Application for Benefits Denials and Appeals

(1) The Department will provide contemporaneous notice to the individual and the employers or covered business entities (where applicable) of the approval or denial of an application for benefits. (2) A covered individual may appeal a denial of family or medical leave benefits to the Department. A covered individual who is denied family or medical leave benefits by a private plan maintained by an employer or covered business entity pursuant to 458 CMR 2.07(6)(a), shall be subject to appeal pursuant to 458 CMR 2.14, and M.G.L. c. 175M, § 8(d). (3) Filing Deadline and Late Appeals. A covered individual's request for an appeal shall be filed within ten calendar days of receipt of notice of the determination. The Department may extend the ten-day filing period where an individual establishes to the satisfaction of the Department that circumstances beyond the individual's control prevented the filing of a request for an appeal within the prescribed ten-day filing period. When the appeal is requested by a covered individual subject to an approved private plan, the covered individual requesting the appeal shall also provide a complete copy of the request to the employer or covered business entity that maintains the approved private plan. (4) When requesting an appeal, a covered individual may request a hearing. A covered individual may agree to a disposition of the matter on the record without a hearing or may submit documents or evidence without appearing at a hearing. The conduct of a hearing regarding an appeal of a denial of benefits shall be in accordance with the procedures prescribed by M.G.L. c. 30A, and 801 CMR 1.02: Informal/Fair Hearing Rules. The Department will issue a final decision affirming, modifying, or revoking the initial determination within 30 calendar days of the hearing. (5) Following the Department's issuance of a final decision on the appeal, an individual aggrieved by the Department's decision may take a further appeal by filing a complaint in the district court for the county in Massachusetts where the individual resides or was last employed. Such court action must be commenced within 30 calendar days of the date the Department's final decision is received by the individual. (6) When a notice of a determination or a decision by the Department is transmitted by means of an electronic communication, it shall be presumed received on the date it is sent, except that any notice transmitted after 5:00 P.M. or on a state or federal holiday, Saturday, or Sunday, shall be presumed received on the next business day. When notice of a determination or a decision is sent by regular mail, it shall be presumed received three calendar days after it is mailed, except that if the third day falls on a state or federal holiday, Saturday, or Sunday, the notice shall be presumed received on the next business day. However the notice is transmitted, the presumption may be rebutted by substantial and credible evidence satisfactory to the Department that the notice was actually received on an earlier or later date. A request for an appeal shall be deemed filed on the postmark date if sent by regular mail and otherwise when actually received by the Department. A request received after 5:00 P.M. shall be deemed filed on the next business day. 2. 13: continued (5) Weekly Benefit Adjustment. As described in 458 CMR 2.12(5), a covered individual who takes leave on an intermittent or reduced schedule shall receive a weekly benefit amount that is reduced in direct proportion to the intermittent or reduced leave schedule. (6) The benefit year for a covered individual who received benefits for an intermittent leave will commence, following an approval by the Department for continued benefits, on the Sunday immediately preceding the first absence following the exhaustion of the prior benefit year. 2. 14: Application for Benefits Denials and Appeals (1) The Department will provide contemporaneous notice to the individual and the employers or covered business entities (where applicable) of the approval or denial of an application for benefits. (2) A covered individual may appeal a denial of family or medical leave benefits to the Department. A covered individual who is denied family or medical leave benefits by a private plan maintained by an employer or covered business entity pursuant to 458 CMR 2.07(6)(a), shall be subject to appeal pursuant to 458 CMR 2.14, and M.G.L. c. 175M, § 8(d). (3) Filing Deadline and Late Appeals. A covered individual's request for an appeal shall be filed within ten calendar days of receipt of notice of the determination. The Department may extend the ten-day filing period where an individual establishes to the satisfaction of the Department that circumstances beyond the individual's control prevented the filing of a request for an appeal within the prescribed ten-day filing period. When the appeal is requested by a covered individual subject to an approved private plan, the covered individual requesting the appeal shall also provide a complete copy of the request to the employer or covered business entity that maintains the approved private plan. (4) When requesting an appeal, a covered individual may request a hearing. A covered individual may agree to a disposition of the matter on the record without a hearing or may submit documents or evidence without appearing at a hearing. The conduct of a hearing regarding an appeal of a denial of benefits shall be in accordance with the procedures prescribed by M.G.L. c. 30A, and 801 CMR 1 .02: Informal/Fair Hearing Rules. The Department will issue a final decision affirming, modifying, or revoking the initial determination within 30 calendar days of the hearing. (5) Following the Department's issuance of a final decision on the appeal, an individual aggrieved by the Department's decision may take a further appeal by filing a complaint in the district court for the county in Massachusetts where the individual resides or was last employed. Such court action must be commenced within 30 calendar days of the date the Department's final decision is received by the individual. (6) When a notice of a determination or a decision by the Department is transmitted by means of an electronic communication, it shall be presumed received on the date it is sent, except that any notice transmitted after 5 :00 P.M. or on a state or federal holiday, Saturday, or Sunday, shall be presumed received on the next business day. When notice of a determination or a decision is sent by regular mail, it shall be presumed received three calendar days after it is mailed, except that if the third day falls on a state or federal holiday, Saturday, or Sunday, the notice shall be presumed received on the next business day. However the notice is transmitted, the presumption may be rebutted by substantial and credible evidence satisfactory to the Department that the notice was actually received on an earlier or later date. A request for an appeal shall be deemed filed on the postmark date if sent by regular mail and otherwise when actually received by the Department. A request received after 5:00 P.M. shall be deemed filed on the next business day.