Solutions, Government, State DI + PFL coordination

Eight statutes, one claimant

CA SDI, CA PFL, NY DBL, NY PFL, NJ TDI, NJ FLI, RI TDI, HI TDI, plus MA, CT, WA, CO and OR. Each state has its own waiting period, weekly maximum, eligibility test and stacking rule with the STD or the FMLA. Owl reads the file, walks each statute, and gives you the order, the amounts, the offset.

2-yr contestability lookbackApp date → DOL
Carrier intakeDay 0
DOL, cardiac event
HRIS, employerDay 0
FMLA designated, 12 wks job-protected
CA EDD statuteDay 7
CA SDI waiting period satisfied
Carrier policyDay 8
STD benefits begin, 60% to weekly max
CA UI Code §2629Day 8
CA SDI integration begins, primary
Owl flag, should integrateDay 30
Carrier sends SDI denial template (incorrect)

Day 8

Where STD and CA SDI integrate

$1,540/wk

CA SDI weekly max, 2025

$0 overpayment

If integration metered correctly

03A real claim, walked end to end

One claim: a CA-resident sales engineer with three benefit streams all running at the same time.

Anonymized composite: claimant 47M, CA resident, $185K base, post-MI cardiac rehab, employer-paid STD, eligible CA SDI.

Claim #
GS-2025-118855
State
CA
Member
47M, sales eng
Streams
STD + CA SDI + FMLA
Owl mode
Integrate, day 8
OwlVision
What it read
Carrier STD policy + cert
64 pp
Read: 60% to $3,500/wk
CA UI Code §§2625-2655
88 pp
Read: Integration cited
Medical record (cardiac)
142 pp
Read: 8-12 wk RTW likely
Employer HRIS, earnings + FMLA
18 pp
Read: Base wage validated
EDD DE 2501 + EDD response
12 pp
Read: CA SDI approved
Structured extraction
Claimant 47M, CA resident, $185K base + variable. DOL 2025-02-14 (cardiac event, STEMI). STD policy 60% to $3,500/wk. CA SDI approved at $1,540/wk (2025 max). FMLA designated for 12 weeks job-protection. Owl recommends: STD pays primary, CA SDI integrates against STD weekly per CA UI Code §2629. STD net = $3,500 − $1,540 = $1,960/wk after integration. No stacking, no overpayment.
OwlSignal
What the world said about the claimant

External data only. None of this lives in your CMS. Owl gathered it from public records, professional networks, registries and the open web, then resolved it to this claimant.

INT-01
CA UI §2629: integration not stacking

CA UI Code §2629 establishes that employer-paid wage continuation (STD) and CA SDI integrate, not stack. Combined benefit cannot exceed claimant’s pre-disability wage. Carrier policy section 7.4 references "applicable state DI offset"; this triggers integration on day 8 of CA SDI eligibility.

CA UI Code §2629Carrier STD policy §7.4CA EDD DE 2588 worksheet
WAG-04
Variable comp: base-wage definition

Claimant has $40K of variable comp on top of $185K base. CA EDD computes weekly benefit on highest-earning quarter wages including variable; carrier STD policy uses base-only. Both calculations reach the respective weekly max. No actionable mismatch on benefit amount, but mismatch matters for any future return-to-work partial-disability period.

CA EDD DE 2589 wage rulesCarrier STD §3.2 base wageEmployer HRIS earnings ledger
FML-09
FMLA: job-protected concurrency

FMLA runs concurrently with both STD and CA SDI for the 12-week job-protection window. No financial interaction (FMLA is unpaid federal leave) but the documentation packet must reflect concurrent designation to preserve employer obligations.

29 USC 2612 (FMLA)DOL FMLA regs 29 CFR 825Employer FMLA SOP
OVP-12
Overpayment risk: day-8 trigger

If carrier pays full STD week 1-4 without integrating CA SDI on day 8, projected overpayment is $6,160 (4 weeks × $1,540). Owl recommends EDD-data-share with EDI weekly. Alternatively, hold-back 25% until first SDI confirmation, then reconcile.

