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My FAMLI+ User Guide: Next Steps

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My FAMLI+ User Guide: Next Steps
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File a Claim as a Designated Representative

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Instructions for filing a claim as a Designated Representative:

You can file on behalf of a family member if they're medically incapacitated, and/or you can file as a Designated Representative if you can prove with documentation that you are in fact a Designated Representative for the individual.

  1. You will be asked if you are a Designated Representative.
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  1. You will be asked if you are filing the claim on behalf of someone you legally represent or someone who is medically incapacitated. Select Yes.
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  1. As a Designated Representative, select the situation that applies to you. You may need to upload additional documents.
  2. Select the checkbox to confirm.
  3. You must also enter the reason why you are filing a claim on their behalf.
  4. Enter the details of the person you are representing.
  5. Select the Next button.
  6. If you selected the option, “I’m a family member filing on behalf of a medically incapacitated individual”, you must upload the claimant's state or government-issued photo ID.
  7. Once the documents are uploaded, select Next. The rest of the process is similar to that of the claimant.
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Edit a Claim

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Instructions for editing your claim details:

  1. Navigate to your dashboard and select the Claims tab.
  2. From the list, select the My Claims option. The Claim Details page will display.
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  1. Select the Edit Claim button.
  2. On the Edit Claim page, you can modify your claim end date. Fill in the new end date in the provided field. You must also state the reason for changing the end date.
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  1. Select the Save button to save your changes.
  2. A message will confirm that the claim was successfully updated.

  1. You can cancel your pending claim if you have filed the claim in error. To begin, select the checkbox under the Cancel Claim section. If you want to cancel an active claim that has already been approved and is paying out benefits, you must call the CDLE FAMLI staff at 1-866-CO-FAMLI (1-866-263-2654) for assistance.
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  1. You must state the reason for canceling the claim.
  2. Select the Save button.
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  1. A dialog box will appear asking you to confirm if you want to proceed with canceling the claim. Select the Cancel Claim button.

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Viewing Your Eligibility Information

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Once you’ve started the application process, you can log in to My FAMLI+ to check your eligibility for benefits and review the status of your claim(s). Instructions for viewing your eligibility information:

  1. Navigate to your dashboard and select the Claims tab.
  2. From the list, select the My Claims option. The Claim Details page will be displayed.
  3. Select the Eligibility Information tab.
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  1. Select the claim you want to review.
  2. You will be able to see your claim details along with the eligibility history.
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Filing An Appeal

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The My FAMLI+ portal allows claimants to file an appeal if they disagree with the determination of their claim(s). Claimants can provide additional information and upload documents.

Instructions to submit an appeal:

  1. Navigate to your dashboard and select the Claims tab.
  2. From the list, select the My Claim option. The Claim Details page will display.
  3. Select the Eligibility Details section.
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  1. You will see the status of your claim. Select the Appeal button.

  1. On the Submit an Appeal page, you must state the reason for your appeal.
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  1. Next, upload documents that support your appeal. The documents you have uploaded are listed at the bottom of the page.
  2. Once you have uploaded the documents, select the Submit button.

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 You must submit an appeal within 49 days of the initial determination of your claim. In case of a delay, you must provide a valid reason for the delay.

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View Payment History

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Instructions for viewing your payment history:

  1. Navigate to your dashboard and select the Payments tab. The Payments page will display.
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  1. Here, you can view all the payments that were made to you. You’ll also see other details such as the claim nickname, the start and end date of the claim, payment date, and the amount paid to you.
  2. As a Designated Representative, you can view the claims you have filed on behalf of someone else in the Managed Claims tab. You can review your personal claims in the My Claims tab.
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  1. You can also filter the payments using the provided fields.

Instructions for viewing your overpayments history:

  1. Navigate to your Dashboard, and under the Payments tab, select the Overpayments option. The Overpayment History page will display.
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  1. Here, you can view all the overpayments made to you.
  2. You also see a summarized view of the amount you were overpaid, the amount repaid, and the balance amount you owe.
  3. If you are not able to make the repayments, you can submit a hardship request. Select the Submit Hardship Request button.
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  1. Provide the details of your hardship.
  2. You may also upload any supporting documents.
  3. Select the Submit button. If your hardship request is accepted, the FAMLI Division may waive all or part of or your overpayment balance.

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