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Message #623 California disability benefits

mp3 #623 California Disability Insurance Benefits (mp3 file)


If you are a California worker who is unable to do your regular or customary work because of an illness or injury, you may be eligible for state disability insurance benefits. If your illness or injury is caused by your job, you may receive workers' compensation insurance benefits, but if your illness or injury is not caused by your job, you may receive disability insurance benefits. This SmartLaw message discusses six questions about state disability insurance benefits:

1- Which workers are covered by disability insurance?

2- What type of illnesses or injuries qualify for disability insurance benefits?

3- How do you apply for disability insurance benefits?

4- When do you apply for disability insurance benefits?

5- How much will your weekly benefit check be, and for how long will you receive checks?

6- What if you disagree with the decisions of the disability insurance office?

First, "What workers are covered by disability insurance?"

Most California workers are covered by state disability insurance. Approximately 12 million California workers pay a mandatory contribution to the State Disability Insurance (SDI) program for disability insurance coverage. Your contribution is paid through a payroll deduction. The State Disability Insurance (SDI) Contribution Rate for 2006 is 0.8%. The SDI taxable wage limit is $79,418 per employee for calendar year 2006. If you are self employed, your SDI premium payment is based upon your income. Contact your local disability insurance office for complete details, or go to the California’s Employment Development Department website at www.edd.ca.gov/direp/diind.htm for more information. But you are probably not covered by disability insurance if you are a government worker, including school districts and special districts, although some government agencies may voluntarily elect to be covered. You are also not covered if you are self-employed or if you are in family employment, unless you voluntarily elect to participate, by making arrangements through your local employment tax district office. Your employer may be covered by a private disability insurance plan, instead of the state disability insurance plan. If you are covered under a private plan, your employer can give you information and claim forms.

The second question is, "What types of illnesses or injuries qualify for state disability insurance benefits?"

Your, disability may include any illness or injury which is not caused by your job. It may be a physical illness or a mental illness. It may be a broken leg due to a skiing accident. It may be a fractured skull suffered in an automobile accident. It may be a heart attack, or it may be a surgery for cancer. It may be complications of pregnancy, childbirth, or a related medical condition. It is any temporary disability which prevents you from working at your regular or customary job.

The third question is, "How do you apply for state disability insurance benefits?"

Your first step is to obtain a claim form from your doctor, your hospital, your employer, or any office of the California Employment Development Department. There are 22 such offices, located in Bakersfield, Chico, City of Industry, Culver City, Eureka, Fresno, Glendale, Long Beach, Los Angeles, Oakland, Redding, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Jose, Santa Ana, Santa Barbara, Santa Rosa, Stockton, and Woodland Hills. For the address of your local office, look in the white pages of your telephone directory, first under California, State of; then under Employment Development Department, and then under Disability Insurance Claims. All of these disability insurance offices will accept collect telephone calls, if you cannot afford to pay for the call yourself.

The Disability Insurance Program is designed to serve you by mail. You do not have to leave home or the hospital, to apply for benefits.

After your claim form is received by the disability insurance office, your claim is examined to determine your eligibility for weekly benefit checks.

The fourth question is, "When do you file your application for disability insurance benefits?"

Mail your claim no earlier than 9 days and no later 49 days after the first day for which benefits are payable. The earlier you file your claim, the sooner you will start receiving your benefit checks. Late filing results in loss of payment for the number of days your claim is late, unless you can establish "good cause" for your delay.

Your benefits may begin with the day following a seven-day waiting period after your disability begins. +

Benefits are paid as quickly as possible, after all needed information is received, and if you meet all eligibility requirements. Your first benefit check will be mailed to you, if you qualify, usually about two weeks after you file your claim. However, in some limited situations, your first benefit check may be issued on the same day that you submit your application.

If you are eligible for continued benefits, a "continued claim" form for the next period will be mailed to you at the same time your check is mailed. Normally these periods will be for two weeks. Partial weeks are paid at 1/7 of the weekly benefits amount, for each day·of disability.

The-fifth question is, "How much will your benefit check be, and for how long will you receive checks?"

The amount of your check depends upon the total wages paid to you during a 12-month base period. Only those wages on which you paid disability insurance tax can be used. Your wages during this 12 month base period must be a total of at least $300. If you do not meet any of the wage requirements, call the SDI office to inquire and provide additional information. The 12-month base period is not the 12 months just before you file your claim. Instead, it is a 12-month period beginning about 18 months before you file your claim, and ending about 6 months before you file your claim. There are several exceptions to what base period is used, and you may learn about these exceptions from your disability insurance office.

You may receive disability insurance checks for 52 weeks, but your total checks for any one claim, may not be more than the total wages you earned during your total base period.

You may not receive disability insurance benefits for the same period that you receive unemployment insurance benefits.

The sixth questions is, "What if you disagree with the decision of the disability insurance claims office?"

If your claim for benefits is denied, or if your benefits are reduced, you are entitled to receive a written statement of the reasons for their decision. You may appeal any decision of the disability insurance office. Instructions on how to appeal will be given to you on any appealable document your receive. Or you may just notify your local office that you wish to appeal its decision. The office will then schedule a hearing before an administrative law judge, where you or your representative will appear in person and present your reason for disagreeing with the office's decision. If you then disagree with the decision of the hearing officer, you may appeal further to the disability insurance appeals board, and after that to the courts.

If you expect your disability to be long-term or permanent, contact Social Security Administration well before you exhaust your SDI benefits. Call the Social Security Administration at 1-800-772-1213 for more information.

If you have a disability which prevents you from getting or keeping a job, the Department of Rehabilitation may be able to assist you with vocational training, education, career, opportunities, independent living and use of assistive technology. For job training contact a One-Stop Career Center at 1-877-872-5627 or www.servicelocator.org for services available in your area.

For more information call SDI at 1-800-480-3287.

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