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Claim for Disability Insurance (DI) Benefits (DE 2501) English: You must submit an original form provided by the EDD, either electronically or through US mail. It cannot be downloaded or reproduced.
The following licensed health professionals can docHub claims: Licensed medical or osteopathic physician/practitioners. Authorized medical officer of a U.S. Government facility. Chiropractor. Podiatrist. Optometrist. Dentist. Psychologist. Nurse practitioner or physician assistant.
This form may be completed online, printed, and mailed or faxed to EDD. Complete this form only if EDD has issued a Wages Notice for you in the past.
How Do I File for Disability? You can file the Claim for Disability Insurance (DI) Benefits (DE 2501) (PDF) claim by mail or even faster with SDI Online. Register and create an account with us through Benefit Programs Online so that you can file and manage your disability claim with SDI Online.
Claim Forms For more information on how to access these forms, you can: Visit Physician/Practitioner Forms and Publications. Call 1-855-342-3645 (TTY users dial the California Relay Service at 711).
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For Disability Insurance claims, fill out and sign Part B Physician/Practitioners Certificate on the Claim for Disability Insurance (DI) Benefits (DE 2501) form. Mail it in within 49 days from the date your patients disability begins.
Form DE 2501, Claim for Disability Insurance (DI) Benefits, is a form to request, by mail, worker-funded benefits to eligible workers who have a full or partial loss of wages due to disabilities that are not work-related.
For Disability Insurance claims, fill out and sign Part B Physician/Practitioners Certificate on the Claim for Disability Insurance (DI) Benefits (DE 2501) form. Mail it in within 49 days from the date your patients disability begins.
E-mail. Send an e-mail to WOTCsupport@edd.ca.gov. Important Security Reminder: For your protection, if you are sending us an email through third party e-mail software (e.g., Yahoo, Gmail, Outlook), please do not include confidential information such as account numbers, passwords, or Social Security numbers.
Life Insurance Waiver of Premium Due to Disability Most group life insurance policies contain provisions that allow for life insurance to continue while an employee is disabled without any requirement to pay premiums for the continued coverage.

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