Eligibility

Basic Eligibility for Your Employees

Eligibility for Disability Insurance

Disability Insurance benefits can be paid only after your employees meet all of the following requirements:

  • The individual must be unable to do their regular or customary work for at least eight consecutive days.
  • The individual must be employed or actively looking for work at the time they become disabled.
  • The individual must have lost wages because of their disability or, if unemployed, have been actively looking for work.
  • The individual must have earned at least $300 from which State Disability Insurance (SDI) deductions were withheld during a previous period.
  • The individual must be under the care and treatment of a licensed physician/practitioner or accredited religious practitioner during the first eight days of their disability. (The beginning date of a claim can be adjusted to meet this requirement.) The individual must remain under care and treatment to continue receiving benefits.
  • The individual’s physician/practitioner must complete the medical certification of their disability. A nurse practitioner may certify to a disability within his/her scope of practice however, he/she must perform a physical examination and collaborate with a physician or surgeon. A licensed midwife, nurse-midwife, or nurse practitioner may complete the medical certification for disabilities related to normal pregnancy or childbirth.
  • If the individual is under the care of an accredited religious practitioner, they may download and print the Claim for Disability Insurance Benefits-Religious Practitioner’s Certificate (DE 2502) (PDF).

Citizenship and immigration status do not affect eligibility.

An independent medical examination to determine the individual’s initial or continuing eligibility may be required.

Ineligibility for Disability Insurance

Your employee may apply for benefits even if they are not sure they are eligible. If they are found to be ineligible for all or part of a period claimed, they will be notified of the ineligible period and the reason. Your employee may not be eligible for Disability Insurance benefits if they:

  • Are claiming or receiving Unemployment Insurance or Paid Family Leave benefits.
  • Became disabled while committing a crime resulting in a felony conviction.
  • Are in jail, prison, recovery home, or any other place because they were convicted of a crime.
  • Are receiving workers' compensation benefits at a weekly rate equal to or greater than the DI rate.
  • Fail to have an independent medical examination when requested to do so.

Eligibility for Paid Family Leave

Employees covered by SDI are also covered for Paid Family Leave (PFL). If a Voluntary Plan insurer provides your company's Disability Insurance coverage, then it must also provide PFL coverage.

An employee may submit a claim for PFL insurance benefits for the following reasons:

  • To care for a seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner.
  • To bond with their new child entering the family through birth, adoption, or foster care placement.
  • To participate in a qualifying event because of a family member's (spouse, registered domestic partner, parent, or child) military deployment to a foreign country.

To qualify for PFL benefits, your employee must:

  • Be unable to do their regular or customary work due to their need for family leave.
  • Be employed or actively looking for work at the time their family leave begins.
  • Have lost wages because of their need to take family leave.
  • Have earned at least $300 from which State Disability Insurance (SDI) deductions were withheld during their base period.
  • Complete and submit their claim form no earlier than the first day their family leave begins, but no later than 41 days after their family leave begins or they may lose benefits.
  • Provide all supplemental documentation required for bonding, care, or military assist claims.
  • Provide a medical certificate on their care claim for the seriously ill family member. The certificate must be completed by the care recipient's physician/practitioner.

Citizenship and immigration status do not affect eligibility.

A serious health condition means an illness, injury, impairment, or physical or mental condition of a patient that involves inpatient care in a hospital, hospice, or residential medical care facility. This includes any period of incapacity (e.g., inability to work, attend school, or perform other regular daily activities) or any subsequent treatment in connection with such inpatient care; or continuing treatment by a physician/practitioner unless complications arise. Cosmetic treatments, the common cold, influenza, earaches, upset stomach, minor ulcers, and headaches other than migraine are examples of conditions that do not meet the definition of a serious health condition for purposes of PFL benefits.

Employers with employees working in San Francisco: You may be required to supplement employee wages under the San Francisco Paid Parental Leave for Bonding with New Child Ordinance. For more information view the Paid Parental Leave Ordinance.

Ineligibility for Paid Family Leave

Your employee may not be eligible for Paid Family Leave benefits if they:

  • Receive Disability Insurance, Unemployment Insurance, or workers’ compensation.
  • Are not working or looking for work at the time they begin their family care leave.
  • Are not suffering a loss of wages.
  • Are in custody due to conviction of a crime.
  • Cannot provide certification by the treating physician/practitioner that they are needed for care, proof of relationship documents for bonding, or certification of the military assist event.