CA EDD EDI partner programCarrier overpayment SOP §9CA UI Code §2629
OwlAssist
What it answered
Examiner asked
What’s the right integration math, week-by-week, for this claim?
Owl answered in 0.7s

Week 1 (days 1-7): STD waiting period or first-day pay per policy ($3,500/wk net). CA SDI is in its 7-day waiting period. Day 8 onward (weeks 2-12, projected RTW): STD pays $3,500 weekly cap, CA SDI pays $1,540 directly to claimant, carrier reduces STD to $1,960/wk net (3,500 − 1,540) per CA UI §2629. Combined to claimant: $3,500/wk. No stacking. Set EDI data-share with EDD to confirm SDI weekly; if SDI weekly arrives mid-week, prorate. Recommended hold-back: $385/wk (25% of SDI estimate) for first 2 weeks until first EDD confirmation, then release.

CA UI Code §2629Carrier STD §7.4CA EDD DE 2588Internal earnings ledger
Examiner asked
Is this claimant eligible for any other state benefits?
Owl answered in 0.6s

No, CA SDI is the only state stream for this claim. Claimant is a CA resident working for a CA-headquartered employer; no PFL because this is the claimant’s own disability (not bonding or family care). If RTW partial occurs, CA SDI partial-benefit calculation applies under §2655. If disability extends past 52 weeks, carrier LTD takes over and CA SDI exhausts; SSDI assistance referral should be teed up at week 16 per the LTD/SSDI playbook.

CA UI Code §2655Claimant residence + employerCarrier LTD §6 SSDI offsetOwl SSDI-eligibility check
04OwlSignal external data

What the world says about your State DI / PFL claimants, none of which lives in your CMS.

Internal claim data is half the picture: it tells you what the claimant told you. OwlSignal continuously gathers external data (public records, professional and corporate registries, court dockets, social and open web) and matches it back to the claimant. These are the families that move the needle on State DI / PFL.

STAState DI + PFL Statutes

Eight currently-active state DI/PFL statutes plus the growing roster (CA, NY, NJ, RI, HI, MA, CT, WA, CO, OR): eligibility tests, weekly maximums, waiting periods, integration and stacking rules.

State statute corpus (10 states)State agency rules + bulletinsOwl state-stacking-rule graph
WMXWeekly Max + Wage Base Tables

Annual weekly-max tables for every state, indexed updates, AWW computation rules, and base-wage definitions per state.

CA EDD DE 2589NY DOL PFL tablesNJ DOL TDI tablesState 2025 indexes
EDIState EDI + Data-Share

CA EDD EDI partner program, NY DBL data-share, NJ TDI data-share, and the workflows that let carriers settle weekly integration without manual reconciliation.

CA EDD EDI partner specNY State EDINJ DOL data-share
FEDFMLA + ADA Concurrency

Federal FMLA, ADA reasonable-accommodation, USERRA, PWFA, read once, walked on every state DI claim where federal-state concurrency matters.

29 USC 2612 (FMLA)ADA + PWFADOL WHD opinions
OUTState Agency Outcomes

State agency processing-times, denial-rate by issue, appeal-reversal-rate, and Owl’s graph of which agencies require which forms in which order.

State agency public statsOwl state-outcomes graphState ALJ disposition data
OVPOverpayment + Reconciliation

Carrier overpayment SOPs, hold-back patterns, weekly reconciliation models, and the math that keeps integration accurate without creating member overpayment exposure.

Carrier overpayment SOPsState overpayment statutesOwl reconciliation models
Refreshed daily, matched by identity-resolution, every observation cited to its source.
05What changes

Numbers from carriers running Owl on State DI / PFL coordination in production.

MetricWithout OwlWith Owl
Correct integration on first touch64%97%
Latent overpayment per 1K claims$1.2M$140K
Cycle time, state filing packet6 days32 minutes
Member-confusion CSAT (1-5)3.14.6
EDI data-share enrollment rate38%94%
Cost per state-filing packet$280$42
Source: rolling 12-month average across 4 STD/LTD carriers, n = 96K claims with state DI/PFL eligibility.

Built for the regulatory shape of State DI / PFL.

07Integrations

Lives where your State DI / PFL files live.

STD/LTD platforms

FINEOS, DXC, Majesco, Origami, in-house

State EDI

CA EDD, NY State, NJ DOL, RI DLT

HRIS / leave

Workday, ADP, UKG, AbsenceSoft, Larkr

Document intake

Box, OnBase, ImageRight

Earnings + tax

Equifax Work Number, employer payroll

Identity & SSO

Okta, Azure AD, PingFederate, SAML, SCIM

08Get started

Bring us a quarter of state-DI eligible claims. We’ll show you the integration math on day one.

Two-week pilot. Your STD/LTD stream, your tenant, your state mix. We measure first-touch integration accuracy, latent overpayment, cycle time and EDI enrollment against your own ground truth.