What Are The Medical Eligibility Requirements For Sdi
SDI gives cash payments to employees who are unable to work because of a non-work-related disability, and SDI defines a disability as “… an illness or injury, either physical or mental, which prevents you from performing your regular and customary work.” The definition also includes elective surgery, pregnancy, childbirth, or other related medical conditions. Your medical provider has to certify that your condition meets this definition.
To get Paid Family Leave because you are caring for a sick relative, the relative has to have a mental or physical condition that requires at-home care or in-patient care in a hosptial, hospice, or residential medical facility, with continuing treatment by a doctor or other health care provider.
How To File A Claim
It isn’t difficult to file an SDI claim in California. Usually, the employer or the employee’s health care practitioner will provide the form you can also get a copy at the website of the state’s Economic Development Department . You must complete part of the form and your health care practitioner must complete the rest. Once the form is complete, you submit it to the EDD you must submit the form within 49 days after becoming disabled, or you might not receive any benefits.
The EDD may call you or otherwise contact you if it has any questions. It will also contact your employer to find out your wages and other information. If the EDD determines that you are eligible, it will send you a notice informing you of your eligibility, your projected benefit amount, and when your benefits will begin. You will receive benefits approximately every two weeks currently, the EDD provides benefits through a bank debit card.
For Paid Family Leave
The forms to apply for Paid Family Leave are different, but the options for applying are the same:
- By mail. EDD explains how to apply for PFL by mail and provides a how-to video for applying for PFL by mail.
There are several parts to the PFL application. You must complete Part A the person you are caring for must sign page 2 and complete Part C and the doctor/medical practitioner for the person you are caring for must complete and sign Part D.
Note: If there are no problems with your forms, youll usually start getting SDI or PFL benefits about two weeks after submitting your claim. Do not file more than one copy of the same claim, as this makes it take longer for you to get benefits.
If SDI decides you don’t qualify for SDI or PFL benefits, they send you a Disqualification Notice and an Appeal From. You have 30 days from the date of the notice to appeal SDI’s decision online or in writing. EDD will look at your appeal, and either decide to give you benefit payments or send your appeal to the local Office of Appeals of the California Unemployment Insurance Appeal Board, which will schedule a hearing.
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What To Expect After You Have Filed For Disability
Once we receive your completed claim application, we will determine your eligibility. You can expect this process to take up to 14 days.
Note: Processing time may vary depending upon the claim. If your claim is incomplete or requires additional information, confirming eligibility can be delayed.
During this time, we will send you a Notice of Computation to inform you of your potential weekly benefit amount based on the wages you earned in your .
Receiving this notice does not confirm your eligibility to receive DI benefits.
The State Of California Pays Partial Wages If You Have Temporary Illness Or Injury That Keeps You From Working
By Bethany K. Laurence, Attorney
Update: California has made it easier for those affected by coronavirus to get SDI benefits. If you are off work due to COVID-19 illness or exposure, see our article oncoronavirus changes to California’s disability insurance program.
The State of California requires all employees to pay into its short-term disability insurance program through payroll deductions. When employees become unable to work due to disability, they can collect weekly benefits from the program until they are either ready to go back to work or the benefits expire. The program is administered by California’s Employment Development Department .
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What Is California State Disability Insurance
The California State Disability Insurance program is offered through the Employment Development Department . It’s a state level version of Social Security Disability Insurance , but has more reach than SSDI. The concept behind SDI is to replace income for employees who are unable to work due to pregnancy, illness, time off to bond with a new child, or take care of a sick relative.
Money for this program comes from the income of people who work in the state of California. A small amount is deducted from paychecks and deposited into a state fund. When someone files a claim with SDI, the money for their claim comes from this fund. Benefits are paid every other week and can last up to a year.
File For Disability In California
When an individual who is suffering from a debilitating impairment wants to begin filing a claim for disability benefits with the Social Security Administration , they have a few options to take. Each option is merely a difference in convenience and one option does not provide a better chance of approval over another. An individual can apply:
- online at the SSA’s website ssa.gov,
- telephone by calling the SSA’s customer service: 1-800-772-1213,
- or in-person at their local Social Security field office.
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Eligibility For California Short
To receive benefits, you must meet all of the following requirements:
- You must be unable to do your regular work for at least eight consecutive days.
- You must have been either employed or actively looking for work at the time you became disabled.
- You must have lost wages because of your disability. For example, if your employer moves you to a light-duty position and continues paying you the same amount, you won’t collect any benefits.
- You must have earned at least $300, from which state disability insurance deductions were withheld, during a previous period.
- You must be under the care and treatment of a licensed doctor or accredited religious practitioner.
- You must complete and mail a claim form within 49 days of the date you became disabled.
