A claim begins the date that the individual’s disability began and the weekly benefit is calculated using his or her base period. Individuals who want their claims to begin at a later date must call 800-480-3287 before filing a claim.
Important: After a claim has been established, the filer cannot change the start date or the dates of the base period.
Workers that are ineligible are those not suffering a loss of wages, those that are claiming or receiving Unemployment Insurance or PFL benefits. Workers that were disabled when committing a crime that resulted in a felony conviction or are serving time in jail, prison or a recovery home because they were convicted of a crime are also ineligible. Any Worker’s Compensation payments must be less than the DI payments. Recipients must also comply with an independent medical examination when requested to do so or they run the risk of becoming ineligible for DI benefits.
Every claim has a 7-day non-payable waiting period, so individuals must be disabled 8 calendar days in order to collect DI benefits.
Those working more than one job that are eligible for DI will see that reflected in their compensation so long as both employers paid into the State Disability Insurance. Individuals need to mark the correct contact information for both employers on their claims and the dates that he or she last worked at each job.
While typically government workers are not offered DI, they are encouraged to file a claim. If they currently work for the government but have wages that were collected by a private employer during the base period, they may be eligible. Also, those in the public education sector may be entitled to DI benefits due to collective bargaining.
Vacation pay is not in conflict with DI, so individuals can receive payment at the same time. However, individuals may not collect sick leave wages that are equivalent to their full salary. Workers that are only collecting part of their salary via sick pay from their employer may be eligible for full or partial DI benefits.
Filing a Claim
Individuals are encouraged to file a claim through SDI Online (edd.ca.gov/disability/default.htm). The secure online filing system is the quickest way to file and for doctors, employers and voluntary plan administrators to submit supplementary information. Individuals simply need to register their accounts and once a claim is made, they’ll be provided with a receipt number that they must present to their medical care professional. Medical professionals and employers will also receive a receipt numbers for confirmation when forms are filed online. After an account is established, individuals can login to SDI Online at anytime. Individuals choosing to forgo the online platform may still file hard copies. Forms can be ordered from edd.ca.gov/forms but may take up to four weeks to be delivered, depending on the amount of copies requested. Individuals may also request forms from their health care professionals and employers. The forms must be mailed to the pre-addressed envelope provided. Individuals may not mail hard copies after submitting a claim at SDI Online.
Most claims are processed within 14 days of receipt with the properly completed forms. SDI Online users may login to their accounts to check the status of their claim at any time.
Individuals may certify for DI benefits using SDI Online if their claims are 10 weeks or more. Those individuals are put on an automatic payment cycle receiving payment every two weeks. Recipients whose claims are less than 10 weeks that are in active payment status need to re-certify (meaning sign off that they haven’t been able to perform their job) every two weeks using the Claim for Continued Disability Benefits (DE2500A) form. The form is not available for printing, but may be submitted at SDI Online. Individuals may also request to have it mailed to them. The form certifies that individuals have been unable to work for the past two weeks. Payment should be received within seven days.
Individuals who receive notice that their final DI payment is being issued and are still disabled need to have their health care provider fill out the Physician/Practitioner’s Supplementary Certificate (DE2525XX) form that accompanies the notice. If individuals are disabled beyond the claim period that was originally established, they may complete and submit the DE 2525XX online. To request the form, they can call 800-480-3287. Individuals whose health care professionals are unwilling to sign off on the extension may receive a second opinion. If they do see a different physician/practitioner, the health care professional must complete the DE 2525XX in order for the individual to continue to receive benefits.
Most individuals receive payment within two weeks of filing. Individuals can expect to receive an electronic benefit payment notification letter, a claim form, and an EDD Debit card separately in the mail the first week that they certify payment and their claim has been approved. Those individuals wishing to set up a direct deposit of the funds into their personal checking or savings accounts must call (866-692-9374) or visit Bank of America online (the partner bank for this program — individuals do not need to have a personal account there).
