7 Colo. Code Regs. § 1107-6.3

Current through Register Vol. 47, No. 24, December 25, 2024

Section 7 CCR 1107-6.3 - Benefits Overpayments

1. A claimant who receives family and medical leave insurance benefits they are not entitled to receive shall be liable for repayment of the amount overpaid, unless otherwise relieved pursuant to section 6.3.7. Circumstances giving rise to a benefits overpayment include, but are not limited to a(n):

A. Division miscalculation that occurs without any fault from the claimant or is caused by a claimant's omission, willful misrepresentation, or fraud;

B. Determination by the Division that the claimant does not qualify for family and medical leave insurance benefits because they are not localized in Colorado pursuant to the in-state status provisions of 7 CCR 1107-1, are not a covered individual, do not have a qualifying condition, or are disqualified from receiving family and medical leave insurance benefits because of a willful false statement or misrepresentation pursuant to C.R.S. § 8-13.3-513;

C. Claimant's failure to notify the Division of an event that causes benefit payments to change pursuant to 7 CCR 1107-3, Section 3.10.1;

D. Claimant who, during time designated as FAMLI leave, performs work for the employer from which they are taking FAMLI leave;

E. Claimant who is receiving family and medical leave insurance benefits, continuous or intermittent, during a period of unemployment, except as described in 7 CCR 1107-3 Section 3.4.1.A;

F. Claimant receiving family and medical leave insurance benefits for an absence from work that is caused by circumstances that would entitle the claimant to temporary indemnity benefits under the Colorado Workers' Compensation Act in violation of 7 CCR 1107-4, Section 4.3;

G. Claimant receiving family and medical leave insurance benefits during any week the individual receives unemployment benefits for the same job pursuant to the Colorado Employment Security Act in violation of 7 CCR 1107-4, Section 4.4;

H. Claimant receiving family and medical leave insurance benefits when their family and medical insurance leave benefits have been exhausted;

I. Employer who incorrectly reports wages for the claimant, causing the claimant to receive family and medical leave insurance benefits in an amount greater than their actual wages would provide;

J. Self-employed individual who reports inflated wages on their own behalf, causing the claimant to receive family and medical leave insurance benefits in an amount greater than their actual wages would provide; or

K. Health care provider who fails to meet the definition of "health care provider" as defined by C.R.S. § 8-13.3-503(13), has provided a diagnosis, treatment, or leave certification outside of their licensed or certified scope of practice, or has a license or certification that has been suspended or revoked at the time the provider completes documentation regarding the individual's need for family and medical leave.

2. Benefit overpayments may be identified through any lawful means, including but not limited to Division audits, Division investigations, or external tips.

3. The Division will notify claimants of any determination of benefit overpayment by sending the claimant a determination letter to the claimant's correct address. If the claimant has provided an email address, the Division shall send the determination via email, and such delivery via email will satisfy the requirement to send the determination letter to the claimant's correct address.

4. The claimant may appeal a determination of benefit overpayment as detailed in 7 CCR 1107-9.

5. Any outstanding benefit overpayment owed to the Fund by the claimant is subject to recovery pursuant to 7 CCR 1107-8, Section 8.8.

6. Any outstanding balance past due shall accrue interest pursuant to 7 CCR 1107-8, Section 8.9

7. At its discretion, the Division may waive, in whole or in part, any amount of benefit overpayment owed to the Fund where such recovery would be against equity and good conscience, unless the overpayment resulted from the individual's willful misrepresentation or willful failure to disclose a material fact to the Division. A request to waive an overpayment is not an appeal, and waiver requests must be submitted through the benefits system. The Division's determination of equity and good conscience shall only be overturned upon a finding that the Division abused its discretion.

7 CCR 1107-6.3

46 CR 12, June 25, 2023, effective 7/15/2023

46 CR 23, December 10, 2023, effective 1/1/2024

47 CR 23, December 10, 2024, effective 1/1/2025