Certify and Manage Claims – Basics for Physicians/Practitioners
Understand the basics in certifying and managing Disability Insurance (DI) and Paid Family Leave (PFL) claims as a physician/practitioner.
Learn more about your role and who can certify patient claims.
Before You Certify
Both you and the patient must certify that the information provided is complete and accurate. Properly completed claims are generally processed within two weeks of our receipt.
When reviewing your certification forms, we pay special attention to:
- International Classification of Diseases (ICD) codes
- Estimated recovery dates
- Timeframe needed to provide family care
- Patient’s age, gender, and occupation
- Patient’s medical history
If the estimated recovery date is longer than what normally would be expected for that diagnosis, 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. Providing sufficient information and an explanation for the longer timeframe can reduce the need for us to make this request.
How to Certify
For Disability Insurance claims, fill out and sign “Part B – Physician/Practitioner’s Certificate” on the Claim for Disability Insurance (DI) Benefits (DE 2501) form. Mail it in within 49 days from the date your patient’s disability begins.
For Paid Family Leave claims, fill out and sign “Part D – Physician/Practitioner’s Certification” on the Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form. Mail it in within 41 days from the date family leave begins.
Below you will find information on how to submit a certification. For more information, we offer a step-by-step tutorial.
Benefit Programs Online (BPO) is a secure portal for EDD customers to access their Disability Insurance, Paid Family Leave, and Unemployment Insurance claims.
With BPO, you can login to SDI Online to view your patient’s initial claim for benefits, fill out and submit claim certifications, and view claim certification history.
You can mail the forms to the EDD using the pre-addressed envelope provided. Do not mail these forms to the EDD if you have already submitted the claim online. Failure to return them on time may cause your patient’s benefits to be denied
To avoid delays in claims processing, complete Part B of Claim for Disability Insurance (DI) Benefits (DE 2501) or Part D of Claim for Paid Family Leave (PFL) Benefits (DE 2501F) forms as follows:
- Use black ink only.
- Type or write clearly within the boxes provided.
- Do not fax the form.
- Mail the completed form to the EDD in the pre-addressed envelope provided.
- Include physician/practitioner’s original signature.
- Include physician/practitioner’s license number.
- Include the estimated date the patient will be able to return to his/her regular or customary work or the estimated date your patient will no longer require care.
- Include the diagnosis and ICD9 code, (If a diagnosis has not been established, a detailed statement of disabling symptoms must be provided.)
Changes to Your Patient’s Claim
If your patient’s disability or the need for care extends beyond the original period of time that was on their initial claim or the most recent medical extension, they will ask you to complete and submit an additional medical certification:
- Physician/Practitioner’s Supplementary Certificate (DE 2525XX) – You can access this form by logging in to your Benefit Programs Online (BPO) account and selecting SDI Online. You can also get a paper copy from your patient.
- Paid Family Leave (PFL) Supplemental Claim Certification (DE 2525XFA) – If your patient’s caregiver needs to continue providing care, you must complete the "Physician/Practitioner’s Supplementary Certificate" section of this form.
If you are an accredited religious practitioner, you can download and print the following forms. Do not compete these forms if you are a licensed physician or practitioner.
- Claim for Disability Insurance Benefits – Religious Practitioner’s Certificate (DE 2502)
- Practitioner’s Certification for Paid Family Leave (PFL) Benefits (DE 2502F)
If your patient has an industrial related illness or injury, please have the patient contact their employer regarding Workers’ Compensation benefits.
Disability Insurance and Paid Family Leave claim forms are available at no cost to you. For more information on how to access these forms, you can:
- Visit Physician/Practitioner Forms and Publications.
- Call 1-855-342-3645 (TTY users dial the California Relay Service at 711).
Last Revised: 04/01/2021