- Your doctor must complete the part of the form that provides medical certification of your disability. A licensed midwife, nurse-midwife, or nurse practitioner may also complete the medical certification for disabilities related to normal pregnancy or childbirth.
Does Sdi Cover Pregnancy
Yes. For a pregnancy without complications, the benefit period is generally from four weeks before your due date to six weeks after your delivery. If your pregnancy prevents you from working before or after that period, your doctor has to explain why on the claim form.
Note: This article focuses on SDI for people with disabilities and Paid Family Leave for people taking care of a person with a disability. If you have questions about Pregnancy Disability Leave, contact the EDD.
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Why Should I Hire An Ssi Or Ssdi California Disability Advocate
SSI or SSDI California disability advocates help with several parts of the disability application process. At GAR Disability Advocates, we help individuals file for disability benefits, manage their reconsideration appeals, and present a strong case at their hearings.
We do everything we can to help every step of the way. Our SSI & SSDI California disability advocates want to guide you through the intimidating disability benefits application process.
We offer a contingency-based service, which means we only get paid if you get your benefits. If you are not approved for benefits, you pay us nothing.
If you need to apply for SSI or SSDI in California, call us today at 201-308-9520 or fill out our online form for a free evaluation.
Getting Help With Your Benefits
If you get Supplemental Security Income , Social Security Disability Insurance , or Childhood Disability Benefits , and you’re looking for a job, a trained Benefits Planner can help you avoid problems with your job plan. If you need help or have questions about your situation, you can call the Ticket to Work Help Line at 1-866-968-7842 or 1-866-833-2967 , Monday through Friday.
View DB101’s full list of experts who can help you understand different benefits.
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Ssi & Ssdi California Hearing Offices
California is part of Region 9 of the SSA. The Region 9 headquarters is in San Francisco. There are also 16 additional hearing offices in California
When applying for SSI or SSDI in California, it is important to know which hearing office you will use and how long you can expect to wait for your hearing. Below is a list of SSDI California hearing offices for your convenience.
Fresno Office of Disability Adjudication and Review
Suite 300
Telephone: 870-6385
Office Hours: 8:00 a.m. to 4:30 p.m.
Services the following Social Security Field Offices: Boyle Heights, Compton, Downey, Huntington Park, Montebello, Norwalk, Whittier
Oakland Office of Disability Adjudication and Review
Oakland Federal Building, Suite 200N
1301 Clay Street
Telephone: 366-4916
Office Hours: 8:00 a.m. to 4:30 p.m.
Services the following Social Security Field Offices: Antioch, Berkeley, East Oakland, Fremont, Hayward/Livermore , Oakland, Richmond, San Leandro, Walnut Creek
Orange Office of Disability Adjudication and Review
Centrum North, Suite 600
1120 West La Veta Avenue
Orange, CA 92868
Telephone: 593-1447
Office Hours: 8:00 a.m. to 4:30 p.m.
Services the following Social Security Field Offices: Anaheim, Brea, Fountain Valley, Garden Grove, Mission Viejo, Ontario, Pomona Valley, Santa Ana
Pasadena Office of Disability Adjudication and Review
Pasadena Towers 1, Suite 500
800 E. Colorado Boulevard
Telephone: 354-0220
Office Hours: 8:00 a.m. to 4:30 p.m.
Suite 250
Telephone: 770-1221
Telephone: 331-2219
How Will I Receive My State Disability Insurance Payments
You will be able to select your payment option when you file your claim.
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EDD Debit Card: If eligible, benefit payments are issued on the EDD Debit Card within 24 hours of processing your certification and immediately available to you.
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EDD Checks by Mail: If eligible, benefit payments are issued by EDD check within 24 hours of processing your certification. Allow 7 to 10 days for delivery of checks in the mail.
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If Youre Not Able To Return To Work Within 12 Months And Are A Member Of Ucrp Talk With The Retirement Administration Service Center About Your Situation
- If you’re eligible for UCRP disability benefits, a representative will send you the required application forms.
- Return the forms ASAP your disability date is based on when your application is received.
- If you apply within 120 days of leaving UC employment, youll preserve your right to continue your retiree health coverage, so long as your coverage is continuous.
- If you receive UCRP Disability and have a CAP balance, youre required to take a distribution or roll over the CAP funds. Its best to choose the rollover otherwise the disability carrier will reduce your monthly benefit by the amount of the distribution. You also have the option to suspend your 403 loan repayments, if you have any.
- Resources
How Do I File For Disability
You can file the Claim for Disability Insurance Benefits claim or even faster with . Register and create an account with us through Benefit Programs Online so that you can file and manage your disability claim with SDI Online.
