A "week" is a period of seven consecutive calendar days beginning on Sunday 12:00 a.m. and ending at 11:59 p.m. the following Saturday.

(1) "Fraud" means an action taken by an employee where either of the following is determined to have occurred:

(a) Willful nondisclosure as defined in WAC 192-500-140; or

(b) Misrepresentation as defined in WAC 192-500-150.

(2) A finding of fraud will result in a disqualification of benefits and applicable penalties under Title 50A RCW.

"Nondisclosure" occurs when information that is known or should have been known by the employee at the time it is requested by the department, is not disclosed either inadvertently or through unintentional oversight.

"Willful nondisclosure" occurs when:

(1) An employee omits or fails to disclose information;

(2) The employee either knew or should have known that the information should have been provided;

(3) The information concerned a fact that was material to the employee's rights and responsibilities under Title 50A RCW; and

(4) The employee omitted or did not disclose the information with the intent that the department would take action on other information the employee did provide.

"Misrepresentation" occurs when:

(1) The employee has made a statement or provided information;

(2) The statement was false;

(3) The employee either knew or should have known the statement or information was false when making or submitting it;

(4) The statement or submission concerned a fact that was material to the employee's rights and responsibilities under Title 50A RCW; and

(5) The employee made the statement or submitted the information with the intent that the department would rely on the statement or information when taking action.

(1) An employee is a "continued claim" recipient if the employee:

(a) Is eligible for benefits; and

(b) Has received credit for the waiting period or payment of benefits for one or more weeks in a claim year and in the current continued claim series.

(2) Continued claim status will end following four or more consecutive weeks for which the employee does not file a claim or is not taking paid family or medical leave.

(1) A "self-employed" person is:

(a) A sole proprietor;

(b) A joint venturer or a member of a partnership that carries on a trade or business, contributes money, property, labor or skill and shares in the profits or losses of the business;

(c) A member of a limited liability company;

(d) An independent contractor who works as described in RCW 50A.04.010 (7)(b)(ii); or

(e) Otherwise in business for oneself as indicated by the facts and circumstances of the situation, including a part-time business.

(2) A corporate officer is an employee and not self-employed.

(1) Examples of wages reportable to the department for premium assessment purposes include, but are not limited to:

(a) Salary or hourly wages;

(b) Cash value of goods or services given in the place of money;

(c) Commissions or piecework;

(d) Bonuses;

(e) Cash value of gifts or prizes;

(f) Cash value of meals and lodging when given as compensation;

(g) Holiday pay;

(h) Paid time off, including vacation leave and sick leave, as well as associated cash outs, unless these wages are considered supplemental benefit payments provided by the employer;

(i) Bereavement leave;

(j) Separation pay including, but not limited to, severance pay, termination pay, and wages in lieu of notice;

(k) Value of stocks at the time of transfer to the employee if given as part of a compensation package;

(l) Compensation for use of specialty equipment, performance of special duties, or working particular shifts; and

(m) Stipends/per diems unless provided to cover a past or future cost incurred by the employee as a result of the performance of the employee's expected job functions.

(2) Examples of what the department will not consider wages include, but are not limited to:

(a) A payment from an employer benefit that is not part of the employee's standard compensation.

Example: While on paid medical leave, an employee receives sixty-one percent of the employee's typical weekly wage from the state. Through an internal short-term disability benefit, the employer pays the employee the remaining thirty-nine percent of the employee's typical weekly wage as a supplemental benefit payment, bringing the employee's total benefit to one hundred percent of the employee's typical weekly wage. Since this supplemental benefit payment is not part of the employee's standard compensation, it is not considered a wage, and should not be reported on either the employee's weekly claim or the employer's quarterly report.

(b) Any payment made to an employee to cover a past or future cost incurred by the employee related to the performance of the employee's expected job functions. Such costs include, but are not limited to, costs of meals and travel.

Example: An employer pays a per diem to an employee on a business trip to cover the cost of local travel and meals. This amount is not considered a wage, even if the per diem exceeds the actual cost incurred.

(c) The amount of any payment made (including any amount paid by an employer for insurance or annuities, or into a fund to provide for any such payment) to, or on behalf of, an individual or the individual's dependents under a plan or system established by an employer which makes provision generally for individuals performing service for the employer (or for such individuals generally and their dependents) or for a class or classes of such individuals (or for a class or classes of such individuals and their dependents) on account of:

(i) Retirement;

(ii) Sickness or accident disability;

(iii) Medical or hospitalization expenses in connection with sickness or accident disability; or

(iv) Death.

(1) If an employee has not been issued a payment on the claim, an employee may cancel a claim within thirty days of the date of the submitted application for benefits.

(2) The commissioner, at the commissioner's discretion, may permit cancellation of a claim without an issued payment after thirty days from the date of the submitted application for benefits in extreme and unusual circumstances.

(3) An employee may not cancel a claim that has been issued a payment. The department will only cancel a claim that has been issued a payment in any amount if the department made the payment due to departmental error.

(4) If the department has denied benefits before the request to cancel the claim was received, the denial will remain in effect.

(5) The denial of a request to cancel a claim is not subject to appeal.

