How to File a Disability Insurance Claim by Mail
Note: If any of the following apply, you should file a paper claim form instead of filing online:
- You do not have a valid California driver license or ID.
- You do not have a valid SSN.
- You have a name that does not fit the space in the online form.
- You had a recent name change.
- You received an error code you cannot resolve or have any other difficulty filing an application online.
Follow these steps to file a Disability Insurance (DI) claim by mail.
You can get a paper Claim for Disability Insurance (DI) Benefits (DE 2501) form by:
- Ordering a form onlineto have it mailed to you.
- Getting the form from your licensed health professional or employer.
- Visiting an SDI Office.
- Calling 1-800-480-3287 and selecting DI Information option 3 to request a paper form by mail.
Note: Allow up to ten days to receive this form.
You must provide the following information to file a DI claim:
- First and last name.
- Most current employer’s business name, phone number, and mailing address (as stated on your W-2 or paystub).
- Last date you worked your normal or usual duties (or the date you began working less than full or modified duty).
You must also give the following information only if it applies to you:
- Any wages you received or expect to receive from your employer (sick leave, paid time off (PTO), vacation pay, annual leave, and wages earned after you stopped working).
- Any workers’ compensation claim information.
- If you receive in-patient treatment at an alcohol recovery home or drug-free rehabilitation facility, provide the name, address, and phone number of the home or facility.
Note: The facility must be licensed and certified by the state in which the facility is located.
You are responsible for filling out Part A - Claimant’s Statement of the DE 2501 form. Write clearly in the spaces provided. Fill out the form completely using black ink only, and sign the form. An incomplete form could delay processing.
You must get a licensed health professional certification for your disability. Once you have filled out Part A of the DE 2501 form, contact your licensed health professional about completing, signing, and submitting your medical certification (Part B – Physician/professional’s Certificate).
Talk to your licensed health professional about their process for submitting a DI claim (not all of them follow the same process). Your licensed health professional must submit the certification no later than 49 days after your disability begins or you may lose benefits.
- If your licensed health professional wants to submit the medical certification using SDI Online, allow 14 calendar days for us to receive and process your claim.
- After your claim has been received, your licensed health professional can find your claim in SDI Online.
There are two parts to completing this form. For your claim to be considered complete, both parts of the DE 2501 form need to be submitted:
- Part A - Claimant’s Statement
- Part B - Physician/professional’s Medical Certificate (a licensed health professional can submit this part)
Your claim will not be processed until we receive both parts. You must submit your completed DE 2501 form within this timeframe:
- Wait nine days after you become disabled to file your claim.
- File your claim within 49 days of becoming disabled to avoid disqualification.
Use the pre-addressed envelope to mail to:
State of California
Employment Development Department
PO Box 989777
West Sacramento, CA 95798-9777
Do not submit the same claim more than once. This will delay your claim.
Note: Your employer will be notified that you have submitted a DI claim. However, medical information is confidential and will not be shared with your employer.