Staff-facing journey after a claimant submits an application: open for review, request information if needed, then approve or deny.
Statuses
Hover a status for its description
Where a case sits while staff review is in progress. Staff cases begin at Submitted when the claimant submits their application. Approved, denied, and withdrawn are terminal — no further actions are available.
| Status | Description | Flags |
|---|---|---|
| Submitted | Claim received from the claimant portal and awaiting staff review. | Initial |
| Approved | Terminal — determination recorded as approved. | Terminal |
| Denied | Terminal — determination recorded as denied. | Terminal |
| In review | Assigned to staff; eligibility checks and determination work in progress. | |
| Awaiting RFI response | Staff sent an RFI; the case is paused until the claimant responds. | |
| Withdrawn | Terminal — claimant withdrew or cancelled the leave request. | Terminal |
Questions tracked while a case is open. These resolve from automated checks, portal submissions, and staff review. A case can be In review while criteria such as employer review or medical certification are still pending.
Employer review
Can complete at multiple points in the lifecycle and does not change case status. Informs determination but is not a workflow state.
Automated eligibility
Expected to be resolved before staff open a case for review. Derived from the eligibility check that runs when a claim is submitted.
Certification documentation
Required for medical leave; not applicable for bonding leave.
| Criterion | Business basis | Expected signals | Resolves to |
|---|---|---|---|
| Identity verification | Claimant identity verified (state ID / DMV match). | ID match score Name match Name mismatch Manual identity decision | VerifiedFlaggedFailed |
| Earnings threshold | Automated financial eligibility determination. | Is financially eligible | VerifiedFailed |
| Employer response | Employer review submitted; employer information matches the claim. | Employer review | VerifiedFlaggedNot applicable |
| Leave balance | Claimant has sufficient leave balance. | Has sufficient leave balance | VerifiedFailed |
| Certification documentation | Supporting documentation for medical leave. | Certification on file Provider license state Provider signature Functional limitations documented | VerifiedFlaggedFailedNot applicable |
Work items assigned during review — to staff, claimants, or employers — with due dates that reflect program SLAs.
| Task | Description | Trigger | SLA | Default assignee |
|---|---|---|---|---|
| Staff review | Review leave application | Case enters In review | Due in 20 days | caseworker |
| Respond to rfi | Respond to request for information | Staff sends a request for information | Due in 1 week (claimant) | — |
| Employer review | Submit employer review | Employer review requested | Due in 1 week (employer) | — |
| Review change request | Review change request | — | — | caseworker |
| Program integrity review | Investigate potential program integrity concern | — | — | — |
| Resolve identity flag | Verify claimant identity | — | — | caseworker |
Configuration
Case type
Pfml va
Config version
v1
Workflow ID
pfml-va-workflow
Initial status
SubmittedAt a glance
Statuses
6
Criteria
5
Transitions
8
Tasks
6
Workflow model
The workflow model describes how claimant's leave applications are modeled for the staff workbench: where a case sits in review, what staff can do at each point, what must be resolved before a determination, and what work is assigned along the way.
Statuses — Where a case sits in the staff review lifecycle (submitted through determination).
Transitions — Staff actions that move a case between statuses, gated by business rules.
Criteria — Decision questions resolved over time from signals and evidence — independent of status.
Tasks — Assignable work for staff, claimants, or employers tied to review actions.
My work
My cases
Needs determination
Overdue RFIs
All cases
Open cases
Closed cases
Saved views
Configuration
Workflow