Washington Paid Leave

Introduction

Starting January 1, 2020, employees who have worked 820 hours in the qualifying period (equal to approximately 16 hours a week for a year) will be able to apply to take paid medical leave or paid family leave. The 820 hours are cumulative, regardless of the number of employers or jobs someone has during a year. All paid work over the course of the year counts toward the 820 hours, including part-time, seasonal and temporary work. (Note: guidance on what constitutes work performed in the state of Washington, for the purposes of calculating this 820-hour requirement is found, in RCW 50A.05.010 (7)(a). This is an analysis that would take place outside the ClaimVantage system.)

Paid Family and Medical Leave allows employees to take up to 12 weeks, as needed, if they:

  • Welcome a child into their family (through birth, adoption or foster placement).

  • Experience a serious illness or injury.

  • Need to care for a seriously ill or injured relative.

  • Need time away from work because of a family member's active duty military service (spend time with the family member during their R&R or during reintegration, attending military ceremonies, dealing with short-notice deployments – pre-deployment and post-deployment activities, and any qualifying exigency event described in the Federal FMLA regulations)

If employees face multiple events in a year, they may be eligible to receive up to a combined total of 16 weeks of paid family leave and paid medical leave, or a combined total of 18 weeks of paid family leave and paid medical leave if they experience a serious health condition during pregnancy that results in incapacity.

Absence Specification Setup

As of the ClaimVantage October 2019 release, you will see a new Absence Specification, named Washington Paid Leave. What is outlined in this section are the details that you will see on the user interface. The subsequent sections are additional rules that were coded in order to accommodate for Washington specific regulatory guidelines.

Calendar Type: Rolling Forward (see Calendar Type section for additional details)

Reasons:

  • Pregnancy/Childbirth

  • Adoption/Foster care

  • Bonding

  • Care of family member

  • Employee's own health condition

  • Military leave: qualifying exigencies

    • Attending counseling

    • Childcare and related activities

    • Deployment

    • Financial and legal arrangements

    • Military events and related activities

    • Rest and recuperation

    • Pre-deployment activities

    • Short notice deployment

    • Post-deployment activities

    • Other

Relationships:

  • Child

  • Grandchild

  • Grandparent

  • Sibling

  • Parent

  • Spouse

  • In loco parentis

  • Domestic Partner

  • Other

Hours Worked in the Qualifying Period: 820 hours (Note: RCW 50A.05.010(18) defines the Qualifying Period.)

Certifications that should apply to this leave:

  • PFL Form

  • PFL Other

Effective Date: 1/1/2020

Typical Workweek Hours

WA PFML has a nuance where, unlike Federal FMLA, 12 weeks does not necessarily mean 12 weeks as the employee is scheduled when they take leave . Instead, WA PFML uses the phrase typical workweek hours , which means the average number of hours worked during the qualifying period . The entitlement is then 12 (for example) multiplied by the employee's typical workweek hours .

The state says this for employees who are salaried when they apply for benefits: typical workweek hours are forty hours, regardless of the number of hours worked in the employee's qualifying period.

The state says this for employees who are not salaried when they apply for benefits: typical workweek hours are determined by dividing the sum of all hours reported in the qualifying period by fifty-two and rounding down to the nearest hour.

(Note: guidance on who should be considered salaried can be found in WAC 192-500-100.)

Qualifying Period means the first four of the last five completed calendar quarters or, if eligibility is not established, the last four completed calendar quarters immediately preceding the application for leave.

  • If, in the first 4 of the last 5 completed calendar quarters, the employee worked at least 820 hours, then the Qualifying Period is the first 4 of the last 5 completed calendar quarters.

  • If, in the first 4 of the last 5 completed calendar quarters, the employee did not work at least 820 hours, then the Qualifying Period is the last 4 completed calendar quarters.

The same Qualifying Period is used for eligibility (the 820 hours mentioned above) and the Typical Workweek Hours concept that dictates the employee's entitlement amount of paid leave.

Calculation: Maximum # of weeks allowed * employee's typical workweek hours = # of hours allowed for leave

Example 1: Hours reported for the employee are 2,080 hours. Create claim for care of a family member, for 15 weeks.

Calculation: 2,080 hours worked / 52 = 40 hours X 12 = 480 hours

Result: 480 hours approved or 12 weeks approved, 120 hours exhausted or 3 weeks exhausted

Example 2: Hours reported for the employee are 1,040 hours. Create claim for care of a family member, for 15 weeks.