Individuals should note the various fees that can be presented when using the EDD Debit Card. They can expect to receive a fee for using a non-Bank of America ATM after their two free transactions per deposit; International ATM withdraws; domestic emergency cash transfer; and fees for any international transaction.
Drug and Alcohol Related Claims
Individuals may be approved to receive DI benefits for up to 45 days if living in an approved drug or alcohol rehabilitation facility. An additional 45 days of DI benefits may be awarded if the individual continues to live there and the health care professional continues to re-certify. Those living in rehabilitation centers for drug and alcohol as an alternative to jail or prison are not eligible for benefits.
Part-time and Supplemental Work
Individuals that are currently working but were told by a health care professional to reduce their hours, and those that are currently working part-time but are still suffering a loss of wages, may file for DI benefits. If their wage loss is greater than their benefit amount, they will receive their full DI rate. If their wage loss is equal to or less than their weekly amount, they will receive the amount of their wage loss only.
Paid Family Leave
Paid Family Leave (PFL) provides benefits for workers that need time off to care for a child, sibling, parent, parent-in-law, spouse, grandparent, grandchild, registered domestic partner. PFL is also available for individuals to take care of an adopted or foster child.
Paid Family Leave Eligibility
Like Disability Insurance, workers may be eligible for PFL if they suffer wage loss when they take time off to care for a sick family member or bond with a new child. Severe health conditions that require inpatient hospital care or hospice for injury, impairment, physical or mental illness that make a family member incapacitated fall into this category. Individuals may be eligible to receive up to six weeks of PFL benefits within the first year of the child’s birth, adoption, or foster care placement. They must complete and submit a claim form within 49 days of the first day of leave or risk losing benefits. Claims must be paid in full one day prior to the one-year anniversary date of the child’s birth, adoption, or foster care placement.
Filing a Claim
Individuals must file a claim through SDI Online to receive PFL benefits. There is a seven-day non-payable waiting period before individuals can start receiving benefits (except for new mothers transitioning from DI to PFL). The required seven-day waiting period can be served on consecutive days or on nonconsecutive days depending on the care required. After the waiting period, individuals are eligible for six weeks of payment. Mothers collecting DI benefits will automatically receive a form (DE 2501FP) to file for PFL when their pregnancy-related DI claim ends.
PFL recipients must report the following types of pay their receive when filing a claim: Adoption Pay, Back Pay, Bereavement Pay, Bonus Pay, Commissions, DI benefits, Donated Sick Leave Credits, Earnings from Partial Return to Work, Employer-Required Vacation pay, Holiday Pay, In Home Support Services wages, In Lieu of Notice Pay, Kin Care, Military Pay, Paid Time Off, Plant Shut Down Pay, Residuals, Rerun Fees, Reuse Fees, Sick Leave Pay, Unemployment Insurance benefits, or Workers’ Compensation benefits.
Those individuals receiving PFL benefits will receive payment the same way as those receiving DI benefits.
Part-time and Supplemental Work
Individuals working part-time may also use PFL benefits intermittently by marking “yes” to question A13 on form DE 2501F) and “yes” to question 6 on form DE 2501FP.
Hawaii Temporary Disability Insurance (TDI) requires employers to provide partial wage replacement for employees that are unable to perform their job due to an illness, pregnancy or an injury that didn’t happen on the job.
- The partial wage replacement program is available to individuals that have been employed in Hawaii for more than 20 hours per week over a 14-week period.
- The individuals must have made more than $400 but could have worked for more than one employers during that time frame.
- The individuals must be currently employed in order to be eligible and his or her employer must be paying TDI.
Not all individuals are eligible; those that work for the government, are under the age of 18, paid only on commission, some fishers, children ages 18-21 who are employed by their parents, interns and those working in conjunction with professional training schools, individuals who distribute newspapers and other types on media to consumers, and independent contractors who receive social service payments.
