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 or your patient’s caregiver’s claim for 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, estimated recovery dates, and the timeframe needed to provide family care. We consider the patient’s age, gender, medical history, and occupation when reviewing the recovery dates and need for care you provide. When an estimated recovery date for a specific diagnosis is longer than what normally would be expected, we may contact you and/or your patient for additional information. We may also send the patient to an Independent Medical Examiner to seek a second medical opinion about the patient’s ability to perform their regular and customary work or need for care. Providing sufficient information about your patient’s condition for us to understand your estimated date of recovery or need for care can reduce the need for us to make this request.
Benefit Programs Online and SDI Online
Benefit Programs Online (BPO) is a secure portal for Employment Development Department (EDD) customers to access State Disability Insurance (SDI) Online and UI OnlineSM using a single login.
SDI Online provides electronic and automated options to submit and manage claims and related documents that are available 24 hours a day, 7 days a week.
The system reduces claim processing time, provides immediate confirmation of forms submitted online, decreases costs in paper and postage, and includes security safeguards to detect and manage fraud and abuse.
You can view your 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, you can view the physician/practitioner’s patient claim for benefits, submit DI and PFL claim certifications, and view claim certification history.
Changes to Your Patient’s Claim
If your patient’s disability extends beyond the original period established on their initial claim or the most recent medical extension, please complete and submit the Physician/Practitioner’s Supplementary Certificate (DE 2525XX). You can submit the DE 2525XX certification online by creating a Benefit Programs Online (BPO) account and registering for SDI Online. Once registered, select SDI Online to complete this form for your patient’s claim from the home page. You may also complete this certification using the paper form your patient will receive by mail with their final payment.
If the patient’s caregiver needs to continue providing care and has not yet used their eight weeks of benefits, they should provide you with the Paid Family Leave (PFL) Supplemental Claim Certification (DE 2525XFA) they receive with their final payment. You must complete the Physician’s Supplementary Certificate section of the DE 2525XFA, and it must be returned to the EDD.
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.
Nurse Practitioner and Physician Assistant
A nurse practitioner or physician assistant can certify for all medical conditions within their scope of practice. However, to certify a claim for DI benefits for a disability other than normal pregnancy and childbirth, the nurse practitioner or physician assistant must perform a physical examination and collaborate with a physician or surgeon.