DI / DE 2578AQ

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EDD Employment Development Department State of California Logo

Notice of Duplicate Benefit Payments

WC Carrier Name
Address Line 1
Address Line 2
Mail Date:
Blank line 
Applicant:
Blank line 
Claim ID:
Blank line 
WC Claim #:
Blank line 
ADJ #:
Blank line 
DOI:
Blank line 
WCC's name BlankLine and Parties of Record : BlankLine

We are notifying all parties that duplicate benefit payments were made in this case in the amount of $ BlankLine for the following period(s):

  • BlankLine
  • BlankLine

The total including interest is $ BlankLine (if interest applies).

Interest is calculated up until the mail date of this letter and will accrue daily if the balance is not paid in full within 30 days.

If any party disputes this information, mail this notice and supporting documentation to the address below.

To make a payment, make a check payable to the Employment Development Department (EDD) taxpayer ID ‎#94-2650401 and mail to:

Employment Development Department
Disability Insurance Office
PO Box 8190
Chico, CA 95927-8190

Legal References

The EDD is entitled to recovery of the disability benefits paid during the same period that the claimant was entitled to workers’ compensation benefits.

Unemployment Insurance (UI) Code Section§ 2629;
Lab. Code Section§§ 4903(f), 4904; 
Bryant v. Indus. Acci. Com. (1951) 37 Cal. 2d 215, 217-223; Aetna Life Ins. Co. v. Indus. Acci. Com. (1952) 38 Cal 2d 599, 601-602; EDD v. WCAB (1976) 61 Cal. App. 3d 470, 473.

We respectfully request that a standing objection be recognized to any Order and/or Award (OA) which does not fully reimburse the EDD lien. If full reimbursement for the amount of duplicate benefits is not granted, the EDD also requests that the OA not include "hold harmless" language.

Sincerely, Blankspace Persons Served Blankspace
Claims Representative
Disability Insurance (DI) Office
‎1-530-895-4350

DE 2578AQ (7-23) (INTRANET)