Basic Eligibility for Your Employees

Your employees may qualify for disability if they can’t work and lose wages due to their own:

• Illness or injury (physical or mental).
• Surgery (including elective surgery).
• Pregnancy.
• Recovery from childbirth or other related medical conditions.
• Residential alcohol or drug addiction recovery.

Note: Citizenship and immigration status do not affect eligibility.

We may approve DI benefits if your employee meets the following requirements:

• Cannot do their regular work for at least eight days.
• Have lost wages because of their disability.
• Are working or looking for work at the time their disability begins.
• Earned at least $300 in their base period with State Disability Insurance (SDI) deducted from their paycheck. (Shown as CASDI on their paystub.)

• They must complete and submit their claim:
• No earlier than nine days after their disability begins.
• No later than 49 days after their disability begins or they may lose benefits.

• Are under the care and treatment of a physician/practitioner. An accredited religious practitioner can also certify the disability. They must remain under care and treatment to continue getting benefits.

• A physician/practitioner must complete the medical certification of their disability.
  
  
• If your employee is under the care of an accredited religious practitioner, they may download and print the Claim for Disability Insurance Benefits-Religious Practitioner’s Certificate (DE 2502) (PDF).

Your employee may qualify for up to 30 days of disability benefits if they meet other eligibility requirements and:

• They live at an approved residential alcohol rehabilitation facility.
• Their physician/practitioner recommends the rehab facility.
• The facility is licensed and certified by the state where it is located.

They may receive an extra 60 days of payments if:

• They remain in the facility for longer treatment.
• Their physician/practitioner certifies the need for continued residential services.

Your employee may qualify for up to 45 days of disability benefits if they meet other eligibility requirements and:

• They live at an approved residential drug-free rehabilitation facility.
• Their physician/practitioner recommends the rehab facility.
• The facility has a license and certification from the state where it is located.

They may receive an extra 45 days of payments if:

• They remain in the facility for longer treatment.
• Their physician/practitioner certifies the need for continued residential services.

Your employee might not be eligible for DI benefits if they:

• Do not pay into State Disability Insurance.
• Are covered by a Voluntary Plan.

Note: Your employee may apply for benefits even if they are not sure they are eligible. They will be notified if we find they are not eligible for all, or part of a period claimed.

If your employee receives a notice of denial, let them know they have the right to appeal the decision. They can do this by writing an explanation of why they disagree and sending it back via mail or online.

Your employees may be eligible for PFL benefits if they can’t work and lose wages because they need to:

• Provide care for a seriously ill family member.
• Bond with a new child.
• Support a family member in the US Armed Forces deploying to a foreign country. For more information about this eligibility, visit Paid Family Leave – Military Assist.

Note: Citizenship and immigration status do not affect eligibility.

We may approve PFL benefits if your employee meets the following requirements:

• They can’t do their regular or customary work due to their need for family leave.
• Are working or looking for work at the time their family leave begins.
• They lost wages because of their need to take family leave.
• Have earned at least $300 in their base period with State Disability Insurance deducted on their paycheck. (Shown as CASDI on their paystub). Learn more at Calculating Paid Family Leave Benefit Payment Amounts.
• They must complete and submit their claim form:
• No earlier than the first day their family leave begins.
• No later than 41 days after their family leave begins or they may lose benefits.
• They must also provide all supporting documentation required for their claim.
• For care claims, they must provide a medical certificate for the seriously ill family member. The care recipient's physician/practitioner must complete and sign the certification.

A serious health condition includes:

• Illness
• Injury
• Impairment
• Physical condition
• Mental condition

These conditions could involve:

• Inpatient care at a hospital, hospice, residential medical facility, or at home.
• Being unable to work, attend school, or perform daily activities.
• Continuing treatment by a physician/practitioner.

If your employee's care recipient is under the care of an accredited religious practitioner, they may download and print the Claim for Disability Insurance Benefits-Religious Practitioner's Certificate (DE 2502) (PDF).

Note: We may ask for an independent medical examination of the care recipient. This means we will get a second opinion to decide their initial or continuing eligibility.

The following are not serious health conditions eligible for PFL care claims:

• Cosmetic treatments.
• Common cold, influenza, or earaches.
• Upset stomach or minor ulcers.
• Headaches other than migraines.

Note: If a health condition is not serious but gets worse, they may qualify for care benefits.

Your employee may not be eligible for PFL benefits if they:

• Do not pay into State Disability Insurance.
• Are covered by a Voluntary Plan.

Note: Your employee may apply for benefits even if they are not sure they are eligible. They will be notified if we find they are not eligible for all, or part of a period claimed.

If your employee receives a notice of denial, let them know they have the right to appeal the decision. They can do this by writing an explanation of why they disagree and sending it back via mail or online.

If you employ workers in San Francisco, you may need to pay part of their wages. This applies when employees receive PFL benefits for bonding with a new child through:

• Childbirth
• Adoption
• Foster care placement

For more information, read the Paid Parental Leave Ordinance.