Individuals whose employers that don’t provide TDI coverage (and should) or have gone bankrupt can apply for a TDI Special Fund. The only other individuals eligible for TDI Special Fund are unemployed individuals who became disabled while collecting unemployment insurance (UI) and then became disabled or had their UI benefits suspended due to their disability.
Filing a Claim
Individuals must alert their employer immediately of their injury or illness. They may ask their employers for a TDI-45 form to submit within 90 days of the start of the disability period. The individual will need to complete Part A of the form, the employer will need to fill our Part B of the form and a physician will need to fill out Part C. The individual must mail the form to the employer’s disability insurance company, and either the employer or the insurance company will notify the individual of the befits he or she is entitled to.
Contesting a problem
If the claim is denied, the employer or the insurance company must send the individual a written notice. If the individual disagrees with the employer or insurance company, he or she may appeal the decision within 20 days by explaining why he or she is entitled to benefits and send two copies of the TDI-46 form to the Disability Compensation Division (P.O. Box 3769 Honolulu, HI 96812-3769) or the closest Department of Labor & Industrial Relations District Office.
Individuals that are approved for TDI but wish to contest the amount of benefits they receive can contact the Disability Compensation Division (P.O. Box 3769 Honolulu, HI 96812-3769) or the closest Department of Labor & Industrial Relations District Office and should submit copies of pay stubs to build a case.
The amount of money received as TDI benefits is determined by the employer’s insurance plan. Minimum benefit standards in the state of Hawaii include 58 percent of an individual’s weekly pay for a maximum of 26 weeks. There’s a seven-consecutive-day waiting period for benefits.
New Jersey Disability Insurance (TDI) can fall into three programs: State Plan Disability Program (SPDP), Private Plan Disability Program (PPDP) and Disability During Unemployment Program.
State Plan Disability Program and Private Plan Disability Program
Both individuals and employers contribute to the SPDP. PPDPs must provide the same amount of coverage, if not more, than the SPDP.
- Individuals must have worked and contributed money to the plan for a minimum of 20 calendar weeks with $168 worth of earnings or have earned a minimum of $8,400 in the 52 weeks leading up to the claim.
- All individuals must have worked in the state of New Jersey in order to be eligible throughout these time frames.
- Individuals must be in the care of a medical doctor, legally licensed physician, certified nurse midwife or advanced practice nurse.
- The individual may receive wages in conjunction with the disability pay, but the two combined may not exceed the amount of individual’s normal wages. All government workers must use all of their sick leave before being eligible for SPDP.
- There is a seven-consecutive-day waiting period for all claims. Individuals are entitled to a maximum 26 weeks of benefits.
- Individuals disabled 14 days after the date they were last employed are not eligible for the SPDP, but can apply for benefits through the Disability During Unemployment Program.
Individuals that are injured because of self-infliction or crimes are not eligible for SPDP. SPDP benefits may be reduced if the individual’s most recent employer contributed to a pension that the individual is receiving.
Private plan claims must be submitted through the employer for the insurance company and private plan carriers determine if an individual is eligible.
Receiving SPDP Benefits
Claims must be written within 30 days of the illness or injury although some exceptions are made for individuals that provide an explanation for the delay. Applications can be submitted online or mailed, and must be filled out by the individual, physician and employer.
Each individual is entitled to 2/3 of the average weekly pay during the eight weeks leading up to the disability or up to $615. If an individual believes that his or her benefits rate is too low, he or she may submit a written request that the rate be recalculated based on average pay 26 weeks before the claim.
Individuals receiving SPDP benefits will receive a Bank of America debit card and fund will be loaded onto that weekly. Individuals do not need to have accounts with Bank of America to use the card. The card can be used without fees anyplace where Visa cards are accepted. Payments are issued every two weeks after the initial payment and although individuals are required to pay taxes on all benefits, taxes are not withheld unless the individual requests that they be. Individuals will be mailed a form to fill out to continue to receive payments.
