Certify and Manage Claims – Basics for Licensed Health Professionals
Understand the basics of certifying and managing Disability Insurance (DI) and Paid Family Leave (PFL) claims as a licensed health professional.
Learn more about your role and who can certify patient claims.
Before You Certify
Both you and the patient must certify that the information provided on a DI or PFL claim is complete and accurate. Properly completed claims are generally processed within two weeks of our receipt.
When reviewing your certification forms, we pay special attention to:
- International Classification of Diseases (ICD) codes
- Estimated recovery dates
- Timeframe needed to provide family care
- Patient’s age, gender, and occupation
- Patient’s medical history
If the estimated recovery date is longer than what normally would be expected for that diagnosis, we may contact you and/or your patient for additional information. We may also send the patient to an Independent Medical Examiner for a second medical opinion. Providing sufficient information and an explanation for the longer timeframe can reduce the need for us to make this request.
How to Certify
For Disability Insurance claims, fill out and sign Part B – Physician/Practitioner’s Certificate on the Claim for Disability Insurance (DI) Benefits (DE 2501) form. Mail it in within 49 days from the date your patient’s disability begins.
For Paid Family Leave claims, fill out and sign Part D – Physician/Practitioner’s Certification on the Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form. Mail it in within 41 days from the date family leave begins.
Below you will find information on how to submit a certification. For more information, we offer a step-by-step tutorial.
You must be licensed through the California Department of Consumer Affairs to file a medical certification online. You will need to complete a one-time registration in myEDD.
myEDD is a secure portal that connects you to disability, paid family leave, unemployment and benefit overpayment services.
With myEDD, you can register for an access account, register for SDI Online, and login to SDI Online to view your patient’s initial claim for benefits, fill out and submit claim certifications, and view claim certification history.
Note: You will be directed to complete the ID.me process before you create a new SDI Online account or before you can continue the certification of claims on your existing SDI Online account.
After you have completed the registration process through myEDD and SDI Online, file your certification by following these steps:
- Log in to your myEDD account.
- Select SDI Online which will direct you to your Home page.
- Search for your patient's information using one of the following:
- The Receipt Number issued when they filed a claim using SDI Online.
- The claim ID number.
- Claimant/patient's last name and date of birth.
- Claimant/patient's last name and Social Security number.
- After locating your patient's claim, complete your certification by answering the applicable questions, and providing the information requested.
You can mail the forms to the EDD using the pre-addressed envelope provided. Do not mail these forms to the EDD if you have already submitted the claim online. Failure to return them on time may cause your patient’s benefits to be denied
To avoid delays in claims processing, complete Part B of Claim for Disability Insurance (DI) Benefits (DE 2501) or Part D of Claim for Paid Family Leave (PFL) Benefits (DE 2501F) forms as follows:
- Use black ink only.
- Type or write clearly within the boxes provided.
- Do not fax the form.
- Mail the completed form to the EDD in the pre-addressed envelope provided.
- Include the licensed health professional’s original signature.
- Include the licensed health professional’s license number.
- Include the estimated date the patient will be able to return to his/her regular or customary work or the estimated date your patient will no longer require care.
- Include the diagnosis and ICD9 code, (If a diagnosis has not been established, a detailed statement of disabling symptoms must be provided.)
Changes to Your Patient’s Claim
If your patient’s disability or the need for care extends beyond the original period of time that was on their initial claim or the most recent medical extension, they will ask you to complete and submit an additional medical certification:
- Physician/Practitioner’s Supplementary Certificate (DE 2525XX) – You can access this form by logging in to your myEDD account and selecting SDI Online. You can also get a paper copy from your patient.
- Paid Family Leave (PFL) Supplemental Claim Certification (DE 2525XFA) – If your patient’s caregiver needs to continue providing care, you must complete the "Physician/Practitioner’s Supplementary Certificate" section of this form.
If you are an accredited religious practitioner, you can download and print the following forms. Do not compete these forms if you are a licensed health professional.
- Claim for Disability Insurance Benefits – Religious Practitioner’s Certificate (DE 2502)
- Practitioner’s Certification for Paid Family Leave (PFL) Benefits (DE 2502F)
Drug and Alcohol Recovery
You may certify your patients for a limited period 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.
If your patient has an industrial-related illness or injury, please have the patient contact their employer regarding Workers’ Compensation benefits.
Using SDI Online: In Section 4A – Claim Information, mark "Yes" or "No" to the question, "Was this disabling condition caused and/or aggravated by the patient’s regular or customary work?"
Using the paper claim form DE 2501: On Part B – Question B29, mark "Yes" or "No" to the question, "Was this disabling condition caused and/or aggravated by the patient’s regular or customary work?"
DI and PFL claim forms are available at no cost to you. For more information on how to access these forms, you can:
- Visit Licensed Health Professional Forms and Publications.
- Call 1-855-342-3645 (TTY users dial the California Relay Service at 711).