New York Life FMLA and leave forms, explained

What is New York Life Group Benefit Solutions, and why is its name on your leave paperwork?

New York Life Group Benefit Solutions (NYL GBS) is the group insurance and absence-management arm of New York Life. New York Life's 2022 FAQ for employees said: "Please note our transition from Cigna to New York Life Group Benefit Solutions is currently underway."

Its employer product is New York Life Absence Assist. New York Life tells employers it "provides a full suite of solutions to help you meet regulatory leave requirements," that "A designated absence manager helps guide employees throughout their leave," and that its portal lets employees "initiate leaves, check status, request extensions, upload documents." Those pages are written for employers.

What New York Life handles depends on your employer: its employee page speaks of the case where it "manages your company's family medical leave," and its disability forms run under your employer's plan. New York Life's toolkit for employers says "Not all customers use the same claims forms. Please check with your HR Department."

Who decides your leave: New York Life or your employer?

New York Life's public pages don't say. They describe managing and processing a leave for your employer, not deciding it: its employee page speaks of the case where New York Life "manages your company's family medical leave."

The rules come from your employer's leave policy and benefit plan, plus the law, and the letters in your case show what was decided.

FMLA eligibility has three tests: 50 or more employees within 75 miles of your worksite, 12 months with the employer, and 1,250 hours in the preceding 12 months. Meeting them is necessary, not sufficient. The reason must also qualify, and your employer designates the leave; what counts as a serious health condition is its own question.

Does New York Life pay you during a leave of absence?

New York Life short-term disability pay depends on what New York Life handles for your employer. If it handles only your leave, pay during the leave comes from your employer's paid leave or plan. If it handles your employer's short-term disability claims, any benefit is paid under that plan's terms; its claim form refers to your employer's "employee health and welfare plan(s)" as "the Plan." For state family leave laws, New York Life's employee page says to "Contact your Human Resources department for additional information about state family medical leave laws."

FMLA leave itself is unpaid, and paid leave can run alongside it. Short-term disability is pay under a plan, a separate decision, and the same weeks can count against both. The short-term disability vs FMLA guide sets the two side by side.

On maternity leave, FMLA leave for the birth of a child runs under its own rule, and any pay comes from paid leave or a plan, where one applies. When you file, New York Life's FAQ asks for "The reason for your leave or expected delivery date (if you're pregnant)," and its forms page lists a separate "Documentation of Bonding" form.

How do you file a New York Life leave and send your forms?

New York Life's claim page, written for employees, says "You can file your Family Medical Leave claim over the phone or online." Online, the path is myNYLGBS.com, then "Review My Coverage," then "Disability/Leave of Absence," then "Submit a request for a disability or leave of absence." The same path covers a short-term disability claim, and if New York Life manages your employer's leave, its employee page says "your claim manager will automatically process your leave request at the same time," with no separate leave request.

By phone, "A representative will walk you through the process." Have ready: your "Personal information, such as your name, address, phone number, birth date, Social Security number, and email address"; your "Employment information, such as employer's name, email address, date of hire, and job title"; and "The reason for your leave request." Its FAQ adds the dates and contact details of any provider or clinic visits.

The FMLA certification form says to return it "to: NYL GBS Leave Solutions" by email, fax or mail, as printed on the form; the short-term disability claim form says "Mail or Fax to" New York Life, with an email address also printed. New York Life tells employers its portal lets employees upload documents. Keep a copy of what you send and every letter you receive.

Tell your employer first.

New York Life's FAQ says to "Contact your employer on, or before, your first day out of work," then New York Life.

File online at myNYLGBS.com, or by phone.

Online, open "Review My Coverage," then "Disability/Leave of Absence."

Get the provider's part completed.

Start with the provider treating you; New York Life's disability forms are addressed to your attending physician.

Return the form by the route on it.

New York Life's forms name email, fax or mail. If your letter names a route, use that one.

Check your status.

New York Life tells employers that with myNYLGBS employees can "file claims, manage a leave-of-absence, view status."

What forms will New York Life ask your provider to complete?

