FAQs – Physicians/Practitioners
A claim for Disability Insurance (DI) has a seven-day, non-payable waiting period. If a claim is filed for the same or related cause or condition within 60 days of the initial claim, it will be processed as a continuation of the initial claim for which a waiting period was already served. There will not be a new waiting period in such cases. Your patient's disability must prevent them from doing their regular or customary work for at least eight days to be eligible for DI benefits.
Paid Family Leave:
A Paid Family Leave (PFL) claim has a seven-day, non-payable waiting period. Your patient’s caregiver who is caring for their seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner, or the parent bonding with a new child must be unable to do their regular or customary work for at least eight days to be eligible for PFL benefits. The only exception to the waiting period is when a woman transitions from a DI claim for pregnancy to a PFL claim for bonding with her newborn.
Yes. To receive timely payments, the claimant depends on your prompt return of a complete and accurate Physician/Practitioner’s Certificate within 49 days from the date your patient’s disability begins.
If you delay the submission of a medical certificate you may cause your patient’s benefits to be denied.
Elective and cosmetic surgeries are covered by SDI. The patient must meet the eligibility requirements.
Disabilities caused by substance abuse and/or addiction are covered by SDI. There may be some limitations specific to these claims.
Physician/Practitioners and their representatives may submit medical certification for SDI claims using SDI Online or by completing and mailing the paper Optical Character Recognition (OCR) claim form.
There is no law that prohibits this.
SDI follows Health Insurance Portability and Accountability Act (HIPAA), and both state and federal laws in the handling of medical records and information.
- What are some tips for completing the Optical Character Recognition (OCR) claim form to prevent a delay in processing?
To avoid delays in claims processing, please complete the form as follows:
- Use black ink only.
- Type or write clearly within the boxes provided.
- Fill out only the physician/practitioner’s portion of the form (Part B).
- Do not fax the form.
- Mail the completed form to the EDD in the pre-addressed envelope provided.
- Do not mail this form to the EDD if you have already submitted the claim online.