35. Common denials that can be resolved at hearing

Not Financially Eligible

There are many reasons why an eligible applicant may be found “not financially eligible” at the initial decision. This can be fixed on appeal, but it usually requires proof of wages and a hearing to explain the work history and proof of wages. 

The relevant wages for being financially eligible are: all wages from the past 4 completed calendar quarters AND wages from the most recent incomplete calendar quarter in which the leave starts. This is basically the last 15 months. To show quarterly earnings, send DFML the last paystub from March, June, September, and December. Or, show other payment records (like bank statements or deposited checks) that are detailed enough to see monthly earnings. You can also submit proof of annual earnings like W-2's and 1099’s. 

Scenario 1: Not financially eligible due to missing wages

DFML is often missing wages from the most recent completed calendar quarter. This happens whenever the application is filed before the employer reports those wages. You can tell if this is the problem if the wage chart on the last page of the denial notice is missing the most recent calendar quarter.  Appeal and ask DFML to use wages once the employer reports them. You can also upload the worker’s paystub from the most recently completed calendar quarter (paystub from right before March 31, June 30, September 30, December 31). DFML will usually fix this without a hearing. 

A less-common reason that wages are missing is the employer failed to report them. If the employer fails to report to DFML, DFML will actually check with DUA before denying the application.  In practice, this happens when the employer is not paying the required payroll contributions. Submit the worker’s W-2 and paystubs and be ready to explain their work history at the hearing. DFML will usually approve this kind of claim and then charge the employer back-taxes. 

Another reason wages can be missing is the employer is reporting wages and paying payroll taxes to the wrong state. This is common if the worker works in MA, but the employer is based in a neighboring state (CT, NH, RI, VT). The worker must submit proof that their work was performed in MA. As of May 2025, it is unlikely that DFML will approve this appeal, and so a court appeal will be necessary. See more information below. 

Scenario 2: Alternate base period

If a worker is not financially eligible using all the methods above, then appeal and ask DFML to use wages from the alternate base period. The worker must upload the paystub showing their work right before the PFML leave started. DFML will be able to calculate the wages earned in the incomplete calendar quarter by subtracting the YTD earnings of the most recently completed calendar quarter. These wages might make the worker eligible.  To check using the PFML benefit calculator, enter the wages from the last 3 completed calendar quarters and the recent wages from the partial quarter in the 4th box. 

Scenario 3: Worker applies with an ITIN

A worker who files taxes with an ITIN has their payroll taxes reported under an SSN. So, when they apply for PFML with an ITIN, there are no PFML payroll taxes in the DOR database. The worker can appeal and submit proof of wages. It is also helpful to submit a copy of an MA state tax return showing the W-2 wages from the SSN are included under the tax filer’s name, address, and ITIN. This will require a hearing to discuss employment history and to verify that the wages were truly earned by the applicant.