Roles of Licensed Health Professionals in State Disability Insurance
Certify and Manage Patient Claims
If your patient or their 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, accuracy, and timeliness of your medical certifications are important to the processing of their DI or PFL claim.
Who Can Certify
The EDD reviews claims to ensure that all eligibility requirements are met; this includes verification of your health professional’s license which must be active and in good standing.
The following licensed health professionals can certify claims:
- Licensed medical or osteopathic physician/practitioners
- Authorized medical officer of a U.S. Government facility
- Nurse practitioner or physician assistant
- Licensed midwife, nurse-midwife, or nurse practitioner for normal pregnancy or childbirth
- Accredited religious practitioner
Note: A nurse practitioner or physician assistant can certify for conditions within their scope of practice. However, to certify a claim for a disability other than normal pregnancy and childbirth, they must perform a physical examination and collaborate with a physician or surgeon.
How to Certify Claims
If your patient or their caregiver asks you for a medical certification for their SDI claim, you can fill out and submit the form using SDI Online. For more information, visit the Certify and Manage Claims - Basics for Licensed Health Professionals page.
Note: You will need to complete an identity and medical license verification through ID.me to register an account and use SDI Online.
Independent Medical Examiner Information
The State Disability Insurance (SDI) program has a panel of Independent Medical Examiners. These are licensed health professionals responsible for the supplemental examinations that verify a disability status by providing a second medical opinion when the original certification is in question. Examinations by the SDI program follow the guidelines listed in Section 2627(c)-1(b) of Title 22 of the California Code of Regulations.
For example, SDI may request an examination if a licensed health professional lists the claimant’s disability as lasting longer than what is considered normal for the diagnosis but doesn’t provide a medically justified reason.
Independent medical examinations assist SDI in preserving the Disability Fund for the benefit of workers who are insured through SDI.
How to Become an Independent Medical Examiner
If you are a licensed health professional and would like to become an Independent Medical Examiner, contact us by emailing DIBMedical@edd.ca.gov or at the mailing address below. Please provide us with a contact phone number, email, and mailing address. We will contact you and provide you with the appropriate forms to complete.
Employment Development Department
Disability Insurance Branch
PO Box 826880, MIC 29
Sacramento, CA 94280-0001