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Eligibility for Disability Insurance

DI benefits can be paid only after you meet all of the following requirements:

  • You must be unable to do your regular or customary work for at least eight consecutive days.
  • You must be employed or actively looking for work at the time you become disabled.
  • You must have lost wages because of your disability or, if unemployed, have been actively looking for work.
  • You must have earned at least $300 from which SDI deductions were withheld during a previous period.
  • You must be under the care and treatment of a licensed doctor or accredited religious practitioner during the first eight days of your disability. (The beginning date of a claim can be adjusted to meet this requirement.) You must remain under care and treatment to continue receiving benefits.
  • You must complete and mail a claim form within 49 days of the date you became disabled or you may lose benefits.
  • Your doctor must complete the medical certification of your disability. A licensed midwife, nurse-midwife, or nurse practitioner may complete the medical certification for disabilities related to normal pregnancy or childbirth. (If you are under the care of a religious practitioner, request a “Practitioner’s Certificate”, DE 2502, from the SDI office. Certification by a religious practitioner is acceptable only if the practitioner has been accredited by Employment Development Department.)

If a spouse, registered domestic partner, parent, or child is providing care for the claimant, he/she may be eligible for Paid Family Leave benefits.

An independent medical examination to determine your initial or continuing eligibility may be required.

Ineligibility - Disability Insurance

You may apply for benefits even if you are not sure you are eligible. If you are found to be ineligible for all or part of a period claimed, you will be notified of the ineligible period and the reason. You may not be eligible for SDI benefits if:

  • You are not suffering a loss of wages
  • 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 an independent medical examination when requested to do so.

Eligibility for Paid Family Leave

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

An employee may submit a claim for Paid Family Leave insurance benefits

for the following reasons:

  • To care for a seriously ill child, spouse, parent, or registered domestic partner;
  • To bond with the employee’s new child or the new child of the employee’s spouse or registered domestic partner; or
  • To bond with a child in connection with the adoption or foster care placement of the child with the employee or the employee's spouse or registered domestic partner.

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 or 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 Paid Family Leave insurance benefits.

Ineligibility - Paid Family Leave

You may not be eligible for PFL insurance benefits if:

  • You are not suffering a loss of wages;
  • You receive Disability Insurance, Unemployment Insurance, or Workers’ Compensation;
  • You are not working or looking for work at the time you begin your family care leave;
  • The need for care is not supported by the certificate of a treating physician or practitioner; or
  • You are in jail, prison, recovery home, or any other place because you were convicted of a crime

Eligibility for Disability Insurance Elective Coverage

Any self-employed individual or general partner(s) who meets the requirements, such as receives the major part of his or her income from the trade, business, or occupation in which he or she is self-employed or a general partner may apply for coverage. It is not required that all active general partners be included in the election. A general partnership also includes a husband and wife co-ownership in which both spouses are active in the operation and management of the business.

Major Requirements

  • You must own your own business or be self-employed.
  • You must have a minimum net profit of $4,600 annually.
  • You must possess a valid active license, if required by your occupation.
  • You must be able to perform all of your normal duties on a full-time basis at the time your application is submitted.
  • You must derive the major portion of your income from your trade, business, or occupation.
  • Your business cannot be seasonal.
  • You must stay in the program for two complete calendar years unless you discontinue your business or move out of California.

Additional information on:

Category: Insurance

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