Welcome to the Employment Development Department

How to File a Claim

How to Apply

Disability Insurance (DI) provides services primarily by telephone, by mail, and in person. You do not need to apply in person to receive benefits. The online version of the DE 2501 may be filled-in and printed. To order claim forms, use the Request A Claim Form for State Disability Insurance Benefits or call 1-800-480-3287 or 1-866-658-8846 (En Español).

Instructions on How to Complete and File a Disability Insurance Claim:
General Instructions Additional Instructions
1. Carefully decide the date you want your claim to begin as this will determine your weekly benefit amount. Disability Insurance Claim Form
2. Complete ALL items on the “Claim Statement of Employee“ and sign it. Make certain that all information is complete and accurate since errors or omissions may cause your claim to be returned and may delay payment. Disability Insurance Claim Form
3. Doctor’s Certificate: Ask your doctor to complete and sign the “Doctor's Certificate“(page 3). Certification may be made by a licensed medical or osteopathic physician and surgeon, chiropractor, dentist, podiatrist, optometrist, designated psychologist, or an authorized medical officer of a United States Government facility. Certification may also be made by a licensed nurse-midwife, nurse practitioner, or licensed midwife for disabilities related to normal pregnancy or childbirth. Disability Insurance Claim Form
4. Cannot Complete Form: If you cannot complete the claim form because of your disability, or if you are an authorized agent filing for benefits on behalf of a physically incapacitated, mentally incapacitated, or deceased claimant, you will need to request the appropriate form(s) for your situation. Call 1-800-480-3287 for further instructions.
5. Religious Practitioner: If you are under the care of an accredited religious practitioner, you must include with your claim form a “Practitioner's Certificate, “DE 2502. Ask your practitioner to complete and sign it. (Rubber stamped signature facsimiles are not accepted.) Call 1-800-480-3287 to get a Practitioner's Certificate, “DE 2502”
6. Temporary Workers’ Compensation: If you are receiving temporary Workers' Compensation benefits and are filing for reduced DI benefits for the same days, the Doctor's Certificate is not required. None
7. Mail your claim to the DI office nearest to your residence no earlier than 9 days--but no later than 49 days--after the first day you became disabled. Mail your completed, signed “Claim Statement of Employee” together with the completed, signed “Doctor's Certificate“ and any other supporting documents. DI Office Locations

NOTE: The United States Postal Service (USPS) will not deliver mail (including benefit checks) to a private mail box (i.e., a mail box rented to you by a non-USPS commercial enterprise) unless it is preceded by the initials “PMB.”