Claimants, employers, and private plan administrators can dispute official FAMLI determinations made by the Colorado Division of Family and Medical Leave Insurance (FAMLI). Claimants can also challenge decisions made by an approved private plan administrator. The paths to dispute FAMLI determinations are slightly different for employers and claimants.
Let’s start with employers.
Employers
To dispute a determination regarding an employee’s FAMLI claim, employers may file a grievance with the Division before filing an appeal. An employer should file a grievance only if it has a good-faith belief, supported by evidence, that the Division has granted FAMLI benefits to a claimant in an amount, duration or frequency beyond what the claimant is entitled to.
Employers are sent instructions on how to file a grievance every time FAMLI informs them about a decision on one of their employees’ claims.
Here are some examples of when employers can file a grievance about a determination made on one of their emloyee’s claims:
- To argue that a claimant lives or moved out of state
- To argue that a claimant worked or is working during FAMLI leave
- To argue that a claimant works out of state
- To argue that a claimant separated from their job
- To argue that a claimant is on leave for a reason other than the reason cited on the the qualified health condition reported to FAMLI
- To argue that a claimant has filed for unemployment insurance
- To argue that a claimant has filed a workers’ compensation claim
Employers can either mail back a grievance form after receiving those instructions, or they fill out the grievance request form online:
If an employer still disagrees with the Division’s decision following the grievance, then they can file a formal appeal. Employers may also file a formal appeal to dispute a FAMLI premiums decision regarding their business. Some examples of when an employer can request an appeal before filing a grievance include:
- To dispute a premium contribution amount
- To dispute the employee headcount assigned to their business (either nine or fewer, or ten or more)
- To dispute fees, fines or penalties imposed by the Division
After requesting an appeal, employers will receive written confirmation from the FAMLI Appeals Unit, once the appeal has been received and accepted.
For more information about the appeals process, please refer to the following Regulations Concerning Appeals.
If you experience difficulty in accessing the appeal form, please send an email to CDLE_FAMLI_appeals@state.co.us.
Claimants
Claimants who want to dispute a decision by the FAMLI Division have a different process.
They should access the “appeals” options provided through their My FAMLI+ account. Log into My FAMLI+, navigate to the “Claim Details” page and follow the instructions for an “appeal.” Refer to the Filing An Appeal section of the My FAMLI+ User Guide for support.
Some things employees can appeal include:
- The length of paid leave approved
- A denial of their request for paid leave
- The amount of their benefit payment
Employees who want to appeal a determination from a private plan administrator may submit the FAMLI Appeal Request form.
NOTE: My FAMLI+ will route an employee’s appeal through a redetermination review. After that review, My FAMLI+ will allow an employee to select “appeal” a second time, which will serve as a request for a hearing before the FAMLI Appeals Unit.
Submit the FAMLI Appeal Request Form
NOTE: Please keep in mind, filing an appeal is a legal action, and the FAMLI Division cannot provide legal advice. This page provides general guidance for the appeals processes authorized by the FAMLI statute and regulations found at the Colorado Revised Statute § 8-13.3-501 through 524 and 7 Colorado Code of Regulations 1107-1 through 9, respectively. For legal advice, you need to contact an attorney.
Appeals FAQs
- What does the FAMLI Appeals Unit do?
The Appeals Unit resolves appeals of FAMLI or Private Plan determinations. To accomplish this, the Appeals Unit sometimes holds status conferences, pre-hearing conferences, and/or evidentiary hearings to address disputed issues raised on appeal. Ultimately, it issues final orders to close appeals.
- What do I need to include with my appeal?
- The reason for your appeal (clear, detailed statement)
- A copy of the determination you are appealing (issued by FAMLI or the employer’s private plan)
- Supporting documentation related to your reason for appeal can be submitted with the appeal request
- What happens after I file my appeal?
The Appeals Unit will review the appeal and notify the relevant parties by email if the appeal has been accepted. If found procedurally valid, the appeal will be assigned as appropriate to a hearing officer to resolve in the most efficient and fair manner, which may include holding a status conference and/or an evidentiary hearing with the parties.