Note: You can choose how you receive your benefits when you file, either by prepaid debit card or EDD check.
- Electronic Payment: If you chose this option, your benefit payments will be deposited to a debit card issued to you.
- Payment by Mail: If you chose this option, your benefit payments will be issued by EDD check. Allow 7 to 10 days for delivery by mail.
To learn more, review the step-by-step overview for the . Review the for detailed answers to commonly asked questions, including
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Other Ways You Can Apply
Apply With Your Local Office
You can do most of your business with Social Security online. If you cannot use these online services, your local Social Security office can help you apply. Although our offices are closed to the public, employees from those offices are assisting people by telephone. You can find the phone number for your local office by using our Office Locator and looking under Social Security Office Information. The toll-free Office number is your local office.
Apply By Phone
If You Do Not Live in the U.S. Or One of Its Territories
Contact the if you live outside the U.S. or a U.S. territory and wish to apply for retirement benefits.
Mailing Your Documents
If you mail any documents to us, you must include the Social Security number so that we can match them with the correct application. Do not write anything on the original documents. Please write the Social Security number on a separate sheet of paper and include it in the mailing envelope along with the documents.
Is State Disability Insurance The Same As The Two Weeks Of Emergency Paid Sick Leave For Workers Impacted By Covid
No. COVID-19 Emergency Paid Sick Leave is paid directly by the employer. To get emergency paid sick leave, you must tell your employer the COVID-19 related reason you are unable to work. On the other hand, SDI is a benefit paid by the State of California. To get SDI, you must apply to the EDD, as described above.
Many workers that are unable to work due to their own COVID-19 related health condition first ask their employer for up to two weeks of emergency paid sick leave. If they were not eligible for emergency paid sick leave or exhaust their leave but are still unable to return to work, they will speak with their healthcare provider about applying for SDI.
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What Do I Need To Know About Advance Designation
You should be aware of another type of representation called Advance Designation. This relates to the Strengthening Protections for Social Security Beneficiaries Act of 2018, which was signed into law on April 13, 2018.
Advance Designation allows capable adult and emancipated minor applicants and beneficiaries of Social Security, Supplemental Security Income, and Special Veterans Benefits to choose one or more individuals to serve as their representative payee in the future, if the need arises.
To help protect whats important to you, we now offer the option to choose a representative payee in advance. In the event that you can no longer make your own decisions, you and your family will have peace of mind knowing you already chose someone you trust to manage your benefits. If you need a representative payee to assist with the management of your benefits, we will first consider your advance designees, but we must still fully evaluate them and determine their suitability at that time.
You can submit your advance designation request when you apply for benefits or after you are already receiving benefits. You may do so through your personal account, by telephone, or in person.
Information You Need To Apply
Before applying, be ready to provide information about yourself, your medical condition, and your work. We recommend you print and review the . It will help you gather the information you need to complete the application.
Information About You
- Your date and place of birth and Social Security number.
- The name, Social Security number, and date of birth or age of your current spouse and any former spouse. You should also know the dates and places of marriage and dates of divorce or death .
- Names and dates of birth of children not yet 18 years of age.
- Your bank or other and the account number.
Information About Your Medical Condition
- Name, address, and phone number of someone we can contact who knows about your medical conditions and can help with your application.
- Detailed information about your medical illnesses, injuries, or conditions:
- Names, addresses, phone numbers, patient ID numbers, and dates of treatment for all doctors, hospitals, and clinics.
- Names of medicines you are taking and who prescribed them.
- Names and dates of medical tests you have had and who ordered them.
Information About Your Work:
- Award letters, pay stubs, settlement agreements, or other .
We accept photocopies of W-2 forms, self-employment tax returns, or medical documents, but we must see the original of most other documents, such as your birth certificate.
Do not delay applying for benefits because you do not have all the documents. We will help you get them.
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If Your Disability Leave Ends And You Can’t Return To Your Previous Work Consider These Options:
- If youre eligible to retire, you can compare your potential retirement income with your disability income your Benefits representative or the Retirement Administration Service Center can give you the figures youll need. Depending on your age, UCRP service credit and other factors, you could receive more monthly income and higher UC medical and dental contributions under UCRP disability than if you retire.
- Talk to your campus disability management specialist to explore other job opportunities.
- Resources
- Campus Contacts
Some Publications That Will Give You More Information On Disability Benefits
The Disability Starter Kit will help you get ready for your disability interview or online application. Kits are available for adults and for children under age 18.
The starter kits provide information about the specific documents and the information that we will request from you.
The kits also provide general information about the disability programs and our decision-making process.
Here are some additional resources with information on disability benefits:
- Disability Evaluation Under Social Security – Medical criteria for evaluating Social Security disability claims
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