Pregnant individuals can generally collect SPDP and PPDP benefits for 10-12 weeks (four weeks before the due date and six weeks after delivery or eight weeks after the delivery in cases of Caesarean sections). Doctors may sign off on individuals for longer periods of time if they experience complications or have another disability. Pregnant mothers should not file claims before they’ve stopped working and they should not file for benefits until their doctor says they need to stop working.
Contesting a Problem
All SDPD appeals to the Division of Temporary Disability must be submitted in writing over mail, email or fax. After an appeal is submitted, the individual will be notified of a hearing date. Individuals are not required to bring an attorney to the hearing but they may bring one or any other person they chose to represent them. Individuals will receive the results of their hearing in the mail.
All private plan must follow the same appeals process, but their hearing may be held in person or over the phone. After the hearing, a Private Plan Officer will make a decision about benefits which may be contested with the Appellate Division of the New Jersey Superior Court within 45 days.
Disability During Unemployment Benefits
Individuals that become sick or injured more than 14 days after his or her last day of work, may be eligible for the Disability During Unemployment insurance program (DDU).
- Individuals must have earned $168 per week over the course of 20 weeks during the base period or a minimum of $8,400 during the base period.
- The base period is the period of time is the first four quarters of the last five completed quarters before the base claim. There are two exceptions to this rule: Individuals may be awarded DDU if they have made a minimum of $8,400 during the past four quarters before the claim or if they made $8,400 during the past three quarters and the weeks leading up to the claim.
- There is a seven-consecutive-day waiting period for individuals filing for DDU.
- The individual must be receiving medical care.
- The individual must not be receiving unemployment insurance, benefits from family leave, sick leave or a disability program.
- The individual must not be receiving a salary or paid time off. Individuals that were fired or have committed fraud and individuals that voluntarily quit their jobs will not be awarded DDU.
Individuals that are out of work because of strikes and other labor disputes are ineligible for DDU as well as those individuals who were injured while committing a crime or whose injuries are self-inflicted.
Filing a Claim
Individuals may mail, email or fax their claims. The claim should be completed by the individual, the doctor and the employers where the individual worked in the past six months. The claim must be submitted within 30 days of the disability.
Individuals can collect DDU benefits up to 26 weeks. Each weekly benefit amount is 60 percent of the average weekly wage earned during the base period up to $650. Individuals may file unemployment insurance and DDU at the same time, but the unemployment insurance benefits generally subtract the amount of money awarded in a DDU claim.
Individuals who aren’t eligible for the maximum weekly benefit rate may be entitled to a dependency rate. Dependents can include an unemployed spouse or civil union partner, unmarried and unemployed children and stepchildren under the age of 18, and unmarried and unemployed children and stepchildren under the age 22 that attend a public or nonprofit college. Individuals may claim a total of three dependents and are awarded an additional seven percent of their benefits for the first dependent and an additional four percent of their benefits for each of the other two dependents.
Benefits are awarded through Bank of America debit cards and the individual does not need to have an account at Bank of America. Individuals will need to re-certify periodically for DDU since New Jersey law requires recipients to be under continuous medical care. Individuals will receive forms in the mail when it’s time for them to recertify.
Pregnant individuals can generally collect DDU benefits for 10-12 weeks (four weeks before the due date and six weeks after delivery or eight weeks after the delivery in cases of Caesarean sections). Doctors may determine that individuals need more time off if they experience complications or have another disability. Pregnant mothers should not file claims before they’ve stopped working and they should not file for benefits until their doctor says they need to stop working.
Contesting a Problem
All DDU appeals to the Division of Temporary Disability must be submitted in writing over mail, email or fax. After an appeal is submitted, the individual will be notified of a hearing date. Individuals are not required to bring an attorney to the hearing but they may bring one or any other person they chose to represent them. Individuals will receive the results of their hearing in the mail.