- What is a status conference?
A status conference is an informal discussion between the parties to an appeal in the presence of the hearing officer to clarify the issues and see if the appeal can be resolved without the need for an evidentiary hearing.
- What is a prehearing conference?
A hearing officer may schedule a prehearing conference to ensure the parties are prepared for an evidentiary hearing and to avoid unfair surprises, more specifically to
- Ensure the parties understand what issues will be addressed
- Address any evidentiary or witness issues and subpoenas
- Set the date for the hearing
- Discuss deadlines to submit documents and witness lists
- What is an evidentiary hearing?
This is a formal legal proceeding before a hearing officer in which the parties present their sworn testimony and documents supporting their arguments on appeal. The hearing officer may issue a prehearing order to the parties prior to the hearing date. See question below about prehearing orders.
- What is a prehearing order?
This is an order sent out by the hearing officer that
- Identifies what issues will be addressed in the evidentiary hearing
- Lists the deadlines for parties to exchange documents and a list of witnesses
- Addresses any special circumstances related to the evidentiary hearing
- What happens during an evidentiary hearing?
Generally, the parties will present their evidence and legal arguments to support their views of the facts and law.
More specifically, to ensure the hearing is orderly, the hearing officer will:- Identify the case and participants
- Explain the issue(s) on appeal and the hearing procedure
- Swear in of parties and their witnesses
- Admit into the record the relevant exhibits submitted by the parties prior to the hearing
- Allow the parties to present their case to the hearing officer and cross-examine the other parties’ witnesses
- What happens after the evidentiary hearing?
The hearing officer will issue a Hearing Officer Decision and Order that will explain the outcome of the hearing. This document will also contain information on the parties’ appeal rights.
- How do I appeal a hearing officer’s decision or final order?
A party can appeal a decision or final order by seeking judicial review in a Colorado district court. For more information about this process, parties should contact an attorney or contact the Colorado Judicial Branch at (303) 606-2300 or through the Judicial Branch website.
- Who can appear at a conference or hearing?
Any interested party to the appeal should appear. In addition, the following individuals may appear:
- Representative (attorney or non-attorney): A person designated by a party to represent them during the appeal process
- Witness: A person called by a party and who has relevant information about the issue being appealed
- Observer: A person the hearing officer permits to observe the conference or hearing after considering any objections raised by any party.
- What if I need to request a postponement of a conference or hearing?
You can send your request to the hearing officer at cdle_famli_hearing@state.co.us. You must include all other parties to the appeal in your email. Make sure to include the case number in the subject line of the email.
- What if I need an interpreter or accommodation for a conference or hearing?
You can send an email to the Appeals Unit indicating which type of interpreter or accommodation you require to participate in a conference or hearing at cdle_famli_appeals@state.co.us. Make sure to include the case number in the subject line of the email.
- Can I withdraw my appeal after it has been filed?
You can send an email indicating that you wish to withdraw your appeal to the Appeals Unit at cdle_famli_appeals@state.co.us. Please include the case number in the subject line of your email.
- What happens if I miss my conference or hearing?
Hearing officers expect the parties to appear at scheduled conferences and hearings. The effect of a non-appearance of a party depends on the circumstances of each appeal.
Appellant (the person who filed the appeal):
The conference or hearing may be canceled and the hearing officer may issue an Order to Show Cause asking you to explain why you failed to appear for the conference or hearing. You can submit your good cause statement to cdle_famli_hearing@state.co.us. Make sure to include your case number in the subject line of the email. In some circumstances, the appeal may be dismissed.
Non-appellant (other parties to the appeal):
In some instances, the conference or hearing may proceed without you and the result may be a favorable ruling for the appellant. In other instances, as described above, the hearing officer may issue an Order to Show Cause asking you to explain why you failed to appear for the conference or hearing.
- How can I get more information about the FAMLI appeals process?
You can email general questions to the Appeals Unit, but the Appeals Unit cannot provide legal advice to parties. The email address is cdle_famli_appeals@state.co.us.