How to File a Disability Insurance Claim by Mail
Follow these steps to file a Disability Insurance (DI) claim by mail.
You can get a paper Claim for Disability Insurance (DI) Benefits (DE 2501) form by:
- Ordering a form online to have it mailed to you.
- Getting the form from your physician/practitioner or employer.
- Visiting an SDI Office.
- Calling 1-800-480-3287 to request a paper form by mail.
Note: It may take two to four weeks to receive this form.
You must provide the following information to file a DI claim:
- First and last name.
- Social Security number.
- Most current employer’s business name, phone number, and mailing address (as stated on your W-2 or paystub).
- Last date you worked your normal or usual duties (or the date you began working less than full or modified duty).
You must also give the following information only if it applies to you:
- Any wages you received or expect to receive from your employer (sick leave, paid time off (PTO), vacation pay, annual leave, and wages earned after you stopped working).
- Any workers’ compensation claim information.
- If you receive in-patient treatment at an alcohol recovery home or drug-free rehabilitation facility, provide the name, address, and phone number of the home or facility.
You are responsible for filling out Part A - Claimant’s Statement of the DE 2501 form. Write clearly in the spaces provided. Fill out the form completely using black ink only, and sign the form. An incomplete form could delay processing.
You must get a physician/practitioner certification for your disability. Once you have filled out Part A of the DE 2501 form, contact your physician/practitioner about completing, signing, and submitting your medical certification (Part B – Physician/Practitioner’s Certificate).
Talk to your physician/practitioner about their process for submitting a DI claim (not every physician/practitioner follows the same steps). Your physician/practitioner must submit the certification no later than 49 days after your disability begins or you may lose benefits.
- If your physician/practitioner wants to submit the medical certification using SDI Online, allow 14 calendar days for us to receive and process your claim.
- After your claim has been received, your physician/practitioner can find your claim in SDI Online.
There are two parts to completing this form. For your claim to be considered complete, both parts of the DE 2501 form need to be submitted:
- Part A - Claimant’s Statement
- Part B - Physician/Practitioner’s Medical Certificate (a physician/practitioner can submit this part)
Your claim will not be processed until we receive both parts. You must submit your completed DE 2501 form within this timeframe:
- Wait nine days after you become disabled to file your claim.
- File your claim within 49 days of becoming disabled to avoid disqualification.
Use the pre-addressed envelope to mail to:
State of California
Employment Development Department
PO Box 989777
West Sacramento, CA 95798-9777
Do not submit the same claim more than once. This will delay your claim.
Note: Your employer will be notified that you have submitted a DI claim. However, medical information is confidential and will not be shared with your employer.
Last Revised: 01/04/2020