New York Life's FMLA forms are on its public forms page, which says "You will need to save them to your computer, complete the forms and submit." For FMLA leave, your employer can require a medical certification. New York Life's employee page says "You may be required to provide medical information from your doctor to support your need for leave."

The forms page lists the certification as "Certification of Health Care Provider for Employee's Own Illness"; the PDF's own title is "Certification of Health Care Provider for Employee's Serious Health Condition," with "Section I: For Completion by the Employee" and "Section II: For Completion by the Health Care Provider." The DOL's WH-380-E is another version.

Either way, the federal rule sets out what it may ask for, including when the condition started, how long it's likely to last, the medical facts supporting the leave, and whether you can do the job's essential functions. A diagnosis isn't required on an FMLA certification, though New York Life's form lists "symptoms, diagnosis, or any regimen of continuing treatment" as examples of relevant medical facts.

New York Life's certification asks the provider for the "Approximate date condition commenced," the "Probable duration of condition," any "other relevant medical facts" and the job functions you are unable to perform. The form tells the provider that a vague duration may not be enough: "terms such as 'lifetime,' 'unknown,' or 'indeterminate' may not be sufficient." It also says "Failure to provide a complete and sufficient medical certification may result in a denial of your FMLA request."

For a short-term disability claim, New York Life's claim form has three parts, plus a disclosure authorization: "To Be Completed by the Employer/Administrator"; "To Be Completed By The Claimant"; and "To Be Completed By Attending Physician," which is the provider's part. New York Life addresses that part to your "Attending Physician," so start with the provider treating you. For a mental-health claim, see short-term disability for mental health.

That part asks for "Diagnosis and Concurrent Conditions, Including ICD or DSM Code," the dates the patient was "Continuously Totally Disabled - (Unable to Work)" and, "If Still Disabled," the date you should be able to return.

New York Life's separate "Physician's Statement of Disability" says "The Remaining Sections of this Form Are To Be Completed By Your Physician(s)." It asks for the diagnosis, what you can do "In an 8-hour work day," the nature of treatment, and "medical documentation to support your findings." These are disability-plan forms, not FMLA certifications, so the FMLA's no-diagnosis rule doesn't govern them. Your employer may use its own versions, and the form you were sent governs.

New York Life's forms page also lists a certification for the care of a family member and an "ADA and PWFA Accommodation Request Form." An accommodation request is its own process; see the reasonable accommodation request guide.

What happens if the form comes back incomplete or late?

For an FMLA certification, you get at least 15 calendar days after the employer's request to return it; New York Life's form says "Your employer must give you at least 15 calendar days to return this form." That deadline doesn't apply where returning it on time isn't practicable despite your diligent, good-faith efforts, so keep a dated record of what you asked your provider and when.

If it's incomplete or insufficient, the employer must say in writing what's missing and generally allow seven calendar days to fix it. A certification that never reaches the employer isn't treated as incomplete; it counts as not provided, so only the 15-day clock applies to it. New York Life's form is returned to NYL GBS Leave Solutions, not to HR, so keep proof of when you sent it.

If the certification is late, the rule depends on the leave. For leave you planned ahead, the employer may deny FMLA coverage until you provide it. For leave you couldn't plan, it may deny FMLA coverage for the days after the deadline until a sufficient certification arrives, unless something outside your control made returning it on time impractical. Read about FMLA denials and what the rules allow next.

Disability-plan forms follow the plan's rules, not the FMLA's clocks; New York Life's short-term disability claim form says "Be sure to answer all questions - failure to do so may delay your claim." Go by any deadline in your letter.

Who completes the provider's part for you?

If the provider already treating you will complete the form, that's the simplest route. Certicare is for when that isn't available, or not in time.

A state-licensed provider completes and signs the provider's part of the form you were sent, after an online evaluation, where the evaluation supports it. Upload the form with your intake; usually no appointment. A provider may follow up for more detail before deciding.

An evaluation doesn't mean a signature: the provider signs only what the evaluation supports. The completed form comes back to you by email, usually within 24 hours after we have everything needed. You return it the way your letter says.

The fee is $49 for the medical leave forms service. If we can't complete your request, for any reason, you're refunded in full.

This service is for your own condition. For a family member, see family care leave forms.