3501 SUBMITTING A CLAIM FOR PAID-LEAVE BENEFITS

3501.1 An applicant shall submit a claim for paid-leave benefits using the online portal, or an electronic or non-electronic format approved by DOES.

3501.2 An applicant may submit a claim for one (1) of three (3) types of qualifying paid leave. The three (3) types of qualifying paid leave are:

1. (a) Qualifying family leave;
2. (b) Qualifying medical leave; and
3. (c) Qualifying parental leave.

3501.3 No claim submitted before the date of the occurrence of a qualifying leave event shall be approved by DOES.

3501.4 No benefits shall be payable for leave taken before the applicant submitted a claim to DOES for paid-leave benefits, except in exigent circumstances.

1. (a) For the purposes of this subsection, “exigent circumstances” means:
2. (1) Physical or mental incapacity that prevented the applicant or the applicant’s authorized representative from filing for benefits following the occurrence of the qualifying event;
3. (2) A demonstrable inability to reasonably access the means by which a claim could have been filed by the applicant or the applicant’s authorized representative following the occurrence of the qualifying event; or
4. (3) Actual lack of knowledge by the applicant of his or her right to apply for benefits under this chapter due to the noncompliance of all of the individual’s covered employers with the notice requirements required by 7 DCMR 3407 during the period when the individual could have received benefits under this chapter. Such employer noncompliance shall be confirmed by DOES audit before the individual shall be eligible for benefits due to exigent circumstances under this section.
5. (b) If an applicant believes that exigent circumstances exist, the applicant or the applicant’s authorized representative shall submit the claim for paid-leave benefits as soon as practicable after the qualifying event and shall provide evidence of the exigent circumstances.

(c) Based on the evidence provided by the applicant or the applicant's representative (and any supplemental evidence requested by DOES and provided by the applicant or the applicant's representative), DOES shall determine whether exigent circumstances existed. If DOES determines that exigent circumstances existed, DOES shall then determine the earliest date on which a claim could practicably have been filed by the applicant or the applicant's authorized representative, taking into consideration the evidence submitted by the applicant, and process the claim based on that date.

3501.5 No benefits shall be payable for qualifying parental leave more than fifty-two (52) calendar weeks after the qualifying parental leave event.

3501.6 When submitting a claim for paid-leave benefits, an applicant shall provide the following information through the online portal, or an electronic or non-electronic format as approved by DOES:

1. (a) The following three (3) elements demonstrating the applicant's identity:
2. (1) The applicant's name;
3. (2) Date of birth; and
4. (3) One of the following:
   1. (A) Social security number; or
   2. (B) Individual taxpayer identification number.
5. (b) Contact information, including the applicant's mailing address, telephone number, and email address;
6. (c) Whether the paid leave will initially be taken continuously or intermittently;
7. (d) If the paid leave will be taken continuously, then the elements set forth in Subsection 3506.4;
8. (e) If the paid leave will be taken intermittently, then the elements set forth in Subsection 3506.5;
9. (f) The specific future dates, or, in exigent circumstances pursuant to § 3501.4, the past dates, for which paid leave is being sought;

(g) For covered employees, the name, business address, telephone number, and email address of the applicant's supervisor or other party with knowledge of the applicant's employment at the covered employer and who bears at least some responsibility for the terms and conditions of the individual's employment;

(h) A signed affirmation certifying that the information provided in support of the claim for paid-leave benefits is true and accurate; and

(i) (1) For a paid medical leave claim:

(A) Proof of a qualifying medical leave event, including medical documentation signed by the health care provider that certifies the diagnosis or occurrence of a serious health condition;

(B) The expected duration of the condition certified by the health care provider and based on industry standards used by health care professionals to identify diagnoses of medical conditions and treatments; and

(C) A form signed by the applicant authorizing the individual's health care provider to provide medical documentation and/or additional information necessary to process the claim for paid leave.

(2) For a paid family leave claim:

(A) Proof of a qualifying family leave event, including medical documentation signed by the health care provider that certifies the diagnosis or occurrence of a serious health condition of a family member;

(B) The expected duration of the condition certified by the health care provider and based on industry standards used by health care professionals to identify diagnoses of medical conditions and treatments;

(C) An affirmation that the applicant will be taking the leave in order to provide care or companionship for the family member with a serious health condition;

(D) A statement of the relationship of the family member

needing care to the applicant, and proof of such relationship, which may be established by a signed affirmation form promulgated by DOES or other documentation approved by DOES;

1. (E) A description of the care or companionship to be provided by the applicant to the family member; and
2. (F) If requested by DOES, a form signed by the family member authorizing the family member's health care provider to provide medical documentation and/or additional information to DOES necessary to process the claim for paid leave.(3) For a paid parental leave claim, proof of a qualifying parental leave event, which shall be established by:- (A) A birth certificate;
3. (B) A court document;
4. (C) A Consular Report of Birth Abroad;
5. (D) A document issued by the health care provider of the child;
6. (E) A document from the adoption or foster care agency involved in the placement that confirms the placement and date of placement;
7. (F) A letter signed by the attorney representing the prospective adoptive parent that confirms the placement and date of placement;
8. (G) An IR-3 immigrant visa, or a successor immigrant visa, for the child issued by the United States Citizenship and Immigration Services;
9. (H) A hospital admission form associated with delivery; or
10. (I) Another document approved by DOES for this purpose.

