When you suffer an injury on the job, you suffer physically and financially since you cannot earn money until you recover. You can suffer another loss when the state denies you short-term disability benefits. But fortunately, you can do something about it. Read below to learn what to do if denied short-term disability in California.
How the Process Starts
The state of California will inform you of a benefit denial after it has processed your claim. The state will send you a notice of determination, which also comes with an appeal form. You must file your appeal electronically or in writing within 30 days of the state issuing the notice.
Receiving the Denial Notice
When you apply for Disability Insurance (DI), the EDD reviews your claim, including medical certification, eligibility, and any required documentation. If EDD decides you are not eligible, they will send you a Notice of Determination, which explains the reason for denial (for instance, insufficient medical evidence, missed deadlines, or ineligibility under DI rules).
With that notice, you will also usually receive an Appeal Form (DE 1000A) to appeal the determination. The notice will tell you when it was issued, what you must do next, and by what deadline you must act.
Why You Might Be Denied at First
Common reasons for denial include:
- Missing or incomplete medical certification.
- Not meeting the eligibility requirements under California’s State Disability Insurance (SDI)—e.g., not having worked enough or not having paid into SDI.
- Errors or omissions on the application.
- Incorrect or insufficient evidence of the disablement or its duration.
If you’re confused about the eligibility requirements you failed to meet, our in-depth guide on qualifying for California short-term disability offers a practical starting point.
How To File Your Appeal
One of the first things you should do if denied short-term disability in California is complete the appeal form and use it to explain why you believe you’re eligible for the benefits. You should also include any documents or information that provides evidence of your claim.
Filing the Appeal Form
If you disagree with EDD’s decision, you must appeal in writing using the DE 1000A appeal form or by a written letter. That form is provided alongside the Notice of Determination.
Complete the Appeal Form (DE 1000A) with a detailed explanation of why you think you are eligible. Time is very important. You generally have 30 days from the date your determination notice was issued to submit your appeal. Please include any missing documents or information that supports your reason for the claim. If you miss the deadline, it might still be accepted—but only if you show good cause for the delay.
Mail your appeal to the return address shown on the notice.
If the form is lost or misplaced, you can also send us a detailed letter.
Need a quick breakdown? Our team has created a step-by-step appeals guide based on EDD’s policies to help you get started confidently.
What to Include in Your Appeal
To maximize chances of success, make your appeal as thorough as possible. Include:
- Your full name, address, and contact info.
- Your DI Claim ID number or EDD Customer Account number.
- Social Security Number (or claimant ID) as required.
- The date of the Notice of Determination.
- A clear explanation of why you believe the denial was wrong.
- All relevant medical or supporting documents you may not have submitted initially.
- Request any special accommodations if needed (language help, etc.).
- A signature and date.
The EDD will evaluate your appeal. If you are eligible, payments will be made if funds are still available on your claim. If your eligibility is not confirmed and EDD is not able to issue payments, your appeal will be forwarded to the California Unemployment Insurance Appeals Board local Office of Appeals.
The Office of Appeals will mail you a notification with your hearing date, time, location, and their phone number. At the hearing, an impartial Administrative Law Judge will listen to both sides of the appeal and make a decision based on facts presented by you and by a State Disability Insurance representative. If you fail to appear, your appeal will be dismissed.
CDI and Paid Family Leave (PFL) Overlap
If your claim is denied for DI, and you believe some portion fits into Paid Family Leave (where applicable), ensure that the appeal addresses both. The same appeals process under EDD applies to PFL, and you might also be eligible to continue benefits pending appeal in some cases if you submitted required forms (like DE 6315D or DE 6315DF) with your appeal.
Why You Should Get an Attorney
The EDD rules for disability appeals are technical. Missing even a minor requirement might lead to a denial. An attorney can:
- Make sure you understand eligibility nuances.
- Help you gather acceptable medical documentation.
- Ensure everything is submitted on time and correctly.
- Craft legal arguments if EDD’s decision uses incorrect interpretation of law or medical criteria.
Representation at Hearings
If EDD doesn’t reverse the denial, your appeal will be forwarded to the California Unemployment Insurance Appeals Board (CUIAB) or a local Office of Appeals, and a hearing will be scheduled before an Administrative Law Judge (ALJ).
Having an attorney means you will have help presenting your case, preparing your testimony or that of witnesses, presenting medical or expert evidence, and cross‑examining or questioning the EDD’s representative, as needed.
Maximizing the Value You Receive
Legal representation can often make a material difference in whether your benefits are paid, how many weeks or what amount, or whether any denials are reversed. Also, attorneys know when a waiver or continuation of benefits during appeal applies.
Conclusion
Before your hearing, it is wise to hire a California disability attorney for representation. An experienced attorney can help you prepare your case and advise you on the decisions that you should make. They can also help you so that you win the highest payout possible. If you’re looking for an attorney who will strive to help you get your benefits faster, contact Pershing Square Law Firm. Our lawyers have experience helping clients unfairly denied short-term disability benefits and can provide you with a free consultation.