Guardian+MAPFL+CLAIM+PACKET+10.2.20v5_fillable

Sep 19, 2026

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Instructions and responsibilities for filing a Guardian Massachusetts Paid Family Leave (PFL) claim using form MA PFL-1, including guidance for intermittent leave timing and cautions about filing within required deadlines. Covers employee/claimant duties such as completing Part A and the required certificate, coordinating submissions with employer signatures, and including a direct deposit form when applicable. Includes employer responsibilities for completing Part B, accurate earnings recording, and ensuring information is complete and legible, along with Guardian contact and mailing details plus the MA PFL-1 form fields for claimant data and leave request reasons.

LanguageEnglish

CategoryForms

FormatPDF

Pages15

Reading Time5 min

AccessFree to download

Employee / Claimant Responsibilities

Employer Responsibilities

Guardian Contact / Claim Filing Information

Massachusetts – Paid Family Leave Claim Form (MA PFL-1) - Part A

Instructions for filing your Guardian– Massachusetts Paid Family Leave (PFL) Claim (form MA PFL-1) . If you are filing a claim for Massachusetts Paid Medical Leave, use form (MA PML-1) . This packet contains the forms that are needed to process your claim for Massachusetts Paid Family Leave Benefits. Please keep this page for future reference and for the Guardian contact information. Note: If you are filing a claim for intermittent leave (periods of less than a full workday), benefits are only considered after you have satisfied the required 7 day wait period, and, the earlier of the date you have accumulated an additional full workday of leave, or, a period of 30 calendar days have elapsed since your benefits commenced. As such, we encourage you to not file your claim until you have used a full day of leave time following satisfaction of the 7 day wait period, or, 30 days have elapsed since your benefits have commenced. Employee / Claimant Responsibilities: 1) . It is your responsibility to file your claim within 30 days following the start of your leave. Late filing could result ina claim denial or delay. See above Note. 2) . Your employer should complete and sign their portion (Part B) of the claim form and return it to you foryour completion and filing of the remaining sections. 3) . You should fully complete your portions ofthe claim form (Part A), as well as the certificate for the type of leave you are requesting (Bonding, Family, Military) 4) . We recommend that you submit ALL sections of the claim (employee, employer and certificate) at the same time. Separate submissions could delay the handling of your claim. 5) . If you would like to enroll in direct deposit, please complete and include the attached GG016672 PFML form. Note: Direct deposit is not available for intermittent leaves, or for situations where your employer is continuing to pay you wages and they are requesting reimbursement. 6) . It is very important that ALL sections are completed fully, accurately, and legibly. 7) . Your signature acknowledges that, to the best of your knowledge, the forms have been completed accurately. Employer Responsibilities: 1) Your employer should fully complete their portion (Part B) of the claim form and return it to you for further completion and submission. This ensures that your information remains private. 2) It is very important that ALL sections are completed fully, accurately, and legibly. Missing, incomplete, or illegible information could delay payment of your claim 3) To ensure the accurate calculation of your MA PFL benefit amount, your employer should be sure to follow the instructions and example in Part B, question \#9, for recording your earnings under the PFL program. I am unable to provide a signature dueto the COVID-19 pandemic. I understand that my typewritten name has the same force and effect as my signature. Guardian Contact / Claim Filing Information Guardian Insurance Paid Leave Claims P.O. Box 14806 Lexington KY 40512 Customer Service \# 1-800-268-2525 Fax \# 610-807-2684 [Email: paid_leave_claims@glic.com](Email: paid_leave_claims@glic.com) | MASSACHUSETTS – PAID FAMILY LEAVE CLAIM FORM
Telephone \# 1-800-268-2525 Fax \# 610-807-2684 Email: paid_leave_claims@gl[ic.com](ic.com) | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | | PART A-Please Print | TO BE COMPLETED BY THE EMPLOYEE / CLAIMANT | | | Guardian Plan \# | | | | | 1. Claimant’s Name: Last First Middle | | | 2. Birth Date | | | | 3.Social Security Number | | | | | | 4. Home Address – required (Street, Apt \#, City, State, Zip Code) | | | | | | | 5. County | | 6. Mailing Address – if different (Street, Apt \#, City State, Zip Code) | | 7. Male
_________
Female
| | | | 8. Occupation | | | 9.Phone No. ( ) E-Mail Address | | | | | | | | | 10. Reason for PFL request: Bond with Child Care for Family Member Military Qualifying

FAQs

When can benefits be considered for an intermittent PFL claim?

For intermittent leave periods of less than a full workday, benefits are considered only after satisfying the required 7 day wait period and either accumulating an additional full workday of leave or 30 calendar days have elapsed since benefits commenced.

What are employee/claimant responsibilities when filing MA PFL-1?

File within 30 days after the start of leave to avoid denial or delay, ensure Part A and the required certificate are fully and accurately completed and legible, and have the employer complete and sign Part B before submitting. Submitting all sections together is recommended to prevent delays.

What must the employer complete and why does it matter?

The employer must fully complete their portion (Part B) and return it for the claimant’s completion and submission. Accurate, complete, and legible information prevents delays in payment, and the employer must follow Part B instructions (including question #9) to support correct calculation of the MA PFL benefit amount.

Sep 19, 2026

Upload by Riley