Connecticut paid leave authority says claims backlog cleared

The fledgling paid leave program, which began providing income replacement benefits to eligible workers in January, is administered by Aflac. The new staff quickly became inundated with requests for benefits when omicron hit Connecticut in January and February, with more than 10,000 applications filed in one month, officials said at a news conference.

Some applicants had to wait up to six weeks or more for a decision on whether they could receive the financial assistance, prompting Aflac to bring in more staff, technology and other investments.

“It did take some time to work through that pool. But as of the 9th it is completely resolved and now we are just dealing with pending claims that are 30 days from leave or fewer,” said Andrea Barton Reeves, the authority’s executive director, who apologized to families that experienced delays.

Scott Beeman, Aflac’s senior vice president of Premier Life, Absence and Disability Solutions, acknowledged there was “a learning curve” for everyone involved in the first months of the program that was exacerbated by the omicron variant.

“Our all-new Connecticut based team were struggling with the same pandemic as individuals and as the heads of family, while administering a new program,” Beeman said. “They were immediately challenged by their own learning curve and getting through high volumes of claims requests for return calls.”

While the system is expected to always have a backlog of claims as they move through the review process, Beeman estimated that the “extra” backlog was about 4,000 claims.

Ultimately, about 85% of COVID-related claims have been denied because they did not meet the criteria for a serious health condition, according to John Simonetti, a compliance specialist at the authority. Just being exposed to COVID-19 or even being diagnosed with COVID-19 is not necessarily a serious health condition that would make someone eligible for the financial assistance.

In order for COVID to be considered a serious health condition, applicants must provide medical documentation that shows their COVID diagnosis required an overnight stay in a hospital or made them incapacitated for work for more than three consecutive days, among other conditions, according to the authority’s website.

The state’s paid leave program, which is entirely employee-funded through a 0.5% payroll deduction, provides benefits for specific reasons, including caring for one’s own serious health condition or a family member’s serious health condition; to bond with a new child; to address issues arising from family violence; and to care for a military family member injured during federal active duty or address issues that arise from a parent, spouse or child’s call to federal active military duty.

The amount of income replacement is based on a worker’s earning and it’s capped at $780 a week. The average claim amount so far has been about $560 a week, Barton Reeves said. More than 44,000 applications have been filed to date and more than $86 million in benefits have been issued.