Disability Insurance (DI)
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. A claim for 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. There will not be a new waiting period because the waiting period was already served.
Paid Family Leave (PFL)
Your patient’s caregiver must be unable to do their regular or customary work while caring for their seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner for at least one day.
Your patient’s caregiver must file their claim within 41 days of their first day of family leave to be eligible for PFL benefits. A PFL claim does not have a waiting period.
Yes. If it is not medically advisable for your patient to perform her regular or customary work, she may file for Disability Insurance benefits. You must submit the medical certification with a valid pregnancy-related diagnosis code for the complication.
Yes. If your patient’s job requirements (e.g., lifting, continuous standing, chemical exposure, etc.) pose a danger to the health of your pregnant patient or the fetus, she can file for Disability Insurance benefits. You must submit the medical certification with a valid pregnancy-related diagnosis code and the applicable diagnosis code for the occupational hazard.
Yes. To receive timely payments, your patient or patient’s caregiver depends on your prompt return of a complete and accurate Physician/Practitioner’s Certificate. These certificates must be returned within 49 days from the date your patient’s disability begins or within 41 days from the date the caregiver’s family leave begins.
If you delay the submission of a medical certificate, you may cause benefits to be delayed, denied or reduced for your patient or your patient's caregiver.
For initial claims, you must submit the Physician/Practitioner’s Certificate within 49 days from the date their disability began. For continued claims, you must submit the medical extension (Physician/Practitioner’s Supplementary Certificate) within 20 days from the mailing or issue date.
Paid Family Leave
For initial claims, you must submit the Physician/Practitioner’s Certificate within 41 days from the date their family leave began. For continued claims, you must submit the medical extension (Physician/Practitioner’s Supplementary Certificate) within 20 days from the mailing date.
Yes. Elective and cosmetic surgeries are covered by Disability Insurance if the patient meets the eligibility requirements.
Yes. Benefits are payable for a limited period to a resident in an alcoholic recovery home or drug-free residential facility. The facility must be licensed and certified by the state in which the facility is located. Disabilities related to or caused by acute chronic alcoholism or drug abuse, which are being medically treated, do not have this limitation.
You may submit medical certification for Disability Insurance or Paid Family Leave claims using SDI Online or by completing and mailing the paper claim form: Claim for Disability Insurance (DI) Benefits (DE 2501) or Claim for Paid Family Leave (PFL) Benefits (DE 2501F). Paper claim forms can be obtained by visiting Online Forms and Publications.
Yes. There is no law that prevents you from charging your patient to complete Disability Insurance or Paid Family Leave forms.
The EDD follows the Health Insurance Portability and Accountability Act (HIPAA), state, and federal laws in the handling of medical records and information for Disability Insurance and Paid Family Leave claims.
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 for Disability Insurance and Part D for Paid Family Leave) and sign the form.
- Do not fax the form.
- Submit the claim online or mail the completed form to the EDD in the pre-addressed envelope provided.
- Do not mail this form if you already submitted it online.