State Disability Insurance – Types of Claims
Important: DI and PFL do not provide job protection, only monetary benefits; however, your job may be protected through other federal or state laws such as the Family and Medical Leave Act (FMLA) or the California Family Rights Act (CFRA).
Your claim begins when you have a loss of wages and your physician/practitioner certifies that your disability prevents you from doing your normal or usual job duties.
Your pregnancy claim begins when you have a loss of wages and your physician/practitioner confirms that you are unable to do your normal or usual job duties.
The usual disability period for a normal pregnancy is up to four weeks before the expected delivery date and up to six weeks (for normal delivery) or eight weeks (for Cesarean section) after the actual delivery. However, your physician/practitioner may certify to a longer disability period prior to or after delivery if there are medical complications and if you are unable to perform your normal or usual job duties.
Your post-partum benefits are limited to the period that you are actually unable to do your normal or usual work.
Note: New mothers transitioning from a DI-related pregnancy claim to PFL-related bonding should remember that when you have recovered from delivering your baby, a Claim for Paid Family Leave (PFL) Benefits – New Mother (DE 2501FP) will be automatically mailed to you in a separate envelope at the same time your final DI payment is issued.
Paid Family Leave (PFL) Bonding provides benefits to eligible workers who need to take time off work to bond with a new child entering the family by birth, adoption, or foster care placement.
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For San Francisco Workers: Your employer may be required to provide supplemental compensation to you if you are receiving PFL benefits for bonding with a new child through birth, adoption, or foster care placement.
You can get more information on the Paid Parental Leave Ordinance (PPLO) from the City and County of San Francisco, Office of Labor Standards Enforcement.
Paid Family Leave (PFL) Care provides benefits to eligible workers who need to take time off work to care for a seriously ill:
- Spouse or registered domestic partner
PFL defines a serious health condition as an illness, injury, impairment, or physical or mental condition of a patient that requires:
- At-home care or in-patient care in a hospital, hospice, or residential medical care facility.
- Continuing treatment by a physician or health care practitioner.
Unless there are complications, the following are examples of conditions that do not qualify as a serious condition for PFL.
- Cosmetic treatments
- Common cold
- Upset stomach
- Minor ulcers
- Non-migraine headaches
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PFL now offers benefits to California workers who take time off work to participate in a qualifying event because of an eligible family member’s (spouse, registered domestic partner, parent, or child) military deployment to a foreign country.
A qualifying event is any military event or an essential need resulting from the family member’s call to deployment, impending call to deployment, or rest and recuperation leave.
If you think you are eligible for benefits, file a claim if you:
- Work part-time.
- Have an intermittent work schedule.
- Have had your hours reduced.
- Have had your wages reduced.
After we receive your claim, we will determine if you are eligible. For more information, review Part-time/Intermittent/Reduced Work Schedule.
If you have a wage loss because you are unable to perform your normal or usual work and are placed in a position that pays less, you may be eligible for reduced or full DI or PFL benefits, depending on the amount of the wage loss.
State Disability Insurance: State Disability Insurance (SDI) benefits are paid for a temporary period of time only. SDI pays a weekly benefit when:
- Your injury or illness is not work-related.
- You are taking time off work to care for a seriously ill family member.
- You are taking time off to bond with a new child.
Workers’ Compensation: Workers’ compensation helps you when your injury or illness is work related. Workers’ compensation may also pay medical bills, benefits for temporary or permanent disabilities, and retraining benefits.
If you are receiving benefits from your employer’s workers’ compensation carrier, usually you cannot receive DI or PFL benefits. However, DI or PFL benefits may be paid if your workers’ compensation claim is denied or your benefits are delayed.
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Eligible employers or a majority of their employees can apply for a Voluntary Plan (VP). A VP pays DI and PFL benefits instead of using SDI coverage.
A VP must:
- Provide all the same benefits as SDI.
- Include at least one benefit that is better than SDI.
- Not cost employees more than SDI.
To file a VP claim, contact your personnel or benefits department.
Disability Insurance Elective Coverage (DIEC) is for employers and self-employed people who are not required to pay into State Disability Insurance, but want to be covered by Disability Insurance (DI) and Paid Family Leave (PFL). DIEC is funded through quarterly premiums and can protect you against partial loss of income when you are unable to work.
DI or PFL provides benefits to eligible DIEC participants when they are unable to work and lose wages due to their own non-work-related illness, injury, pregnancy, or childbirth or to care for a seriously ill family member, bond with a new child or participate in a qualifying event because of an eligible family member’s military deployment to a foreign country.
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State Disability Insurance (SDI), which includes Disability Insurance and Paid Family Leave, provides short-term wage replacement benefits to eligible California workers who lose wages when they need time off work:
- Due to a non-work-related illness, injury, or pregnancy.
- To bond with a new child entering the family.
- To care for a seriously ill family member.
- To participate in a qualifying event because of an eligible family member’s military deployment to a foreign country.
SDI was negotiated for employees in Bargaining Units 1, 3, 4, 11, 14, 15, 17, 20, and 21. All other state employees will be covered by Nonindustrial Disability Insurance (NDI).
Nonindustrial Disability Insurance provides partial wage replacement to covered state government employees who have a loss of wages due to a non-work-related illness, injury, or pregnancy.
Nonindustrial Disability Insurance - Family Care Leave (NDI-FCL) provides partial wage replacement to covered state government employees who have a loss of wages due to caring for a seriously ill family member, bonding with a new child entering the family, or participating in a qualifying event because of an eligible family member’s military deployment to a foreign country.
NDI and NDI-FCL covers excluded employees and rank-and-file employees in bargaining units 2, 5, 6, 7, 8, 9, 10, 12, 13, 16, 18, and 19.
Managerial and supervisory employees participate in the NDI and NDI-FCL programs (both the regular and enhanced benefit levels).