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Disability insurance edd disability form. State disability insurance sdi is a state program that gives a cash benefit for one year or less to californians who are disabled due to significant illness who worked before becoming disabled. State disability insurance disability insurance and paid family leave benefits. Visit accessibility if you need reasonable accommodation or an alternative format to access information on our website. Visit online forms and publications to search view and order state disability insurance forms.
Review your completed form information for accuracy. Disability insurance di provides short term benefits to eligible workers who have a full or partial loss of wages due to a non work related illness injury or pregnancy. To avoid stocking outdated forms order a six month supply or less. Form de 2501 claim for disability insurance di benefits is a form to request by mail worker funded benefits to eligible workers who have a full or partial loss of wages due to disabilities that are not work related.
Sdi generally pays 55 of your wages for up to 52 weeks of disability. You may be eligible for di if you are unable to work due to non work related illness or injury pregnancy or. I authorize any physician practitioner hospital vocational rehabilitation counselor or workers compensation insurance carrier to furnish and disclose to employees of california employment development department edd all facts concerning my disability that are. The pdfs on this website are replicas of the official edd forms and publications.
Claim for disability insurance di benefits de 2501 english you must submit an original form provided by the edd either electronically or through us mail. Sdi forms and publications. The documents on this webpage are pdfs. It cannot be downloaded or reproduced.
On the confirmation page write down the form receipt number. This summary report contains monthly information on claims activities average weekly benefit amounts average duration of claims benefits authorized the di fund balance and other statistics. To submit the de 2501 electronically visit how to file a disability insurance claim in sdi online. Health insurance portability and accountability act authorization.
Select submit to send the completed sdi online part a claimant s statement to the edd. The california state disability insurance sdi program provides short term disability insurance di and paid family leave pfl wage replacement benefits to eligible workers who need time off work. Select disability insurance and follow the steps in each section to fill out the form.
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