An individual can be disqualified from receiving DI benefits if their disability arises out of, and in the course of, a trade dispute. Section 2677 of the CUIC addresses trade disputes. The disqualification applies if the individual’s unemployment is directly caused by a stoppage of work due to a trade dispute at the individual’s place of employment. The key is establishing a direct causal link between the trade dispute and the disability. If the disability is entirely unrelated to the trade dispute, benefits may still be payable. The EDD will investigate the nature of the disability and the circumstances surrounding the trade dispute to determine eligibility. The claimant has the burden of proving that their disability is not connected to the trade dispute.

The EDD uses a multi-factor test to determine whether an individual is an employee or an independent contractor. This determination is crucial for DI eligibility, as only employees are covered. The primary factor is the right to control the manner and means of accomplishing the result desired. This is based on common law principles and is codified in various sections of the CUIC, including sections related to employer contributions and employee definitions. The EDD considers factors such as whether the individual is engaged in a distinct occupation or business, the level of supervision, who supplies the tools and materials, the length of time employed, the method of payment (hourly vs. project-based), and whether the work is part of the regular business of the hiring entity. Case law, such as S. G. Borello & Sons, Inc. v. Department of Industrial Relations (1989) 48 Cal.3d 341, provides further guidance on this determination.

A valid medical certificate is essential for a DI claim. The certificate must be completed by a licensed physician, surgeon, chiropractor, optometrist, dentist, podiatrist, psychologist, or authorized medical officer of a U.S. government facility. It must contain a diagnosis, the date the disability began, the probable duration of the disability, and a statement that the individual is unable to perform their regular or customary work. California Code of Regulations, Title 22, Section 2626.2, provides detailed requirements. Submitting a false or misleading certificate can lead to denial of benefits, penalties, and potential criminal prosecution for fraud under CUIC Section 2113. The EDD may investigate discrepancies or inconsistencies in the medical certification.

DI provides benefits for individuals unable to work due to their own disability, while PFL provides benefits to care for a seriously ill family member or bond with a new child. An individual cannot receive DI and PFL concurrently for the same period. However, they can receive them consecutively. For example, a woman could receive DI for pregnancy-related disability before childbirth and then transition to PFL to bond with the newborn. The maximum combined benefit duration for DI and PFL within a 52-week period is generally limited. The EDD coordinates these benefits to prevent overpayment and ensure compliance with CUIC Sections 3300 et seq. and 2601 et seq., which govern PFL and DI, respectively.

If a DI claim is denied, the claimant has the right to appeal. The initial appeal must be filed within 30 days of the date of the denial notice, as outlined in CUIC Section 2707.2. The appeal process involves several levels: first, a hearing before an Administrative Law Judge (ALJ); second, an appeal to the California Unemployment Insurance Appeals Board (CUIAB); and finally, a potential appeal to the California Superior Court. At each level, the claimant can present evidence, including medical records, witness testimony, and other relevant documentation, to support their claim. The CUIAB is the final administrative level of appeal and reviews the ALJ’s decision for errors of law or fact. The CUIAB’s decisions are binding unless overturned by a court.

The EDD has the authority to require a DI claimant to undergo an IME to verify the claimant’s disability. This is typically done when there are questions about the medical certification or the duration of the disability. The EDD’s authority is derived from CUIC Section 2708. The claimant is required to attend the IME and cooperate with the examining physician. Failure to attend or cooperate can result in suspension or denial of benefits. The claimant has the right to be informed of the purpose of the examination and to receive a copy of the IME report. The EDD must pay for the IME. The IME physician’s opinion is considered along with other medical evidence in determining eligibility for benefits.

DI benefit amounts are based on earnings during a base period. The standard base period is the 12-month period ending approximately 5 to 7 months before the date the claim begins. The weekly benefit amount (WBA) is calculated by dividing the highest quarter earnings in the base period by 39. This calculation is governed by CUIC Section 2655. There are minimum and maximum WBA amounts, which are adjusted annually. If an individual worked for multiple employers during the base period, all wages subject to DI contributions are combined to determine the WBA. The EDD uses this combined wage history to calculate the benefit amount, ensuring that all covered earnings are considered.

The EDD calculates the WBA based on the claimant’s earnings during their base period. The base period is generally the first four of the last five completed calendar quarters before the disability began. The EDD uses a formula based on the highest quarter of earnings within the base period. If standard wage records are insufficient, the claimant must provide documentation such as pay stubs, W-2 forms, or self-employment tax returns to substantiate their prior earnings. According to California Unemployment Insurance Code (CUIC) Section 2655, the WBA is determined by dividing the wages paid in the highest quarter of the base period by 39, subject to minimum and maximum WBA amounts. Claimants should refer to DE 2515, Disability Insurance Provisions, for detailed information on benefit calculations and required documentation.

