requested extended leave period at issue; 2. Whether the employer or covered business entity has approved or intends to approve the request for extension under the Family and Medical Leave Act of 1993 (29 U.S.C. 2601), or any other policy of the employer or covered business entity allowing for paid or unpaid leave; and 3. Any other relevant information or records related to the request for extension including, but not limited to, evidence of a fraudulent application for benefits. (e) The initial seven-calendar day waiting period for benefits, referenced in 458 CMR 2.12(7), shall not apply to an approved extension of benefits. (f) Any extension of an application for benefits shall be limited to any period of paid family or medical leave the employee remains eligible for in the benefit year pursuant to 458 CMR 2.10. (g) Applications for requests for extensions shall be deemed complete at the time the information required under 458 CMR 2.10(4)(b) has been received by the Department or the expiration of ten business days after the Department requests the information under 458 CMR 2.10(4)(c) from the employer or covered business entity, whichever is sooner, and is subject to the application for benefits approval process in 458 CMR 2.09. (h) The Department shall provide contemporaneous notice to the covered individual and to the employer or covered business entity, if any, of the Department's approval or denial of the extension request. (i) A covered individual must apply for and be eligible for benefits in any subsequent benefit year. (j) An employer or covered business entity may seek a medical recertification of the employee or covered contract worker's serious health condition following the expiration of the initial period of incapacity cited in the healthcare certification or where an intermittent leave has extended for a period of more than six months from the approval by the Department, whichever occurs first.