Claim Filing & Processing
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Basic Eligibility
Benefit Interruption and Termination
Benefit Reductions
Disqualification
Federal Privacy Act
Fraud
How Benefits are Paid
How to Apply How to Complete the Claim Form
Ineligibility
Information Collection and Access
Overpayment
Special Circumstances
Your Benefit Amounts
Your Responsibilities
Your Rights
BASIC ELIGIBILITY
SDI 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 (see "YOUR BENEFIT AMOUNTS" in next column).
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.)
We may require an independent medical examination to determine your initial or continuing eligibility.
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INELIGIBILITY
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 claiming or receiving Unemployment Insurance or Paid Family Leave benefits.
became disabled while committing a crime resulting in a felony conviction.
are receiving workers' compensation benefits at a weekly rate equal to or greater than the SDI rate.
are in jail, prison, or recovery home because you were convicted of a crime.
fail to have an independent medical examination when requested to do so.
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FRAUD
Under sections 2101, 2116, and 2122 of the California Unemployment Insurance Code, it is a violation to willfully make a false statement or knowingly conceal a material fact in order to obtain the payment of any benefits, such violation being punishable by imprisonment and/or by a fine not exceeding $20,000 or both. To detect and discourage fraud, SDI continually monitors claim payments, vigorously investigates suspicious activity, and will seek restitution and conviction through prosecution.
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YOUR RESPONSIBILITIES
File your claim and other forms completely, accurately, and in a timely manner. If a form is late, include with the form a written explanation of the reason(s).
Read carefully the instructions on this and all other forms you receive from SDI. If you are not sure what is required, contact the SDI office.
Report in writing to the SDI office any:
change of address or telephone number.
return to part-time or full-time work.
recovery from your disability.
income you receive.
Keep an appointment for an independent medical examination, if requested.
Include your name and Social Security number on all correspondence.
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YOUR RIGHTS
Information about your claim will be kept confidential, except for the purposes allowed by law. California Civil Code, section 1798.34, gives you the right to inspect any personal records maintained about you by the Employment Development Department. Section 1798.35 permits you to request that the record be corrected if you believe it is not accurate, relevant, timely, or complete. Certain types of information that would generally be considered personal are exempt from disclosure to you: medical or psychological records where knowledge of the contents might be harmful to the subject (Civil Code, section 1798.40); records of active criminal, civil, or administrative investigations (Civil Code, section 1798.40). If you are denied access to records which you believe you have a right to inspect or if your request to amend your records is refused, you may file an appeal with the SDI office. You may request a copy of your file by calling SDI at 1-800-480-3287.
You also have the right to appeal any disqualification, overpayment, or penalty. Specific instructions on how to appeal will be provided on any appealable document you receive. If you file an appeal and you remain disabled, you must continue to complete and return continued claim certifications.
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YOUR BENEFIT AMOUNTS
Your claim begins on the date your disability began. SDI calculates your weekly benefit amount using your base period. The date your disability began determines your base period, unless the claim effective date is adjusted by SDI. If you want your claim to begin later so that you will have a different base period, please call SDI at 1-800-480-3287 before you file your claim.
This base period covers 12 months and is divided into four consecutive quarters. Your base period includes wages subject to SDI tax which you were paid approximately 5 to 17 months before your disability claim begins. Your base period does not include wages being paid at the time the disability begins. For a disability claim to be valid, you must have at least $300 in wages in the base period. Using the following, you may determine the base period for your claim.
If your claim begins in:
January, February, or March, your base period is the 12 months ending last September 30. (Example: A claim beginning February 14, 2005, uses a base period of October 1, 2003, through September 30, 2004.)
April, May, or June, your base period is the 12 months ending last December 31. (Example: A claim beginning June 20, 2005, uses a base period of January 1, 2004, through December 31, 2004.)
July, August, or September, your base period is the 12 months ending last March 31. (Example: A claim beginning September 27, 2005, uses a base period of April 1, 2004, through March 31, 2005.)
October, November, or December, your base period is the 12 months ending last June 30. (Example: A claim beginning November 2, 2005, uses a base period of July 1, 2004, through June 30, 2005.)
The quarter of your base period in which you were paid the highest wages determines your weekly benefit amount. Refer to the DI Weekly Benefit Chart for further information. You may need to download the free Adobe Reader to view and print linked documents.
You may not change the beginning date of your claim or adjust your base period after you have established a valid claim.
Your daily benefit amount is your weekly benefit amount divided by seven. Your maximum benefit amount is 52 times your weekly benefit amount or the total wages subject to SDI tax paid in your base period, whichever is less. Exceptions are as follows:
For employers and self-employed individuals who elect SDI coverage, the maximum benefit amount is 39 times the weekly rate.
For residents in a state-approved alcoholic recovery home or drug-free residential facility, the maximum payable period is 90 days. (However, disabilities related to or caused by acute or chronic alcoholism or drug abuse which are being medically treated do not have this limitation.)
Contact the SDI office to inquire and to provide additional information if your situation fits any of these circumstances: If you do not have sufficient base period wages and you remain disabled, you may be able to establish a valid claim by using a later beginning date. If you do not have enough base period wages and you were actively seeking work for 60 days or more in any quarter of the base period, you may be able to substitute wages paid in prior quarters. Additionally, you may be entitled to substitute wages paid in prior quarters either to make your claim valid or to increase your benefit amount if during your base period you were in the military service, received workers' compensation benefits, or did not work because of a labor dispute.
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HOW BENEFITS ARE PAID
When your claim is received, the SDI office will notify you of your weekly benefit amount and request any additional information needed to determine your eligibility. If you meet all requirements, a check will be mailed to you from a central payment center. The majority of claims are processed and payments issued within 14 days of receipt of both the claimant's and the doctor's portions of the claim. The first seven days of your claim is a waiting period for which no benefits are paid.
If you are eligible for further benefits, either additional payments will be sent automatically or a continued claim certification form for the next period will be enclosed. Usually the certification periods are for two weeks; however, the period will vary under certain circumstances. You will be paid 1/7 of your weekly benefit amount for each calendar day you are eligible and disabled unless benefits are reduced for some reason. (See "BENEFIT REDUCTIONS" below.) If you receive SDI benefits in place of unemployment insurance or paid family leave benefits, the amounts paid will be reported to the Internal Revenue Service. Contact the Internal Revenue Service for more specific tax information.
2007-02-07 09:42:48
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answer #4
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answered by scm82 2
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