An individual can be disqualified from receiving DI benefits under several circumstances, including failing to submit to a reasonable medical examination, making false statements to obtain benefits, or being incarcerated. Additionally, if an individual is receiving unemployment insurance benefits concurrently, they are generally ineligible for DI. California Unemployment Insurance Code (CUIC) Section 2675 outlines specific disqualification criteria. If disqualified, the claimant has the right to appeal the decision. The appeal process typically involves filing a written appeal with the EDD within a specified timeframe, followed by an administrative hearing before an Administrative Law Judge (ALJ). Further appeals can be made to the California Unemployment Insurance Appeals Board (CUIAB). Claimants should consult CUIC Division 1, Part 2, Chapter 6 for detailed information on disqualifications and appeals.

California’s DI program provides wage replacement benefits during periods of disability, while FMLA and CFRA provide job-protected leave. An employee may be eligible for both DI benefits and job-protected leave concurrently. FMLA and CFRA generally provide up to 12 weeks of unpaid, job-protected leave for qualifying reasons, such as a serious health condition. During this leave, an employee may also receive DI benefits if their condition meets the DI eligibility requirements. The leave runs concurrently, meaning the 12 weeks of FMLA/CFRA leave and the period during which DI benefits are paid overlap. However, DI does not provide job protection; FMLA/CFRA does. Employers must comply with both laws, providing job protection under FMLA/CFRA and coordinating with the EDD for DI benefits. Refer to the Department of Labor’s FMLA regulations (29 CFR Part 825) and the California Family Rights Act (Government Code Section 12945.2) for detailed information.

If a DI claim is denied, the claimant has the right to appeal. The initial step is to file a written appeal with the EDD within 30 days of the date of the denial notice. The appeal should clearly state the reasons for disagreeing with the denial. If the EDD upholds the denial, the claimant can appeal to the California Unemployment Insurance Appeals Board (CUIAB). The CUIAB will conduct a hearing, where the claimant can present evidence and testimony. Effective evidence includes medical records from treating physicians, detailed statements from the claimant describing their disability, and any other documentation supporting the claim. The CUIAB’s decision can be further appealed to the Superior Court. California Unemployment Insurance Code (CUIC) Sections 404-414 outline the appeal process and timelines. Claimants should consult legal counsel for guidance on presenting a strong case.

A medical certification for DI benefits must be completed by a licensed physician, podiatrist, chiropractor, optometrist, dentist, psychologist, or authorized medical practitioner. The certification must include a diagnosis of the claimant’s disability, the date the disability began, the expected duration of the disability, and a statement that the claimant is unable to perform their regular or customary work. The physician must also provide their license number and signature. Providing false or misleading information on a medical certification can result in civil and criminal penalties, including fines, imprisonment, and revocation of the physician’s license. California Insurance Code Section 1871.4 addresses fraudulent claims and provides for penalties for healthcare professionals who knowingly participate in such fraud. Physicians should refer to the EDD’s guidelines for completing medical certifications accurately and ethically.

The EDD may require an individual receiving DI benefits to undergo an IME if there are questions about the validity or extent of their disability. This is typically done when the EDD needs a second opinion or when there is conflicting medical information. The claimant must comply with the request for an IME. If the individual disagrees with the findings of the IME, they have the right to submit additional medical evidence from their treating physician to refute the IME’s conclusions. They can also request a hearing to present their case and challenge the IME’s findings. The EDD will consider all evidence presented before making a final determination. California Unemployment Insurance Code (CUIC) Section 2708 allows the EDD to require medical examinations. Claimants should document all communication with the EDD and seek legal advice if they believe the IME was conducted unfairly or inaccurately.

When a disability is related to a work-related injury or illness, the individual may be eligible for both DI and workers’ compensation benefits. However, an individual cannot receive full benefits from both programs simultaneously. Generally, if an individual is receiving temporary disability benefits under workers’ compensation, the DI benefits will be reduced or offset to prevent double compensation. The EDD coordinates with the workers’ compensation insurer to determine the appropriate benefit amounts. If the workers’ compensation claim is denied or delayed, the individual may be eligible for full DI benefits, subject to later reimbursement to the EDD if the workers’ compensation claim is subsequently approved. California Unemployment Insurance Code (CUIC) Section 2629.1 addresses the coordination of DI and workers’ compensation benefits. Claimants should report any work-related injury or illness to both the EDD and their employer to ensure proper benefit coordination.