Calculation: 1,040 hours worked / 52 = 20 hours X 12 = 240 hours

Result: 240 hours approved or 12 weeks approved, 60 hours exhausted or 3 weeks exhausted

Example 3: The employee worked a schedule of 20 hours per week from their date of hire four years ago up until yesterday, when they started working the default schedule. Hours reported for the employee are 1,040 hours. That means they have an average of 20 hours worked per week. Create a claim for care of a family member, for 15 weeks.

Calculation: 1,040 hours worked / 52 = 20 hours X 12 = 240 hours

Result: 240 hours approved or 6 weeks approved, 180 hours exhausted or 9 weeks exhausted

Example 4: The employee worked various scheduled from their date of hire four years ago up until yesterday. Hours reported for the employee are 1,560 hours. They have an average of 30 hours worked per week. Create a claim for care of a family member, for 15 weeks.

Calculation: 1,560 hours worked / 52 = 30 hours X 12 = 360 hours

Result: 360 hours approved or 9 weeks approved, 180 hours exhausted or 6 weeks exhausted

If the employee does not have total hours reported, the system utilizes the employee's schedule over the qualifying period to determine the hours worked in the qualifying period and dividing by 52 to get the Typical Workweek Hours.

As much as we would like for all of our calculations to be able to utilize the weeks method, because of the way the regulation was written, you will see the pie chart calculations displayed in hours. You can also leverage an existing ClaimVantage absence field named Pending in weeks on the Absence Type object to give you a view into the weeks equivalent to what you are seeing on the pie charts.

Leave Entitlement

Taking the prior section into account, here's how the maximum amount of time available to an employee is calculated.

The state says:

WAC 192-610-055 What is an employee's maximum benefit length?

(1) The maximum duration of paid family leave may not exceed twelve times the typical workweek hours during a claim year.

(2) The maximum duration of paid medical leave may not exceed twelve times the typical workweek hours during a claim year. This leave may be extended to fourteen times the typical workweek hours during a claim year if the employee experiences a serious health condition with a pregnancy that results in a period of incapacity. (3) An employee is not entitled to paid family or medical leave benefits under this chapter that exceeds a combined total of sixteen times the typical workweek hours during a claim year. The combined total of family and medical leave may be extended to eighteen times the typical workweek hours during a claim year if the employee experiences a serious health condition with a pregnancy that results in a period of incapacity.

We designed Washington Paid Leave as one absence specification, with rules behind the scenes to accommodate for the various scenarios regarding how much time and employee can be out or work for this paid leave.

We've defined the maximum amount of time that an employee is allowed for this leave as the following:

  1. For care of family member, qualifying exigency leave, bonding, adoption/foster care (in other words, the leave reasons that fall under Family Leave), an employee can take up to 12 weeks of leave.

  2. For e mployee's own health condition and p regnancy/childbirth (in other words, the leave reasons that fall under Medical Leave), an employee can take up to 12 weeks of leave.

  3. If the employee takes leave for pregnancy/childbirth that has resulted in a period of incapacity (indicated within the claim as "with complications") an employee may take up to 14 weeks of leave.

  4. Scenarios 1 and 2 cannot exceed 16 weeks total.

  5. Scenarios 1 and 3 cannot exceed 18 weeks total.

*During intake or when entering a provider certification, if the reason for leave is pregnancy/childbirth, the question Are you experiencing any complications? is displayed (existing functionality). If the check box for that question is left unchecked, the solution assumes scenario 2 (pregnancy/childbirthwithout complications). If the check box for that question is checked, the solution assumes scenario 3 (pregnancy/childbirthwith complications). The field on the provider certification will override what is entered for this field at intake.

images/download/attachments/81860828/Leave+entitlement+examples.png

Calendar Type

Currently, in ClaimVantage Absence, if an absence specification has a calendar type of Rolling Forward, the fifty-two week benefit period begins as of the first day of absence. However, WA PFML has different rules for when that benefit period begins.

The state says:

WAC 192-500-070 Claim year.

(1) "Claim year" is the fifty-two week period beginning Sunday of the week of:

(a) The date of the birth or placement of a child; or

(b) The date of the filing of a complete and timely application for all other qualifying events.

(2) For applications that are backdated, the claim year is the fifty-two week period beginning Sunday of the week to which the application was backdated.

(3) An employee may only have one valid claim year at a time.

Here is an outline of what we have done.

  1. For pregnancy/childbirth, bonding, and adoption/foster care, the fifty-two week benefit period will start on the Sunday prior to the child's date of birth or placement date.

  2. For all other reasons, the fifty-two week benefit period will start on the Sunday prior to the date that is entered in the date reported field.

Waiting Period

WA PFML program includes a 7-day waiting period, beginning with the Sunday of the first week an employee starts their leave, before benefits begin. We've recently introduced the ability for a user to apply a waiting period to an absence specification, however, there were additional customizations that we had to develop in order to meet the needs of WA PFML.

