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Physicians/Practitioners FAQs

Yes, you or your office may charge patients for completing the forms. There is no law that stops you from charging a fee to complete Disability or Paid Family Leave forms.

No, we cannot require a physician/practitioner to certify a claim or a medical extension. All certifications are at the discretion of the physician/practitioner.

Disability Insurance (DI)

Your patient must be unable to perform their regular work for at least eight days to qualify for benefits.

If your patient files a new claim for the same condition within 60 days of the initial claim, there will be no new waiting period. We treat it as a continuation of the initial claim.

Paid Family Leave (PFL)

There is no waiting period for PFL claims. However, for care claims, your patient’s caregiver must be unable to do their regular work for at least one day due to the need to provide care.

You can provide a medical certification on a care claim for any serious health condition. A serious health condition is:

  • Any illness, injury, impairment, or physical or mental condition that involves patient care:
    • At home.
    • In a hospital.
    • In hospice.
    • In a residential medical care facility.

It also includes any period of being unable to:

  • Work.
  • Attend school.
  • Perform other regular daily activities.

Providing care may include:

  • Helping with medical needs.
  • Eating.
  • Self-care.
  • Transportation.
  • Providing emotional support.
  • Planning future care.
  • Providing relief for other caregivers.

Any eligible California worker who takes time off work to care for an ill family member may file a Paid Family Leave care claim. They must meet all the eligibility requirements.

Eligible family members include:

  • Child.
  • Spouse.
  • Parent.
  • Parent-in-law.
  • Grandparent.
  • Grandchild.
  • Sibling.

Yes, your patient can file for Disability Insurance if it’s medically unsafe for them to continue their regular work. You must certify their claim with a valid pregnancy-related diagnosis code for the complication.

Yes, your patient can file for disability benefits if their job requirements (e.g., lifting, continuous standing, chemical exposure, etc.) pose a risk to their health or the fetus. You must provide a medical certification with a valid:

  • Pregnancy-related diagnosis code (e.g., supervision of a normal pregnancy).
  • Occupational hazard code (e.g., exposure to toxic agents in agriculture or manufacturing).

Disability claims

You must return your medical certification as soon as possible but no later than 49 days from the date your patient’s disability begins.

Paid Family Leave Care Claim

You must return your medical certification as soon as possible but no later than 41 days from the date the caregiver’s family leave begins.

Important: We will not process the claim until we receive the medical certification for the disability or care claim.

If you don’t submit your medical certificate or medical extension on time, your patient’s or their caregiver’s benefits may be:

  • Delayed
  • Denied
  • Reduced

If the medical certificate is not received on time, we will notify your patient or their caregiver of any updates.

Yes, disability covers elective and cosmetic surgeries if:

Yes, benefits are available for a limited time to residents in an alcohol recovery home or drug-free facility. Disabilities caused by acute or chronic alcoholism or drug abuse are not limited if they are being treated.

Alcohol Rehabilitation

Your patient may qualify for up to 30 days of disability benefits if:

  • They live at an approved, residential alcohol rehabilitation facility.
  • You recommend the rehab facility.
  • The facility has a license and certification from the state where it is located.

They may receive an extra 60 days of payments if:

  • They stay in the facility for longer treatment.
  • You certify they need the continued residential services.

Drug Rehabilitation

Your patient may qualify for up to 45 days of disability benefits if:

  • They live at an approved, residential drug-free rehabilitation facility.
  • You recommend the rehab facility.
  • The facility has a license and certification from the state where it is located.

They may receive an extra 45 days of payments if:

  • They stay in the facility for longer treatment.
  • You certify they need the continued residential services.

You may submit medical certifications through SDI Online or by mailing a paper claim form: 

  • Claim for Disability Insurance (DI) Benefits(DE 2501) Part B-Physician or Practitioner’s Certificate.
  • Claim for Paid Family Leave (PFL) Benefits(DE 2501F) Part D-Physician/Practitioner’s Certification.

For more information, visit Certify and Manage Claims – Basics for Physicians/Practitioners.

We follow all Health Insurance Portability and Accountability Act (HIPAA), state, and federal laws in the handling of medical records.