DI / DE 2578D

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

 

Workers' Compensation Instructions For Claimants

Blank box
Your State Disability Insurance (SDI) or Paid Family Leave (PFL) claim indicates that you may have suffered a work-related accident or illness. If so, you may be entitled to workers' compensation benefits from your employer's workers' compensation insurance company, instead of SDI or PFL benefits. We urge you to take the following steps:
  1. Report your work-related illness or disability to your employer if you have not already done so.
  2. Contact the State Division of Workers' Compensation Information and Assistance toll-free number at 1-800-736-7401 for advise if your workers' compensation claim was denied or benefits were suspended and you believe you are still eligible for benefits.
  3. Notify SDI/PFL immediately if you receive workers' compensation benefits from your employer. You are not entitled to receive SDI/PFL and workers' compensation benefits for the same period unless the workers' compensation benefit is less than your SDI/PFL weekly benefit amount. In those cases, you may be eligible to be paid the difference in SDI/PFL benefits.
  4. Notify SDI/PFL if you receive or already have a Workers' Compensation Appeals Board case number.
State Disability Insurance (SDI):
1-800-480-3287
Paid Family Leave (PFL):
1-877-238-4373

DE 2578D Rev. 16 (4-21) (INTRANET)