Employers may not require employees to take paid vacation leave, paid sick leave, or other forms of paid time off provided by the employer before, in place of, or concurrently with paid family or medical leave benefits.

(1) When an employee has an existing claim year and more than four consecutive weeks have passed since the employee filed a weekly claim for benefits, or the employee experiences a new qualifying event, the employee must reopen the claim in order to receive benefit payments.

(2) If the duration of leave for a qualifying event has not expired:

(a) The employee can reopen the claim and file weekly claims as necessary.

(b) If the employee requests to claim the weeks prior to the date the claim is reopened, the employee must have good cause as defined in WAC 192-610-040 to claim prior weeks.

(3) If the duration of leave for the qualifying event has expired or the reason for leave is not the same as the previous qualifying event, the employee must reopen the claim by updating the application as required under WAC 192-610-010 before benefits will be paid.

An employee may reopen a claim by:

(1) By using the department's online services;

(2) Contacting the paid family and medical leave customer care center by telephone; or

(3) Alternate methods authorized by the commissioner.

WEEKLY BENEFITS

(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.

(1) An employee must file a weekly claim to receive benefits.

(2) An employee may file a weekly claim by:

(a) Using the department's online services;

(b) Using the department's telephone services; or

(c) The commissioner may authorize alternative methods of filing weekly claims.

(3) A weekly claim can only be made after the end of the week being claimed.

(4) A weekly claim must be completed in its entirety. Incomplete weekly claims will not be processed.

(5) No more than four weeks of claims can be made at one time, except in limited circumstances, such as backdating for good cause as defined in WAC 192-610-040.

(1) The department must determine if an employee qualifies for benefits when the employee files a weekly claim for the payment of benefits. For the week that the employee is claiming, the department will ask if the employee:

(a) Worked during the week, and for the hours associated with that work;

(b) Received any paid leave such as vacation leave, sick leave, or other paid time off that was not considered a supplemental benefit payment provided by the employer, and the hours associated with that leave;

(c) Received any benefit that may disqualify the employee for paid family or medical leave, such as unemployment insurance; and

(d) Experienced a change in the qualifying event that affects the eligibility for, or duration of, paid family or medical leave benefits.

(2) The employee may be asked to provide additional information.

(1) If an employee is a continued claim recipient, and eligibility is questioned by the department, the employee will be conditionally paid benefits for weeks the employee claims without delay.

(2) The employee may request the department to hold conditional payments until the question of eligibility is resolved when the employee has been notified the department questions their eligibility.

(3) An overpayment for a conditionally paid week cannot be waived and must be repaid.

CLAIM DETERMINATIONS

(1) The department will send interested parties a notice when the department has a question of whether an employee is qualified for benefits prior to making a determination on the claim. The notice will include:

(a) The department's questions regarding the employee's qualification for benefits; and

(b) The date by which the interested parties must respond. This date will be no earlier than ten calendar days from the date the notice is sent. Reasonable mailing time will be added when the notice is sent via postal service. 

(2) The employee has a right to respond to the department on qualification issues.

(1) If an interested party fails to respond by the due date on the notice provided under WAC 192-630-005, the department will make a determination based on available information.

(2) Subject to RCW 50A.04.510, if benefits are denied because the employee did not respond to a request for information, the denial will remain in effect until the employee provides sufficient information to establish that the employee is qualified for paid family or medical leave.

(1) When the department has issued a notice under WAC 192-630-005 the department will not make a determination on whether an employee qualifies for paid family or medical leave until all interested parties have had an opportunity to provide information about the question of eligibility by the due date indicated on the notice.

(2) If new facts are discovered before the determination is made, the department will provide interested parties with an opportunity to respond to the new information.

(3) After the department makes a determination, all interested parties will be provided with a copy of that determination.

(4) If the department receives new and relevant information after a determination is made:

(a) The information will be considered by the department;

(b) Interested parties will be given an opportunity to respond, if necessary; and

(c) The department may make a new determination based on the newly provided information.

The department will determine if fraud has been committed under WAC 192-500-120 based on a showing of clear, cogent, and convincing evidence.

(1) The department will assess disqualification periods and penalties for each fraud determination individually under RCW 50A.04.045(3).

(2) All disqualifications and penalties in RCW 50A.04.045(3) are in addition to the required repayment of any benefits paid as a result of fraud.

(3) The department will assess the fraud penalties established under RCW 50A.04.045(3) based on the percentage of benefits paid for those weeks in which the fraud occurred or that were paid as a result of fraud. The penalty will not apply to other weeks that may be included in the same eligibility decision.

(4) The penalty amount, if not a multiple of one dollar, is rounded up to the next higher dollar.

(1) Determinations of fraud are appealable. If an employee has been assessed with multiple determinations of fraud and any determination changes due to a redetermination or an appeal, the department will send a new fraud determination showing the corrected disqualification period and penalty under Title 50A RCW.

Example: The department issues a determination that an employee has committed a third occurrence of fraud. Through appeal, the second occurrence is overturned. The department will send a redetermination of the third occurrence indicating that it is now the second occurrence of fraud and the appropriate penalties will apply.

(2) Although the revised determination in subsection (1) of this section does not restart the appeal period included in the original decision, employees may appeal a change in the penalty amount or length of disqualification.