Individuals in New York may be eligible for temporary disability benefits when they’re sick or injured off the job. The program acts as a partial wage replacement program and isn’t meant to completely replace wages. Most employers with more than one employee in the state are required to carry it.
- Individuals are eligible for coverage if they’ve worked for one or more employers who carry temporary disability benefits for a minimum of four consecutive weeks.
- Domestic employees who work 40 or more hours per week for a sole employer are also covered.
- Also covered are employees who work for a company that provides benefits through Application for Voluntary Coverage for the NY State Worker’s Compensation Board.
- All claims must be filed within 30 days of becoming disabled.
Ineligible individuals include sole proprietors and partners of limited liability companies; children of employers who are under the age of 18; government, fishers, railroad and farm workers; members of religious orders; corporate officers of nonprofit organizations; people who work for nonprofits in return for aid; one or two corporate officers who own all of the stock in a company that doesn’t have any other employees; golf caddies; and traditional elementary and high school students who work part-time during the school year and vacation periods.
Filing a Claim
After an injury or illness occurs, an individual needs to obtain a DB-450 from his or her employer. The individual fills out one portion, the individual’s physician fills out another portion and the employer fills out the remaining portion. The document can be mailed to Document Control Center, NYSIF-Disability Claims,1 Watervliet Avenue Ext., Albany, NY 12206 or faxed. If NYSIF is not the individual’s claims carrier, he or she is encouraged to contact the New York State Worker’s Compensation Board for help.
Benefits are only awarded to those injured or ill, family illness and adoption do not apply. Individuals can expect to receive 50 percent of their average wages for the past eight weeks for a maximum amount of $170 per week. Employees are eligible for 26 weeks of disability benefits during a 52-week period. Benefits are processed every two weeks.
Individuals are entitled to six weeks of benefits after a normal delivery or eight weeks of benefits after a Caesarean section including the seven-day wait period. Those individuals that experience complications may be awarded benefits longer.
Individuals in Puerto Rico can collect benefits through the territory’s Disability Insurance Temporary Non-Occupational (SINOT) program. The program is meant to partially replace lost wages due to an illness or injury that’s non-automobile related and didn’t occur on the job.
- In order to be eligible, individuals must be under the treatment of a doctor or chiropractor.
- The individual and the employer must have both contributed to the program.
- All employers must pay contributions with the exception of nonprofit institutions, private domestic employers, chauffeurs, and the municipal, state and federal government.
- Individuals must have received $150 in wages during the base year. Companies contribute to the benefits on the last day of March, June, September and December which is how the base year is calculated.
- Individuals must be employed in Puerto Rico for a full year before receiving benefits.
Examples of eligible claims include, but are not limited to:
- Pregnancy if the individual doesn’t have paid sick leave available.
- Individuals injured during periods of unemployment if they don’t collect unemployment insurance while collecting temporary disability benefits.
- Individuals who receive pension and payments from retirement funds as long as he or she worked a minimum of 15 weeks leading up to the disability.
Making a Claim
The claim application must be filled out by three people: the individual, the physician and the employer. Individuals can collect benefits for up to 26 weeks in a 52-consecutvive-week time frame. The amount of the benefits is based on the amount of the wages an individual earned and contributed. Benefits start at $12 per week but individuals can receive up to $55 per week in the agricultural sector and up to $113 per week in the industrial sector. Individuals are entitled up to 26 weeks of benefits annually.
Death and Dismemberment Claims
In the case of dismemberment, individuals and their families are entitled to benefits ranging from $2,000-$4,000. In the case of the death, an individual’s direct dependents can be awarded $4,000.
Individuals can apply for benefits for eight weeks and receive up to 50 percent of their wages in compensation.
Rhode Island offers Temporary Disability Insurance (TDI) and Temporary Caregivers Insurance (TCI) to residents who were injured off of the job, suffering from an illness, or taking care of a seriously ill spouse, domestic partner, parent, in-law, grandparent or child. Individuals may also apply for TDI benefits to bond with a new-born, adopted or foster child.
