An employee covered by a private paid family and medical leave plan insured by The Standard who takes leave for their own condition receives an Own Serious Health Condition packet, and Form PFML-7 is its provider certification. The provider documents medical facts and the leave needed, including flare-ups. The Standard decides a complete claim within 5 days of receiving it.
The employee enters their name and date of birth; the employee's health care provider completes Part A (medical facts) and Part B (amount of leave needed) and signs. The employer completes Part B of the PFML-1 request.
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Paid Family And Medical Leave Certification for Own Serious Health Condition (Form PFML-7)
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An optional authorization the employee signs so The Standard can contact the provider to clarify or authenticate a completed certification. The employee gives it to the provider, who keeps it. Signing is not required, but it can shorten the time needed to clarify the form later.
Not for patients working in Connecticut, Delaware, Massachusetts, Minnesota or Washington; the form asks providers to omit the diagnosis and primary ICD code for those states. Elsewhere, the diagnosis and ICD code fields are completed with the other medical facts.
The packet's instructions say The Standard accepts or denies the claim within 5 days once a complete claim is received. A complete claim means the PFML-1 with the employer's part and the provider's PFML-7, so an unanswered question can delay the decision.