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Roles of Licensed Health Professionals in State Disability Insurance

Patients or their caregivers may be eligible to file for benefits if they pay into State Disability Insurance (SDI).

There are two SDI benefits:

  • Disability Insurance (DI)
  • Paid Family Leave (PFL)

You will need to provide a medical certification to support an SDI claim when:

  • Your patient files a disability claim for themselves.
  • Your patient’s caregiver files a PFL care claim.

It is important that your certification is accurate, signed, and returned to us as soon as possible. You must return the form within 49 days from the date the DI claim begins and 41 days from the date the PFL claim begins.

Only specific licensed health professionals can certify for claims. Out-of-state and out-of-country licensed health professionals can also certify. Health professionals must be licensed through their local licensing entity. A license must be active and in good standing with the local licensing board. We verify that licenses are current and in good standing before certification.

To learn more, visit Certify and Manage Claims - Basics for Licensed Health Professionals.

The SDI program contracts with a group of Independent Medical Examiners (IME). These licensed health professionals do examinations and provide a second medical opinion.

We sometimes have questions about the original certification when it’s not clear. The second opinion helps us verify the disability status. IMEs help us preserve the Disability Fund for the benefit of all workers insured through SDI.

IME examinations  follow the guidelines listed here:

Section 2627(c)-1(b) of Title 22 of the California Code of Regulations.

We may request an examination for a diagnosis if:

  • The medical certificate shows the disability will last longer than normal.
  • It does not provide a valid medical reason for the longer timeframe.

If we request an IME, we pay the fees for examinations, laboratory work, and X-ray procedures. The IME physician bills us for reimbursement of exam costs. The claimant is not responsible for these fees. If a claimant does not attend an IME, we will find them ineligible for future benefit payments.

Licensed health professionals interested in becoming an Independent Medical Examiner can:

Employment Development Department
Disability Insurance Branch
PO Box 826880, MIC 29
Sacramento, CA 94280-0001

Please include:

  • Your contact phone number
  • Your email address
  • Your mailing address

Once we receive your information, we will send you the forms to complete.

Additional Resources