Appeals Process Updated for Challenges to FAMLI Decisions

By Jacqueline Talbot posted 01-13-2025 07:58 AM

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Colorado’s Family and Medical Leave Insurance Program (FAMLI) Division has adopted new regulations as of January 1, 2025, that update the appeals process for everyone who wants to dispute a decision.

The update gives employers, claimants, legal representatives, and other interested parties a new platform to file, track, and manage appeals. Keep in mind that all appeals filed before December 5, 2024, will not be carried over into the new platform. So, for active cases currently in the FAMLI appeals process, continue to communicate with the hearings officer and file documents as done previously.

Now, employers can create an appeals account within My FAMLI+ to file, manage, and track all FAMLI-related appeals. This is separate from the My FAMLI+ Employer portal employers use to pay premiums and submit wage reports.

The first step when challenging a FAMLI decision is to request a reconsideration (previously known as filing a grievance). Employers can either mail in their request for reconsideration after receiving the determination notice from FAMLI with those instructions or they can fill out the request online.

If you still disagree with FAMLI’s decision after you complete the reconsideration process, you may choose to file an appeal. This can be done by going here on the FAMLI website.

Here are the details about the upgraded appeals process:

In most cases, the first step when challenging a FAMLI decision is to request a reconsideration or file a grievance. Employers are used to seeing this as “file a grievance,” It has been renamed “request a reconsideration” to match the newly adopted rules. “File a grievance” and “request a reconsideration” mean the same thing.

Employers can fill out an online form to request a reconsideration (file a grievance), or they can follow the instructions included on the mailed correspondence they get when the FAMLI Division notifies them about a decision made on one of their employees’ claims.

If an employer still disagrees with the outcome of that reconsideration they can file an appeal.

Employers will need to create an account in My FAMLI+ to file, manage, or track an appeal.

The upgrade also means that legal representatives and other interested parties can create an appeals account within My FAMLI+ to file, manage, or track FAMLI appeals even if they don’t have an existing claimant or employer account.

Remember that employers should first file a reconsideration of FAMLI benefits decisions and go through that process before they file an appeal. There are a few exceptions:

Employees who work for employers with an approved private plan to manage their FAMLI obligations can also appeal a benefits decision by creating an appeals account in My FAMLI+ and selecting “File and Manage an Appeal” when they create that account. These employees do not have to request a reconsideration first, since their original claim was managed by the private plan and not FAMLI.

Employers disputing decisions involving their employer account unrelated to FAMLI benefit claims do not have to request a reconsideration first. Please see the FAMLI appeals page for more details.

If you are a Consulting or Enterprise member and are considering filing a FAMLI decision appeal, please reach out to Employers Council for guidance. There are also helpful resources on the FAMLI Division website.