- Individuals are eligible for TDI if they are out of work for seven consecutive days due to illness or injury.
- Claims last for a maximum of four weeks but can renewed after an additional seven-consecutive-day waiting period.
- Individuals collecting benefits must be under the care of a medical professional who will confirm that an individual is unable to perform his or her work duties. Individuals may be asked to make an additional appointment with an impartial medical professional if there is any question regarding the validity of the claim.
- Individuals must have earned a minimum of $11,520 in the last four or five quarters. An individual who did not earn that amount may still be eligible if he or she earned a minimum of $1,920 in one of five quarters before filing a claim, the earnings from the five quarters are at least 1.5 times that of the individual’s most profitable quarter, and base period taxable wages are a minimum of $3,840.
- Individuals that can work part-time or are being paid during their time off are able to apply for benefits, however, they must claim any income that they receive and they must be certified unable to perform their normal tasks.
Individuals receiving unemployment insurance are ineligible for TDI and TCI.
Filing a Claim
Individuals must either submit the forms online, print the forms online and mail them to the office (TDI, P.O. Box 20100, Cranston, RI 02920), or they may request to have forms mailed to them and then mail them into the office. Individuals are awarded between $84 and $795 each week (without the dependency allowance). Individuals receive benefits calculated by 4.62 percent of wages that they were paid in their most profitable quarter before filing. Individuals are entitled up to 30 weeks of benefits annually.
An allowance for dependents may be awarded to an individual also if he or she has dependent children under the age of 18 or has incapacitated children over the age of 18. An individual can claim up to five dependents and the allowance is either $10 or 7 percent (whichever is greater) per person.
Benefits are issued on a debit card or in direct deposit form. Individuals can download an application online and mail it to TDI, P.O. Box 20070, Cranston, RI 02920. Most individuals receive their benefits within three or four weeks from submitting their application.
Those with long-term disabilities are awarded benefits for 36 percent of his or her total wages in the past five quarters divided by his or her weekly benefit rate. Individuals are only allowed to collect benefits in the amount equivalent to 30 weeks during a year. Individuals are encouraged to apply for social security benefits if their conditions will last a minimum of one year.
Individuals looking to return to work may call 401-462-8700 at any time.
Pregnant individuals may apply for TDI if their doctor determines them unable to work. Individuals that just delivered a baby are granted four weeks of TDI to recover and may request another four weeks of TCI to bond with the child.
Contesting a Claim
Individuals can appeal any decisions made in regards to their claim. A written request must be mailed to TDI Appeals Coordinator at PO Box 20100, Cranston, RI 02920-0941 or by faxed at 401-462-8466. A review will be scheduled and individuals will be allowed to bring witnesses to testify on their behalf or may choose to be represented by someone else. They should come prepared with documents, pay stubs, etc. that support their claims.
TDI and Military Service Members
The TDI base period pertaining to filing claims and calculating benefits is adjusted for members of the military, the Rhode Island National Guard, or the military reserves who served in a declared combat zone. These individuals who are considered ineligible because of the base periods (earned a minimum of $11,520 in the last four or five quarters; or a minimum of $1,920 in one of five quarters before filing a claim, the earnings from the five quarters are at least 1.5 times that of the individual’s most profitable quarter, and base period taxable wages are a minimum of $3,840) may be eligible by using the time frame of the last four calendar quarters before going into active duty.
Individuals in the military that are required to attend drills lasting less than one day will be allowed to continue to receive TDI benefits. Those that are instructed to participate in two-week training periods are not eligible for TDI during the period and must re-file when the training is over.
State Disability Benefits are meant to be partial wage replacements programs for five states and Puerto Rico. Those participating must have a seven-day waiting period of some type before obtaining benefits, be employed and have a medical professional willing to testify on behalf of their condition. Worker’s Compensation may not be collected in conjunction with any of the programs.