Understanding California State Disability Insurance

According to the CDC, about 26% of adults in the U.S. are living with some type of disability – and even among younger adults, the rate is surprisingly high: 21% of people aged 18-44 have a disability.¹ Yet, few people really understand how disability insurance works or how to access it.

There are several different types of disability insurance. Some are from private insurance companies (such as Guardian), and others are government-sponsored, with distinct eligibility requirements and benefits varying by state.* This article is specific to California State Disability Insurance and provides a helpful overview of that program's eligibility requirements, the different types of claims, and the weekly benefit paid. It will also help you understand how you may be able to extend these benefits beyond the maximum allotments should you be out of work due to an eligible disability.

What is California Disability Insurance?

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 due to non-work-related illness or injury, pregnancy, or childbirth. The program is administered by California's Employment Development Department (EDD).²

What is the difference between disability insurance (DI) and paid family leave (PFL)?

Both types of benefits are designed to provide temporary assistance to help workers navigate challenging circumstances.³ Disability insurance provides weekly payments to replace lost income when you can't work due to an injury or mental or physical condition that isn't job-related. (Job-related issues are covered by Worker's Compensation).⁴ PFL benefits help replace income when you can't work due to covered family leave, such as for childbirth or adoption, or to care for an immediate family member.⁵

How much can you get if you qualify for California SDI benefits?

The California SDI program is designed to provide weekly payments that replace a portion of your normal wages:⁶

• The exact amount received is dependent on your highest earning quarter in the base period⁷

• It's estimated as 60% to 70% of the wages you earned 5 to 18 months before your claim start date and up to the maximum weekly payment amount of $1,620 (2023)⁸

• The maximum benefit duration is 52 weeks, or 39 weeks if you are self-employed⁹

The Paid Family Leave (PFL) benefit pays approximately 60-70% of wages (depending on income) for up to eight weeks within a 12-month period.¹⁰ The benefits are paid through a California EDD debit card.¹¹ Use this calculator from the EDD to determine your estimated disability or paid family leave benefits.

Eligibility requirements for California SDI benefits:¹²

To qualify for the California State Disability Insurance, you must meet the following criteria:

1. You should have earned at least $300 during the “base period” – a benefit period of 12 months corresponding to one of four quarters: Jan-Mar, Apr-June, Jul-Sep, Oct-Dec.

2. You must be unable to do your regular or customary work for at least eight consecutive days.

3. You must be actively seeking treatment from a licensed doctor or accredited religious practitioner during the first eight days of your disability.

4. You must remain under the care and treatment of a licensed doctor or accredited religious practitioner to continue receiving a weekly benefit.

There are several types of claims you can make under the California SDI program:¹³

• Disability Insurance (DI) Claim
  This provides short term disability benefits to eligible workers who have lost wages due to a non-work-related illness, injury, or pregnancy.

• Pregnancy Claim
  You can claim DI benefits if your pregnancy or childbirth-related conditions prevent you from performing regular or customary work activities. Certification from a medical provider documenting the condition and its impact on your work capacity may be required.

• Paid Family Leave Bonding Claim
  Specifically designed for new parents who need to take time off work to bond with their newborn baby, adopted child, or foster child, it allows you to claim up to eight weeks of paid leave.

• Paid Family Leave (PFL) Care Claim
  PFL claims provide up to six weeks of benefit payments if you lose wages when you take time off work to care for a seriously ill family member.

• Paid Family Leave Military Assistance Claim
  The PFL program also provides benefit payments to workers who need time off work to participate in a qualifying event because of a family member’s military deployment to a foreign country.

• Part-Time Worker—Disability and Paid Family Leave
  Part-time workers may be eligible to claim both DI and PFL under the California State Disability Insurance program, as long as you have paid into the SDI fund via payroll taxes. The amount of the benefit is determined by your wages during the base period of the claim. Each claim requires specific documentation to validate the claim and determine the weekly benefit amount.

• Reduced Wages—Disability Insurance and Paid Family Leave
  Under the California SDI program, you can file a claim for DI or PFL due to reduced wages if you are working less than full-time due to a disabling condition, need to care for a seriously ill family member, bond with a new child, or assist a family member called to active military duty.

• Self-Employed Disability Leave Insurance Elective Coverage (EC)
  EC claims are for self-employed or independent contractors who have opted to pay into the SDI program. This provides coverage for DI and PFL benefits.

• SDI and Nonindustrial Disability Insurance (NDI) for State Employees
  NDI provides partial wage replacement to state workers who lose wages due to a non-work-related illness, injury, or pregnancy. This is typically for California employees who do not pay into the State DI Fund but are provided similar benefits through the NDI program.