3501.7 For paid medical leave claims or paid family leave claims, applicants shall also include a medical certification. The medical certification must be completed by a health care provider. The applicant shall bear the cost, if any, charged by the health care provider for completing the certification. The medical certification

shall include the following information:

(a) Contact information for the health care provider, including the name, address, telephone number, and email address;

(b) Medical license information for the health care provider;

(c) The date that the serious health condition began;

(d) The expected duration of the serious health condition;

(e) A physician's opinion as to the employee's (or, in the case of family leave, the family member's) ability, and the expected duration of any inability, to work, attend school, or perform other regular daily activities due to the serious health condition, treatment of the serious health condition, or recovery from the serious health condition;

(f) If family leave, the type of care or companionship required by the family member, and the expected frequency and duration of the leave that is required for the applicant to provide that care to the family member; and

(g) A summary of the medical condition.

3501.8 (a) DOES may, to the extent necessary to administer the paid-leave program under the Act and to the extent consistent with federal and District law, seek records from the applicant that are deemed confidential under federal or District law.

(b) If an applicant does not consent to the disclosure of information necessary to process a claim or to determine eligibility, an individual's claim for paid-leave benefits may be denied.

(c) All records shall be kept confidential by DOES and may only be released to parties other than authorized DOES staff when such release is required by law. Information contained in the records pertaining to an individual under this chapter shall be confidential and not open to public inspection, other than to public employees in the performance of their official duties, pursuant to Section 106(h) of the Act (D.C. Official Code § 32-541.06(h)).

3501.9 Any applicant filing a new claim for paid leave shall be advised at the time of filing the claim that:

(a) Paid-leave benefits may be subject to federal, state, and local income taxes;

and

(b) The applicant is responsible for complying with applicable federal, state, and local tax laws.

3501.10 DOES may require that the applicant obtain additional medical documentation if:

(a) The applicant requests an extension of leave or a different type or frequency of leave, beyond what the applicant requested in his or her initial application for the qualifying leave event; or

(b) DOES obtains new information which causes it to doubt the validity of the applicant's stated reason for the leave or the validity of the medical documentation.

3501.11 If the eligible individual's status as an adoptive or foster parent ends while an application for paid parental leave is pending or while the eligible individual is currently receiving paid-leave benefits based on their status as an adoptive or foster parent, the applicant or eligible individual shall notify DOES within ten (10) business days of the end of the status through the online portal or an electronic or non-electronic format approved by DOES. The individual shall not be eligible for parental leave benefits payable beginning on the date on which the individual's status as an adoptive or foster parent ended. An individual who submitted an initial application for parental leave benefits in good faith and whose status as an adoptive or foster parent ended during an open claim shall not be required to repay benefits payable for dates before the date of the end of the status as an adoptive or foster parent.

3501.12 For qualifying family leave, if the family member to whom the eligible individual provides care or companionship dies or recovers to the extent that the individual would no longer be eligible for family leave benefits under this chapter, the eligible individual shall notify DOES within ten (10) business days of the status change through the online portal or an electronic or non-electronic format approved by DOES. The individual shall not be eligible for family leave benefits payable beginning on the date on which the family member's status changed.

3501.13 DOES shall permit authorized representatives to file and manage claims on behalf of applicants. In order to be designated as an authorized representative, an individual or entity must submit appropriate legal documentation sufficient to establish bona fide legal authority to represent the applicant. Such documentation may include a court order, proof of designation as a power of attorney, or other documentation approved by DOES.

3501.14 (a) An applicant may have more than one (1) open claim at a time, provided

that the simultaneously open claims are for different qualifying events.

(b) The multiple qualifying events may be within the same type of qualifying event; for example, there may be two (2) open qualifying family leave claims or two (2) open qualifying medical leave claims for an individual at a time.

(c) An individual shall not receive payment for more than one (1) open claim on any particular day.

3501.15 During an open claim, an applicant may request a continuation of leave for the claim. A continuation of leave occurs when an applicant requests and is approved for a new last payable date of the claim that is later than the existing last payable date of the claim. DOES shall process the request for continuation of leave in a manner consistent with the provisions of this chapter.

3501.16 During an open claim, an applicant may request a reduction in leave for the claim. A reduction of leave occurs when an applicant requests and is approved for a new last payable date of the claim that is sooner than the existing last payable date of the claim. DOES shall process the request for reduction of leave in a manner consistent with the provisions of this chapter.

3501.17 Unless an applicant requests a continuation of leave pursuant to Subsection 3501.14, a claim shall be considered a closed claim after the last payable date.

SOURCE: Final Rulemaking published at 67 DCR 3997 (April 10, 2020).