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  • Edd Disability Extension Form Pdf

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N of a disability. If the estimated date of recovery you provide exceeds the normally expected duration of a disability for the certified medical diagnosis, we may: Contact you and/or the claimant to clarify and obtain additional information to substantiate a longer disability period, or to ascertain how symptoms/ diagnosis is disabling, etc. Require the claimant to submit to an Independent Medical Examination (IME) to determine their ability to perform their regular or customary work.

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If You Need to Extend Your DI Period You will receive a Physician/Practitioner's Supplementary Certificate (DE 2525XX) with your final payment. Have your physician/practitioner complete and submit this form to find out if you are eligible for an extension. Your physician/practitioner can find your claim in SDI Online.

If your claim is on automatic payment, after 10 weeks of payment, you will receive a Disability Claim Continued Eligibility Questionnaire (DE 2593). Return the form to the EDD either by mail or through your SDI Online account to certify that your disability continues.

The DE 2500A, commonly called a continued claim certification, is your request for continued disability benefits. By signing and dating the front of the form, you certify that during the dates shown on the continued claim certification you were still disabled.

Complete the entire form by answering all questions using black or blue ink. Provide your gross wages, total number of hours worked, and complete employer information for each week that you worked. Be sure to sign your name next to the “X” on the signature line and return the form by the due date indicated.

How to Certify. For Disability Insurance claims, fill out and sign Part B – Physician/Practitioner's Certificate on the Claim for Disability Insurance (DI) Benefits (DE 2501) form. Mail it in within 49 days from the date your patient's disability begins.

You may submit medical certifications using SDI Online or by completing and mailing the paper claim form: Claim for Disability Insurance (DI) Benefits (DE 2501) or Claim for Paid Family Leave (PFL) Benefits (DE 2501F). For more information, visit Certify and Manage Claims – Basics for Physicians/Practitioners.

English: 1-800-480-3287. Spanish: 1-866-658-8846.

To search and order brochures and forms from the EDD, visit Online Forms and Publications....Forms Visit Online Forms and Publications. Select Keyword(s) or Form Number from the dropdown. Enter DE 2501 for an English form or DE 2501/S for a Spanish form. Select Search.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232