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How to qualify for disability insurance

how to qualify for disability insurance

Talk to a Disability Lawyer

California is one of a handful of states that has a paid short-term disability program. This program, which is funded by employee contributions made through payroll withholding, pays employees a portion of their usual wages while they are temporarily unable to work due to disability.

Most California employees qualify for disability benefits through this program, as long as they meet the state’s eligibility requirements. If you meet these requirements and file the necessary paperwork, you will receive benefit payments, generally every two weeks, until you are able to return to work.

Eligibility for California Short-Term Disability Insurance (SDI)

To receive benefits, you must meet all of the following requirements:

  • You must be unable to do your regular work for at least eight consecutive days. (There is a seven-day waiting period, during which you may not collect benefits. On the eighth day, you become eligible for SDI.)
  • You must have been either employed or actively looking for work at the time you became disabled.
  • You must have lost wages because of your disability. For example, if your employer moves you to a light duty position and continues paying you the same amount, you won’t collect any benefits.
  • You must have earned at least $300, from which state disability insurance deductions were withheld, during a previous period.
  • You must be under the care and treatment of a licensed doctor or accredited religious practitioner.
  • You must complete and mail a claim form within 49 days of the date you became disabled.
  • Your doctor must complete the part of the form that provides medical certification of your disability. A licensed midwife, nurse-midwife, or nurse practitioner may also complete the medical certification for disabilities related to normal pregnancy or childbirth. (There is a separate form to be completed by a religious practitioner, if you are not under the care of a medical professional.)

Ineligibility for SDI

There are a number of reasons why an applicant may not be eligible for SDI benefits. You won’t be eligible in these circumstances:

  • You are not suffering a loss of wages. If you are still working and receiving your regular salary, or you are on paid sick leave, you may not have any wage

    loss to be made up by SDI benefits.

  • You are claiming or receiving Unemployment Insurance or Paid Family Leave benefits.
  • You became disabled while committing a crime resulting in a felony conviction.
  • You are in jail, prison, recovery home, or any other place because you were convicted of a crime.
  • You are receiving Workers' Compensation benefits at a weekly rate equal to or greater than the DI rate.
  • You fail to have a requested independent medical examination.

How to File a Claim

It isn’t difficult to file an SDI claim in California. Usually, the employer or the employee’s health care practitioner will provide the form; you can also get a copy at the website of the state’s Economic Development Department (EDD). You must complete part of the form and your health care practitioner must complete the rest. Once the form is complete, you submit it to the EDD; you must submit the form within 49 days after becoming disabled, or you might not receive any benefits.

The EDD may call you or otherwise contact you if it has any questions. It will also contact your employer to find out your wages and other information. If the EDD determines that you are eligible, it will send you a notice informing you of your eligibility, your projected benefit amount, and when your benefits will begin. You will receive benefits approximately every two weeks; currently, the EDD provides benefits through a bank debit card.

How Much Will You Receive?

California’s SDI program pays approximately 55% of your usual wages, up to a cap. This amount is not subject to tax, so no withholding will be taken from the payment.

Your “usual” wages isn’t necessarily the amount you were earning just before becoming disabled. Instead, California calculates benefits using the “base period.” In most cases, this is the 12-month period ending just before the last complete calendar quarter you worked before becoming disabled. For example, if you became disabled in August of 2013, the base period would be April 1, 2012 through March 31, 2013. You will be paid about 55% of the wages you received during the highest-paid quarter of your base period. For more information, see our article on how to calculate your short-term disability benefits in California .

Category: Insurance

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