If your patient and/or your patient’s 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 and accuracy of your medical certifications are vital to the processing of your patient’s claim for DI and/or PFL benefits. The timeliness of medical certifications we receive directly affects the service we provide your patient or your patient’s caregiver.
We pay special attention to your diagnoses, International Classification of Diseases (ICD) codes, and estimated recovery dates. We also consider the claimant’s age, gender, medical history, and occupation when considering recovery dates you provide. When an estimated recovery date for a specific diagnosis is materially more than what normally would be expected, we may contact you and/or your patient for additional information, or send the patient to an Independent Medical Examiner to seek a second medical opinion regarding the patient’s ability to perform his/her regular and customary work.
State Disability Insurance (SDI) Online
The Employment Development Department (EDD) automated some key SDI services to better serve our customers. SDI Online provides customers with electronic and automated options that are simple to use and available 24 hours a day, 7 days a week.
SDI Online is convenient and secure. The system reduces claim processing time, provides immediate electronic confirmation of forms submitted, decreases costs in paper and postage, and includes security safeguards to detect and manage fraud and abuse.
Physicians/Practitioners can view patient’s initial claim for benefits, submit DI and PFL claim certifications, and view claim certification history. For Physician/Practitioner Representatives, the Physician/Practitioner needs to register for an account first and add you as an authorized representative. Once registered, Representatives can view the Physician/Practitioner’s patient claim for benefits, submit DI and PFL claim certifications, and view claim certification history.
For more information, visit the SDI Online page.
Changes to Your Patient’s Claim
If your patient’s disability should extend beyond the original period established on your patient’s initial claim or the most recent medical extension, please complete and submit the Physician/Practitioner’s Supplementary Certificate, DE 2525XX. The DE 2525XX can be submitted online by accessing SDI Online. To order this form, call 1-800-480-3287 or 1-866-658-8846 (en español).
Other Illness or Injury
If your patient has an industrial related illness or injury, please have the patient contact their employer regarding Workers’ Compensation benefits.
A Nurse Practitioner can certify for all medical conditions within his/her scope of practice. However, to certify a claim for DI benefits for a disability other than normal pregnancy and childbirth, the nurse practitioner must perform a physical examination and collaborate with a physician or surgeon.
To certify a claim for PFL benefits, the nurse practitioner must attach a completed Nurse Practitioner Certification for Paid Family Leave Benefits, DE 2509F to the Claim for PFL Benefits (DE 2501F).
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