If your patient and/or your patient’s caregiver are eligible for State Disability Insurance (SDI) they may be covered by one of two benefits: Disability Insurance (DI) or Paid Family Leave (PFL).
The quality and accuracy of your medical certifications are vital to the processing of your patient’s claim for DI or your patient’s caregiver’s claim for PFL benefits. The timeliness of medical certifications we receive directly affects the service we provide your patient or your patient’s caregiver.
We pay special attention to your diagnoses, International Classification of Diseases (ICD) codes, and estimated recovery dates. We consider the patient’s age, gender, medical history, and occupation when reviewing recovery dates you provide. When an estimated recovery date for a specific diagnosis is longer than what normally would be expected, we may contact you and/or your patient for additional information, or send the patient to an Independent Medical Examiner to seek a second medical opinion about the patient’s ability to perform their regular and customary work. Providing sufficient information about your patient’s condition for us to understand your estimated date of recovery can reduce the need for us to make this request.
State Disability Insurance (SDI) Online
The Employment Development Department (EDD) automated some key services to better serve you. SDI Online provides options that are simple to use and available 24 hours a day, 7 days a week.
SDI Online is convenient and secure. The system reduces claim processing time, provides immediate confirmation of forms submitted online, decreases costs in paper and postage, and includes security safeguards to detect and manage fraud and abuse.
Physicians/practitioners can view their patient’s initial claim for benefits, submit DI and PFL claim certifications, and view claim certification history.
For physician/practitioner representatives, the physician/practitioner needs to register for an account first and add you as an authorized representative. Once registered, you can view the physician/practitioner’s patient claim for benefits, submit DI and PFL claim certifications, and view claim certification history.
For more information, visit the SDI Online page.
Changes to Your Patient’s Claim
If your patient’s disability extends beyond the original period established on their initial claim or the most recent medical extension, please complete and submit the Physician/Practitioner’s Supplementary Certificate (DE 2525XX). The DE 2525XX can be submitted online by accessing SDI Online. To order this form, call 1-855-342-3645 (TTY users dial the California Relay Service at 711).
Other Illness or Injury
If your patient has an industrial related illness or injury, please have the patient contact their employer regarding Workers’ Compensation benefits.
Nurse Practitioner and Physician Assistant
A nurse practitioner or physician assistant can certify for all medical conditions within their scope of practice. However, to certify a claim for DI benefits for a disability other than normal pregnancy and childbirth, the nurse practitioner or physician assistant must perform a physical examination and collaborate with a physician or surgeon.