Specifically, the WA PFML rules explain that the waiting period is 7 consecutive calendar days. The rules also explain that the waiting period does not apply to claims for bonding, or adoption/foster care. Because the state of Washington set up a consecutive calendar day waiting period, that means employees don't have to be out of work for 7 days before their benefits are payable. Once 7 calendar days have passed since the employee's first absence that meets the minimum claim duration (next section), the employee's WA PFML benefits are potentially payable.

The state says:

RCW 50A.04.020

(1)(a) Beginning January 1, 2020, family and medical leave are available and benefits are payable to a qualified employee under this section. Following a waiting period consisting of the first seven consecutive calendar days, benefits are payable when family or medical leave is required. However, no waiting period is required for leave for the birth or placement of a child. The waiting period begins when an otherwise eligible employee takes leave for the minimum claim duration under subsection (2)(c) of this section.

(b) Benefits may continue during the continuance of the need for family and medical leave, subject to the maximum and minimum weekly benefits, duration, and other conditions and limitations established in this title. Successive periods of family and medical leave caused by the same or related injury or sickness are deemed a single period of family and medical leave only if separated by less than four months.

WAC 192-500-185 Waiting period.

(1) A "waiting period" is the first seven consecutive calendar days beginning with the Sunday of the first week an eligible employee starts taking paid family or medical leave.

(...)

(6) The waiting period does not apply to family leave taken for bonding after the child's birth or placement.

We've coded the WA PFML to support the following:

  • Apply a 7-day waiting period for care of family member, employee's own health condition, pregnancy/childbirth and qualifying exigency leave (the waiting period date range will have a status of Waiting)

Example 1: Employee who works Monday-Friday, 8 hours per day, goes out on leave for care of family member starting on May 1, 2020 through May 17, 2020. A waiting period would begin on April 26, 2020, therefore applied to May 1 - May 2 and payments would begin on Monday May 4.

Example 2: Employee who works Monday-Friday, 8 hours per days, goes out on leave for care of family member for one day May 1, 2020 and requests another day May 10, 2020. A waiting period would be applied to May 1. May 10 would be in a pending status, potentially approvable if a certification is received.

  • Ignore the waiting period on bonding and adoption/foster care claims

Example 3: Employee goes out on leave for bonding starting on May 1, 2020 through May 17, 2020, payments would begin on May 1.

  • Ignore the waiting period if the employee goes back out of work for the same reason within four months of returning to work

Example 4: Employee goes out on leave for employee's own health condition starting on May 1, 2020 through May 17, 2020 (waiting period applied for first 7 consecutive calendar days beginning with the Sunday of the first week the employee starts taking leave). Employee requests another leave for employee's own health condition starting on July 15, 2020 through August 1, 2020: no waiting period shall be applied.

Example 5: Employee goes out on leave for employee's own health condition starting on May 1, 2020 through May 17, 2020 (waiting period applied for first 7 consecutive calendar days beginning with the Sunday of the first week the employee starts taking leave). Employee requests another leave for care of family member starting on July 15, 2020 through August 1, 2020: no waiting period shall be applied.

Example 6: Employee goes out on leave for employee's own health condition starting on May 1, 2020 through May 17, 2020 (waiting period applied for first 7 consecutive calendar days beginning with the Sunday of the first week the employee starts taking leave). Employee requests another leave for employee's own health condition starting on October 15, 2020 through November 1, 2020: no waiting period shall be applied.

Minimum Claim Duration

WA PFML has a "minimum claim duration" concept where, in any given week, the employee must be out for 8 consecutive hours before benefits are payable. Once the employee has been out for 8 consecutive hours in a week, additional time in one-hour increments can be approved for benefits, and that additional time does not need to be consecutive.

The state says:

WAC 192-620-005 What is the minimum claim duration?

(1) The minimum claim duration for paid family or medical leave is eight consecutive hours in a week. If an employee on leave claims eight consecutive hours at any point during a week, the minimum claim duration is satisfied.

Example 1: An employee typically works six-hour shifts each weekday. The employee takes leave Monday, works Tuesday and Wednesday, and takes leave Thursday and Friday. The minimum claim duration requirement would be satisfied with the leave taken Thursday and Friday. That employee could also include the hours missed on Monday in the weekly claim.

(2) If an employee on leave typically works less than eight-hour shifts, the employee will meet the requirement of a minimum claim when the employee has missed eight consecutive hours at any point during a week the employee typically would have been scheduled.

Example 2: An employee typically works four-hour shifts. The employee will need to take two consecutive shifts of leave in a week to have a minimum claim.