You may be eligible for other benefit programs instead of California SDI:

• Worker’s Compensation
  Workers' Compensation is an employer-paid insurance program for employees who sustain work-related injuries or illnesses. Consequently, if the illness or injury is work-related, you should file for Workers' Compensation, not SDI.¹⁴

• Voluntary Plan—Disability and Paid Family
  A Voluntary Plan (VP) is an alternative to the state-run California SDI and PFL programs. Some companies opt for a VP to provide their employees with benefits equal to, or better than, those offered by the state programs. VPs can offer advantages like faster claims processing, higher weekly benefits, and better customer service. These plans must be approved by the Employment Development Department (EDD) of California and must not cost employees more than the state plan.¹⁵

How the California Disability Insurance program impacts or integrates with other benefits:

Paid vacation

The California SDI program operates independently from your other benefits, like paid vacation. While these benefits don't directly integrate with your vacation benefits, some employers may have policies that require you to use your paid vacation time before tapping into SDI benefits.¹⁶

Sick days

Similar to vacation benefits, the SDI program typically operates separately from your sick leave benefit. However, employers may require you to exhaust your accrued sick leave before you can begin receiving SDI benefits. Receiving SDI does not prevent you from utilizing your sick days; instead, it serves as an additional form of support when you cannot work due to disability or family care needs.¹⁷

Social Security Disability (SSDI)

SDI insurance can complement Social Security disability benefits. The California SDI program is designed to provide short-term support, typically for conditions that last a year or less. SSDI is designed to provide longer-term disability, usually for conditions expected to last over a year, or result in death. The two programs can, in some circumstances, work together to provide short term and long term disability insurance coverage. However, the process for claiming SSDI benefits is stringent just 35% of all claims are approved.¹⁸ And, if your claim is accepted, the average monthly benefit is approximately $1,3583, or just above the federal poverty level.¹⁹ That’s why many people prefer to rely on private long-term disability insurance purchased individually or through their employer (if available).²⁰

How to apply for or file an SDI claim:

You can create an account at myEDD (Employee Development Department) for the State of California to submit a claim. You must complete and mail the Claim for Disability Insurance (DI) Benefits (DE 2501) on the day your disability begins, but no later than 49 days after the onset of your disability to avoid losing benefits. Expect to provide the following information when filing a claim:²¹

• Valid California Driver's License (CDL) or Identification (ID) card number

• Your full legal name as it appears on your CDL or ID

• Date of birth as shown on your CDL or ID

• Social Security number

• Most current employer’s business name, phone number, and mailing address (as stated on your W-2 or paystub)

• Last date you worked your normal or usual duties (or the date you began working less than full or modified duty)

You will also need your physician/practitioner to complete the medical certification portion of your disability claim. Note that there are several circumstances that could disqualify you from receiving California SDI, including but not limited to:

• You are not employed and cannot prove that you were actively seeking employment at the time of the disability.

• Your disability was not confirmed by a certified medical professional, or you refused to undergo a required medical examination.

• You are receiving Unemployment Insurance or Paid Family Leave benefits.

• You are not suffering a loss of wages (for example, if your employer is still paying you a full salary).

• You failed to apply within the 49-day deadline from the onset of your disability.

What happens when California State Disability runs out?

Your benefit eligibility lasts until the expected recovery date provided by your doctor. If you have not fully recovered and need to continue your benefits, you must submit a Physician/Practitioner’s Supplementary Certificate (DE 2525XX) with your final payment. Have your physician/practitioner complete and submit this claim form to find out if you are eligible for an extension.²²

Other benefit options when SDI benefits run out:

If your disability is projected to last longer than the 39- or 52-week program limit, you may also want to look into other programs.

• Social Security Disability Insurance (SSDI) This program, administered by the Social Security Administration, provides financial support to individuals who are unable to work due to a severe, long-term, or permanent disability. However, SSDI benefits can be difficult to qualify for and typically include an individual's work history, the nature and severity of their disability, and their inability to perform substantial gainful activity. And if approved, the average benefit amount may be challenging to live on.²³

• Supplemental Social Security Income (SSI) This provides financial assistance to individuals who are aged, blind, or disabled and who have limited income and resources, with the means to meet their basic needs, such as food, clothing, and shelter. Eligibility for SSI is determined based on specific criteria, including the individual's income, resources, and residential status.²⁴

• Unemployment Insurance (UI) This provides temporary financial assistance to individuals who have lost their jobs through no fault of their own, and who are actively seeking employment. Eligibility for unemployment benefits is determined by specific criteria, primarily based on the individual's previous earnings and the circumstances of their unemployment.²⁵

• Private long-term disability insurance Many employers offer group long-term disability insurance as a voluntary (employee-paid) benefit. These plans typically have a waiting period until benefits start (3-6 months is common) and are typically designed to replace between 40%-70% of income. Depending on the policy, long-term disability benefits can last 2, 5, 10 years, or even until retirement age. If you're looking for more protection than what's offered by your employer plan, supplemental disability insurance is also available.

Guardian can help you get long term disability protection

If you're concerned about the potential impact of a lasting disability on your finances and lifestyle, you can get ahead of the problem by purchasing a long-term disability insurance plan. If coverage isn't available either through your employer, individual disability insurance can be an excellent option.

This is a policy you purchase for yourself, so you can tailor it to your needs. So, for example, you can lower your premiums by getting a policy with a 1-year waiting period, that starts paying after California SDI benefits ends. How much does long-term disability insurance cost? Expect to 1% - 3% of your salary.²⁶ These policies are typically bought through a financial representative; if you don't have one, or if that person doesn't have a lot of experience with disability insurance, a Guardian financial professional can give you a disability insurance quote.

Frequently asked questions about the California Disability Insurance program