How can we help?

Documents and Forms

Applying for Paid Leave

How do I apply for leave?

You can apply online or with a paper application. To request the paper application contact us at or by phone at (833) 717-2273.

Will my employer file for Paid Family and Medical Leave on my behalf?

No. After you notify your employer that you need to take leave, you are responsible for completing the application process. See application checklist.

What documents do I need?

See the application checklist for a list of documents you’ll need.

Can someone else apply for me or help me apply?

You may designate an authorized representative to act on your behalf. The Designation of an Authorized Representative form is available by request from the Customer Care Team. You will be required to apply using the paper application.

What do I tell my employer?

If you know you will be taking Paid Leave well before it happens (for example, if you are expecting a baby or your family member has a planned surgery coming up), you’ll need to give your employer written notice at least 30 days in advance.

If you take Paid Leave unexpectedly (for example, after a serious injury), written notice to your employer is still required. Provide notice as soon as you are able, or ask someone else, like a family member or a neighbor, to provide notice for you.

In your written notice, let your employer know you need to take paid family or medical leave and about how long you expect you’ll be out. Emails, text messages and handwritten notes all count as written notice. It is always a good idea to keep a copy for your records.

Download sample written notification.

Is there any information I need from my employer before I apply?

To apply for Paid Leave, you do not need information from your employer. But you must notify them in writing that you plan to take leave. You will also want to identify any supplemental benefits your employer provides you and have this information available to file your weekly claims.

What notifications will my employer receive?

Your employer will be notified by mail when you apply for Paid Leave. They will have 18 calendar days to contest your application if they feel you are not eligible for the program. They will also be notified when your leave is approved or denied.

When should I apply?

You should apply during the two weeks after your event takes place. We are not able to approve applications before the qualifying event. You may be able to backdate your claim if you have a good cause reason to do so, such as being hospitalized or otherwise incapacitated. Please call the Customer Care Team to find out if your circumstances qualify as “good cause.”

Can I backdate my claim?

You can apply within two weeks of your qualifying event without needing a good cause reason for backdating your application.

If it’s been more than two weeks since your qualifying event, you can backdate your claim for a “good cause” reason that prevented you from applying for Paid Leave immediately after your event. A “good cause” reason can be the result of a serious health condition, such as being in the hospital during a period of incapacity or because of natural disaster.

The Certification of Serious Health Condition form may provide the information we need to determine if you are eligible to backdate your claim, but we may need additional information.

What is “good cause”?

You can backdate your claim for a “good cause” reason. A “good cause” reason can be the result of a serious health condition, a period of incapacity or because of a natural disaster. A medical certification form may provide the information we need to determine if you are eligible to backdate your claim, but it is likely we will ask for additional information as to why you need to backdate your claim.