This topic contains the following information:

• Determining Eligibility for SDI
• Filing Period for SDI
• Providing Employee Information for SDI
• Determining Ineligibility for SDI Payments
• SDI Disqualifications
• Appealing the EDD’s SDI Decision

Determining Eligibility for SDI

Individuals entitled to disability insurance benefits can receive compensation for mental or physical conditions, including pregnancy (see “SDI and Pregnancy Disability” in Coordinating State Disability Insurance With Other Benefits), that prevent them from performing their customary work.

An employee is considered disabled on any day in which they are:

• Certified disabled by their physician or practitioner.
• Ordered not to work by a written order from a state or local health officer because they areinfected with or suspected of being infected with a communicable disease.
• Being medically treated for acute alcoholism or acute drug-induced illness.1

To receive SDI benefits, an individual must be covered by one of the SDI plans (see Employment Covered by State Disability Insurance) and meet all of the following requirements:

• Be unable to perform their regular or customary work.
• Have a loss of wages because of a disability.
• Be disabled at least eight calendar days.2
• Be under the care and treatment of a physician or practitioner who certifies that the individual is disabled. Certification can be made by:
• A licensed medical or osteopathic physician or surgeon, chiropractor, dentist, podiatrist, optometrist, designated psychologist or an authorized medical officer of a U.S. government facility.
• A licensed midwife, nurse-midwife or nurse practitioner can certify a normal pregnancy and childbirth.
• Physician assistants.3
• In some instances, an authorized and accredited religious practitioner may certify a disability.4
• Mailed a timely claim for SDI benefits within 49 days from the date of becoming disabled. The EDD can extend this time if the individual can establish good cause for filing late.
• Be employed or actively looking for employment when the disability began.
• Earned at least $300 during a previous 12-month base period, from which SDI taxes were withheld.

Individuals who are residents in licensed drug-free residential facilities or alcoholic recovery homes and/or referred there by a physician, are eligible for the following disability benefits:

Facilities must:

• Be located in California or be licensed by the state in which they are located and recommended by the referring physician.
• Certify that the individual is participating in an approved drug-free residential program5 or alcoholic recovery program.6

Filing Period for SDI

After an individual suffers unemployment resulting from disability, they must file a claim for disability benefits within 49 days of the first day of disability, although the EDD’s director can extend this time for good cause.7 The EDD provides a form that individuals must use in making the claim, Form DE 2501 - Claim for State Disability Insurance Benefits. The application for disability benefits must be accompanied by a certificate from a physician or religious organization. The EDD will return incomplete forms to the claimant for resubmission within 10 days.

If an individual files a claim for subsequent disability arising from the same cause as the initial disability and not separated by more than 60 days from the original disability, the EDD uses a single disability period.8

The individual must file an application for subsequent period benefits within 49 days after the subsequent period of disability begins.

Providing Employee Information for SDI

After the claimant initially applies for benefits, their last employer receives notice of the claim ( DE 2503 - Notice to Employer of Disability Claim Filed ).9 An employer must notify the EDD of any information relevant to eligibility within two working days. However, if the claimant ceased working for an employer, the employer can transmit information about eligibility either two working days after notice or five working days after termination, whichever is later.10

Determining Ineligibility for SDI Payments

An employee cannot receive SDI payments if they are:

• Receiving unemployment insurance payments.
• Receiving full wages.
• In legal custody as a result of a conviction or when confined by court order.
• Receiving workers’ compensation at a weekly rate equal to or greater than the SDI rate.

People involved in trade disputes who are ineligible for UI benefits do not lose SDI if they otherwise qualify for those benefits.

An individual may be denied SDI benefits if they’ve been confined or institutionalized as an alcoholic, drug addict or sexual psychopath, despite being otherwise qualified. This disqualification ends with release from confinement.11

People who willfully make false statements or conceal material facts to obtain disability benefits are disqualified, which can last from seven to 35 days.12 Time will not be counted as satisfying this period of disqualification unless the claimant remains, in all other respects, eligible for benefits. A subsequent offense of this kind carries a disqualification up to 56 days.13

SDI Disqualifications

Disqualification from UI also creates a presumption of ineligibility for state disability benefits.14 This presumptive disqualification covers people who:

• Leave work without good cause and voluntarily
• Are terminated for misconduct
• Give false information or refuse to apply for or take suitable employment
• Fail to report to a public employment office during a prior disqualification period
• Are additionally disqualified by the EDD’s director for not having a bona fide illness or injury for successive quarterly periods covered by the benefits15

A disqualification for disability benefits on grounds that the claimant lacks UI eligibility will last as long as the unemployment disqualification lasts.16 But a claimant may be eligible for SDI benefits if they can show that the unemployment is the result of an illness or injury and that they otherwise meets disability requirements.17 For more information on UI, please see Unemployment Insurance.

Any individual who, with the intent to defraud, falsely certifies the medical condition of any person to obtain disability insurance benefits may receive a fine up to $20,000, up to one year imprisonment, or both.18

Appealing the EDD’s SDI Decision

The EDD evaluates all information and determines eligibility. If the EDD finds the claimant has no right to SDI benefits, the agency notifies the claimant.19

Within 20 days of receiving a notice of benefit amounts, an eligible claimant can protest to the EDD. If the EDD denies the claim for benefits, the claimant can appeal to an Administrative Law Judge (ALJ) within 20 days. The period for appealing eligibility or computation questions can be extended for good cause.20

In addition, the EDD can act on its own to reconsider prior rulings on benefits or eligibility. The EDD must notify the claimant of any reconsideration. The claimant has a right to appeal the decision in the same manner as an original ruling. To reconsider a decision, the EDD must have good cause. It can undertake reconsideration only within the time before a claimant’s appeal.

Employees and employers can appeal a decision of the ALJ to the Unemployment Insurance Appeals Board using procedures for appeals in unemployment compensation cases.21

1. UI Code sec. 2626