If you are temporarily unable to work because of an injury, illness, pregnancy, or mental health condition, you may wonder what qualifies you for short-term disability in California. The lawyers at Kampf, Schiavone & Associates seek to provide insight into short-term disability so that you understand if you are eligible for this benefit.
Qualifications for Short-Term Disability in California
Short-Term Disability (STD) benefits are allocated from the State Disability Insurance (SDI) program, and this program provides compensation to employees who are unable to work temporarily because of an illness, injury, pregnancy, or mental health condition. Workers’ compensation lawyers can assist in understanding the differences between STD benefits and workers’ compensation benefits, helping to ensure that your claims are handled effectively. Below are key items that may qualify you for short-term disability benefits:
- Non-Work-Related Injury or Illness: Short-term disability may be available if you have suffered or experienced a non-work-related injury or illness that inhibits your ability to perform regular job duties. This can include physical injuries such as back pain and broken bones, illnesses such as cancer and heart conditions, and mental health conditions such as depression and anxiety.
- Pregnancy or Childbirth: California’s SDI program can also provide short-term disability benefits for pregnancy-related conditions such as pregnancy complications and time needed for recovery from childbirth. The duration of pregnancy-related disability benefits is often varied and dependent on a doctor’s recommendations.
- Doctor Certification: Employees are required to provide medical evidence to prove that their condition prevents them from working in order to qualify for SDI benefits. This generally requires that a doctor or licensed healthcare provider certify that you are temporarily unable to work because of a disability.A doctor must provide specific insights and details into your condition and its severity, share how the condition impacts your performance of job duties, and the expected duration of your disability.
- Employment Status: It may seem obvious, but you must be an employee to receive SDI, and you may not qualify if you are a contractor or are self-employed. You must have also contributed to the California State Disability Insurance program through paycheck deductions.
It is important to note that you must file your claim within 49 days of becoming disabled, and if you wait beyond this deadline, you may not be eligible for benefits even if you have a qualifying condition. It may be possible to receive both SDI benefits and other disability benefits at the same time, for example, you may also be eligible for workers’ compensation.
There are a few exceptions for what injuries can qualify for short-term disability. These exceptions include injuries sustained while committing a crime, self-inflicted injuries, and work-related injuries. Work-related injuries are generally handled through workers’ compensation, not SDI unless there is no workers’ compensation coverage for some reason. An injury considered to be work-related may include accidents that occur during the course of employment, such as slips, falls, and repetitive motion injuries.
How To Apply for Short-Term Disability
There are a few key steps you must follow in order to apply for Short-Term Disability (STD) benefits in California. Before applying, it is vital that you meet all of the eligibility criteria. This includes being an employee, contributing to the California SDI program, having a qualifying condition, and filing the claim on time.
You will also need a healthcare provider to verify that you are unable to work to qualify for benefits. You must complete a Doctor’s Certification or Physician’s Report and confirm the nature of your disability with an estimated timeline for how long the disability may last. You can then file your STD claim with the California Employment Development Department (EDD). This process can be done by mail, on the phone, or online. Beware of false doctors who may provide misleading or inaccurate information that could harm your claim. Always ensure your healthcare provider is reputable and properly documents your condition.
Once your claim is submitted, the EDD will review your claim and send a notice of eligibility. If you are denied, you will receive official reasons for the denial. You may have the option to appeal the decision if you disagree with the denial and believe you are eligible for the benefit.
FAQs
What Qualifies for Short-Term Disability Benefits in California?
In California, there are several medical conditions that can qualify for short-term disability benefits that are provided through the State Disability Insurance program, provided that the individual can prove their condition impacts their ability to perform their usual work duties. Eligible medical conditions include broken bones, infections, complications during pregnancy or childbirth, and mental health conditions.
What Conditions Automatically Qualify You for Disability in California?
In California, there are no automatically qualifying conditions. Instead, eligibility for disability is determined based on an individual’s ability to perform their regular work duties. Generally, in order to qualify, your condition must have prevented you from working for at least eight consecutive days, it must be certified by a healthcare provider, and it must be a non-work-related condition, as workplace conditions fall under workers’ comp.
Why Did My Short-Term Disability Claim Get Denied?
Short-term disability claims can get denied for a wide array of reasons, often related to eligibility, documentation, and procedural issues. A common reason disability is denied is because there is not enough medical evidence to prove the severity of your condition and your inability to work. It is key to ask for detailed documentation from your healthcare provider, including important test results and doctors’ notes, to prove your condition.
How Much Does California Short-Term Disability Pay?
In California, there is no set amount the State Disability Insurance program pays because it is based on how much you make. Typically, the SDI program pays 60% to 70% of your wages based on your highest-earning quarter during the base period, which is generally the first four of the last five completed calendar quarters before your disability claim.
Contact Kampf, Schiavone & Associates to Get Help with Short-Term Disability
If you believe you are eligible for Short-Term Disability benefits or have applied and been denied, it is time to meet with a trusted workers’ compensation attorney from Kampf, Schiavone & Associates. Reach out today to schedule an initial consultation and learn how our legal team can provide the support you need to see that you are given the benefits that you are eligible for based on your specific situation. Our team is ready to guide and support you.
