Navigating leave can be confusing, largely due to the claims process. Throughout a leave of absence, it’s common for claim and benefit programs to serve as one of or more of your sources of leave pay. If you are eligible, these benefits may be supplemental to employer pay that you’re receiving or they may be your only source of pay while on leave.
Your company has partnered with Cocoon to help guide you through this process to ensure you know exactly which claims you might need to file and how to do so. Below you can learn more about claims and why they are important.
What are claims?
Claims are applications to benefit programs from insurance carriers and state government programs that provide pay while you’re out on leave. Most commonly, these will be either short term disability claims or paid family leave claims.
Short term disability claims - STD claims provide wage replacement when you are out on leave to care for your own serious injury or disability.
Paid family leave claims - PFL claims provide wage replacement when you are out on leave to care for a seriously ill family member, to bond with a new child, or certain events for military families.
What are benefit payments?
Benefit payments are the pay that a particular program will provide once an application/claim for that program has been submitted and approved.
Benefit amounts are determined by a variety of factors including your current income, your past income, your bonuses or commission as well as whether you are receiving benefits from other programs. These calculations can be complex and you typically will not know the exact benefit amounts you are eligible for until you receive your first benefit payment which includes a statement listing your exact weekly benefit amount.
Why are claims needed?
Claims are needed for a few reasons, but mostly to make sure you get paid.
Here’s how it works:
You may qualify for pay from your state’s paid family leave program or disability insurance.
If you qualify for these programs, your company may deduct your expected benefits amounts from your pay or these benefit programs may be your only source of leave pay.
Cocoon will provide guidance to you when the time comes to file for these programs to ensure you maximize your pay while on leave.
Does everyone need to submit claims?
No. Claims are dependent on your company, your leave circumstances and your state of residence. Cocoon will help you determine whether you’ll need to file for claims while you’re on leave.
What parts of my leave are covered by claims?
The time/pay that is covered by benefits programs depends on your company, location and the reason for your leave.
How do I know which claims I need to file?
Once you submit a leave, Cocoon automatically identifies any benefits you may be eligible to receive and which claims you need to file to receive them.
You can find this information with step-by-step guidance on the Your tasks tab of your Cocoon Dashboard.
When do I need to file my claims?
This depends on your circumstances and which type of claims you need to be complete. See examples below:
1) If your leave is related to your own disability (either due to pregnancy or a serious health condition), you may need to complete:
Disability claim forms
Claims can be submitted as early as the first week of your disability leave
Other considerations: In order to submit your claims, your provider must complete their section of the claim form (this is typically where claims are delayed). If this information is not provided by your doctor in a timely manner, your claim benefits will be delayed.
2) If you are taking leave to bond with a new child (parental leave) or to provide care for a seriously ill family member (caregiver leave), you may need to complete:
Paid Family Leave claim forms for parental leave
Claims can be submitted on the first day of your bonding leave
Other considerations: In order to submit your paid family leave claim, you will need to provide proof of relationship and birth. If this information is not provided in a timely manner, your claim benefits will be delayed.
Paid Family Leave claim forms for caregiver leave
Claims can be submitted the first day of your caregiver leave
Other considerations: In order to submit your paid family leave claim, your family member’s medical provider must complete their section of the claim form (this is typically where claims are delayed). If this information is not provided by their medical provider in a timely manner, your claim benefits will be delayed.
Who approves claims?
After claims are completed, they are submitted to the applicable state or insurance carrier for approval. Typically, it will take 2-4 weeks processing time before you hear from these carriers around a decision or next steps. In some cases, the state or insurance carrier may request additional information.
Keep an eye out for any outreach from your claim providers, as they’ll reach out to you directly with any requests for additional information. If you’re not sure how to take next steps, don’t hesitate to reach out to the Cocoon Support Team and we’re happy to provide guidance wherever we can.
Have Questions? We're here to help!
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