FAQ - Physicians-Practitioners
Disability Insurance (DI):
A claim for DI has a seven-day, non-payable waiting period. Your patient's disability must prevent them from doing their regular or customary work for at least eight days to be eligible for DI benefits.
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 for which a waiting period was already served. There will not be a new waiting period in such cases.
Paid Family Leave (PFL):
A PFL claim does not have a waiting period. 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. They must file their claim within 41 days of their first day of leave to be eligible for PFL benefits.
- My patient’s high-risk pregnancy will require her to stop working earlier than the four weeks prior to her estimated due date. Can she file for Disability Insurance (DI) benefits?
Yes. If your patient has pregnancy complications, she may file for DI benefits. You must submit the medical certification with a valid pregnancy-related diagnosis code and the applicable diagnosis code for the complication.
- My patient’s job requirements (e.g., lifting, continuous standing, regular chemical exposure, etc.) pose a known medical danger to the fetus during pregnancy. Can my patient file for DI benefits?
Yes. If your patient’s job requirements prevent her from sustaining the life of the fetus, she can file for DI benefits. You must submit the medical certification with a valid pregnancy related diagnosis code and the applicable diagnosis code for the occupational hazard (e.g., occupational exposure to toxic agents in agriculture).
Yes. To receive timely payments, your patient or patient’s caregiver depends on your prompt return of a complete and accurate Physician/Practitioner’s Certificate. It 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.
DI: If you delay the submission of a medical certificate you may cause your patient’s DI benefits to be denied or reduced. You must submit the Physician/practitioner’s Certificate within 49 days from the date their disability began.
PFL: If you delay the submission of a medical certificate you may cause your patient’s caregiver’s PFL benefits to be denied or reduced. You must submit the Physician/practitioner’s Certificate within 41 days from the date their family leave began.
Yes, elective and cosmetic surgeries are covered by SDI if the patient meets the eligibility requirements.
Yes. Benefits are payable only for a limited period to a resident in an alcoholic recovery home or drug-free residential facility that is both licensed and certified by the state in which the facility is located. Disabilities related to or caused by acute chronic alcoholism or drug abuse, being medically treated, do not have this limitation.
You may submit medical certification for SDI claims 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). Paper claim forms can be obtained by visiting the Online Forms and Publications page.
Yes. There is no law that prevents you from charging your patient to complete SDI forms.
SDI follows the Health Insurance Portability and Accountability Act (HIPAA), state, and federal laws in the handling of medical records and information.
To avoid delays in claims processing, please complete the form as follows:
- Use black ink only.
- Type or write clearly within the boxes provided.
- Fill out only the physician/practitioner’s portion of the form (Part B for DI and Part D for PFL) and be sure to sign the form.
- Do not fax the form.
- Mail the completed form to the EDD in the pre-addressed envelope provided.
- Do not mail this form to the EDD if you have already submitted the claim online.