CT Paid Leave Authority to withhold $375,000 from claims company for missing performance goals
The Accountability Project found in a recent investigation that some applicants experienced delays and confusion when applying for leave.
The Connecticut Paid Leave Authority will recoup money from a private vendor that handles its claims process after the company failed to meet performance targets in the program’s first year.
The authority signed a $72 million contract with insurance giant Aflac in 2021 to handle claims administration for the paid leave program, which provides up to 12 weeks of paid time off for new parents, caregivers, people recovering from illness and other qualifying workers.
But the program served fewer people than experts and state officials expected during its first year. Some workers who spoke with Connecticut Public said they found the claims process confusing and described missteps by Aflac’s front-line customer service employees. About one-third of all claims filed last year were denied.
Speaking on Feb. 7 to the Paid Leave Authority’s board of directors, the authority's CEO, Erin Choquette, announced that Aflac failed to meet four of 18 performance standards spelled out in its service agreement with the state, which led to applicants experiencing delays and inaccurate calculations of the money they were owed. The state will receive a credit from Aflac in the amount $375,000 as a result of subpar performance last year, she said.
Aflac did not immediately respond to a request for comment.
Three of the missed standards relate to timeliness of decision making and responses, and one relates to the accuracy of benefit calculations, Choquette said. In one example, Aflac was expected to reach 98% accuracy in benefit calculations, but it achieved a cumulative score of 95% over the course of the year, Choquette said.
“I think one of the continuing struggles, candidly, is they’ve done a really great job responding to phone calls,” she said. “They have put in place new protocols to respond to [online] portal messages. That’s one of the ones that I’m looking at to see how that is going, because that was taking them a little bit more time.”
Responding Friday to questions from Connecticut Public, Choquette said she did not have information readily available regarding the other metrics the company failed to achieve.
The Paid Leave Authority has yet to satisfy requests from Connecticut Public for copies of its contract with Aflac, and for a previous cost analysis generated for the authority describing anticipated utilization of the program.
The program is funded through a 0.5% payroll deduction. Once approved, applicants receive a percentage of their regular pay each week during their leave period. Gov. Ned Lamont signed the initiative into law in 2019, making Connecticut one of the first states in the country to implement its own paid leave program.
The authority began accepting claims from workers in December 2021, but the program saw higher-than-expected claims denials during its early months. Officials say that trend was due in part to a surge of applications in January 2022 amid a wave of COVID-19 infections in the state.
According to the Connecticut Paid Leave 2022 annual report, within the first six months of benefits being paid out, 40% of applicants were denied. Within the first year it was 32%.
State records show that missing or incomplete paperwork accounted for the majority of denials.
Under its three-year contract, Aflac is responsible for conducting initial intake and adjudication of all claims, collecting necessary documentation, calculating benefits due to recipients and making payments from a state fund.
Choquette said the authority is implementing strategies to improve its system, including adding a dedicated team to respond to digital communications. She said the authority will receive offsets to its future expenses in the amount of $375,000 based on Aflac missing performance goals last year.
“We have implemented various strategies to make sure that Aflac is better able to meet their service level requirements,” Choquette told directors this month. “Our goal is for is them to actually meet them, not for us to get these offsets, so we’re looking forward to even better service levels this coming year.”