Disability Insurance (DI)
Your patient's disability must prevent them from doing their regular or customary work for at least eight days to be eligible for benefits. There is a seven-day, non-payable waiting period.
If a claim is filed for the same or related cause or condition within 60 days of the initial claim, it will be processed as a continuation of the initial claim. There will not be a new waiting period because the waiting period was already served.
Paid Family Leave (PFL)
Your patient’s caregiver must file their claim within 41 days of their first day of family leave to be eligible for benefits. There is no waiting period for PFL claims.
Your patient’s caregiver must be unable to do their regular or customary work while caring for their seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner for at least one day.
Yes. If it is not medically advisable for your patient to perform her regular or customary work, she may file for Disability Insurance benefits. You must submit the medical certification with a valid pregnancy-related diagnosis code for the complication.
Yes. If your patient’s job requirements (e.g., lifting, continuous standing, chemical exposure, etc.) pose a danger to the health of your pregnant patient or the fetus, she can file for Disability Insurance benefits. You must submit the medical certification with a valid pregnancy-related diagnosis code and the applicable diagnosis code for the occupational hazard.
Any eligible California worker who takes time off work to care for an ill family member may file a Paid Family Leave care claim. Family members include:
Care includes helping with medical needs, eating, self-care, transportation, or providing emotional support. Care also includes planning future care or providing relief for other care givers. You can provide medical certification for any of these reasons.
Yes. To receive timely payments, your patient or patient’s caregiver need you to promptly return a complete and accurate Physician/Practitioner’s Certificate. These certificates must be returned within 49 days from the date your patient’s disability begins or within 41 days from the date the caregiver’s family leave begins.
If you delay in certifying the claim, you may cause benefits to be delayed, denied, or reduced for your patient or your patient's caregiver.
For initial claims, you must submit the Physician/Practitioner’s Certificate within 49 days from the date their disability began. For continued claims, you must submit the medical extension (Physician/Practitioner’s Supplementary Certificate) within 20 days from the mailing or issue date.
Paid Family Leave
For initial claims, you must submit the Physician/Practitioner’s Certificate within 41 days from the date their family leave began. For continued claims, you must submit the medical extension (Physician/Practitioner’s Supplementary Certificate) within 20 days from the mailing date.
Yes. Elective and cosmetic surgeries are covered if the patient meets the eligibility requirements.
Yes. Benefits are payable for a limited period to a resident 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. Disabilities related to or caused by acute chronic alcoholism or drug abuse, which are being medically treated, do not have this limitation.
You may submit medical certifications using SDI Online or by completing and mailing the paper claim form: Claim for Disability Insurance (DI) Benefits (DE 2501) or Claim for Paid Family Leave (PFL) Benefits (DE 2501F). For more information, visit Certify and Manage Claims – Basics for Physicians/Practitioners.
Yes. There is no law that prevents you from charging your patient to complete Disability Insurance or Paid Family Leave forms.
We follow all Health Insurance Portability and Accountability Act (HIPAA), state, and federal laws in the handling of medical records and information for Disability Insurance and Paid Family Leave claims.
Visit Certify and Manage Claims – Basics for Physicians/Practitioners for tips on how to fill out and submit claims. You can also find more information on the Physicians/Practitioners Role in SDI page.