Here is how we implemented this requirement. If an absence is added to a claim for WA PFML, and it would otherwise be approved, but the resulting date range is less than 8 hours, and there is not yet an 8+ hour date range in that week, the system should set the new date range to pending instead of approved.

  • A WA PFML Date Range for 8 hours or more is approvable, the same way a Federal FMLA date range (for example) for any length of time would be approvable.

  • A WA PFML Date Range for less than 8 hours, in a week that already has an 8+ hour WA PFML date range, can be set to approved status automatically.

  • A WA PFML Date Range for less than 8 hours, in a week that doesn't already have an 8+ hour WA PFML Date Range, cannot be set to approved status automatically.

  • Exhausted status and other functionality, such as timely reporting will continue to behave as it does today.

Out of scope: At this time, we will not build functionality to wait until the end of a week and look back to see if any pending date ranges can be automatically set to approved.

Payment Calculation

While on leave, the employee is entitled to partial wage replacement. The benefit is generally up to 90 percent of the employee's average weekly wage, with a minimum of $100 per week and a current maximum of $1,000 per week. The maximum weekly benefit will be adjusted annually every September 30 and take effect the following January 1.

In order to calculate the employee's average weekly wage, the total reported wages from the two highest paid quarters during the qualifying period and are added up, and the result is divided by 26.

Qualifying period means the first four of the last five completed calendar quarters or, if eligibility is not established, the last four completed calendar quarters immediately preceding the application for leave.

  • If, in the first 4 of the last 5 completed calendar quarters, the employee worked at least 820 hours, then the Qualifying Period is the first 4 of the last 5 completed calendar quarters.

  • If, in the first 4 of the last 5 completed calendar quarters, the employee did not work at least 820 hours, then the Qualifying Period is the last 4 completed calendar quarters.

The state says:

RCW 50A.15.020

(4) The weekly benefit for family and medical leave shall be determined as follows:

If the employee's average weekly wage is:

(a) Equal to or less than one-half of the state average weekly wage, then the benefit amount is equal to ninety percent of the employee's average weekly wage; or

(b) greater than one-half of the state average weekly wage, then the benefit amount is the sum of:

(i) Ninety percent of one-half of the state average weekly wage; and

(ii) Fifty percent of the difference of the employee's average weekly wage and one-half of the state average weekly wage.

(5)(a) The maximum weekly benefit for family and medical leave that occurs on or after January 1, 2020, shall be one thousand dollars. By September 30, 2020, and by each subsequent September 30th, the commissioner shall adjust the maximum weekly benefit amount to ninety percent of the state average weekly wage. The adjusted maximum weekly benefit amount takes effect on the following January 1st.

(b) The minimum weekly benefit shall not be less than one hundred dollars per week except that if the employee's average weekly wage at the time of family and medical leave is less than one hundred dollars per week, the weekly benefit shall be the employee's full wage.

ClaimVantage Absence has been configured to account for the following data elements in order to accurately calculate payments for WA PFML:

  • The minimum weekly benefit shall not be less than $100 per week except that if the employee's average weekly wage is < $100 per week, the weekly benefit shall be the employee's full wage

  • The maximum weekly benefit shall be $1000

  • As of 1/1/2021 the maximum weekly benefit shall be $1,206

  • The state average weekly wage (SAWW) shall be $1255

  • As of 1/1/2021 the SAWW shall be $1,340

  • The employee's average weekly wage (AWW) - this number is rounded down to the next lowest dollar

  • The employee's weekly benefit - this number is rounded down to the next lowest dollar

The employee's average weekly wage can be determined from the employee's earnings records if needed, but first the system should see whether a user has entered a dollar amount via the Physician Statement. A new field labeled Employee's Average Weekly Wage has been added to the physician statement screen and will be displayed if Washington Paid Family is on the absence claim.

Calculation:

AWW < 1/2 SAWW then 90% of AWW otherwise

90% of 1/2 SAWW + 50% of (AWW - 1/2 SAWW)

Below are examples for each situation:

If the employee's average weekly wage is equal to or less than half of the state average weekly wage then the weekly benefit is 90% of their average weekly wage

Example 1: Employee's average weekly wage is $500, which is less than $627.50 (half of $1255)

then their benefit is 90% of $500 = $450

In all other the cases, the benefit is 90% of half of state average weekly wage + 50% of the difference between the employee's average weekly wage and half of the state average weekly wage

Example 2: Employee's average weekly wage is $1100, which is more than $627.50 (half of $1255)

then their weekly benefit is 90% of $627.50 + 50% of ($1100 - $627.50) = $801