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DI / DE 2578BF
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SAMPLE
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Date:
Blank space
INFORMATION CONCERNING
EDD
LIEN -
PFL
Blank box
Attached is a copy of a Notice and Request for Allowance of Lien,
DE 2581
, which the Employment Development Department (EDD) filed in your Workers’ Compensation case.
You are currently receiving or previously received Paid Family Leave (PFL) benefits from
EDD
. You also filed a Workers’ Compensation action against your employer. The California Unemployment Insurance Code (CUIC) does not allow an individual to receive
PFL
benefits and Workers’ Compensation benefits for the same period of time. Workers’ Compensation benefits that conflict with
PFL
benefits include temporary disability, vocational rehabilitation, maintenance allowance, and permanent disability insurance benefits.
If your employer, employer’s Workers’ Compensation insurance carrier, or the Workers’ Compensation Appeals Board (WCAB) finds that you were entitled to Workers’ Compensation for the same period that you received
PFL
benefits,
EDD
may be entitled to reimbursement. In order to be reimbursed,
EDD
has filed a lien with the
WCAB
for the
PFL
benefits paid to you.
If you have an attorney who will represent you before the
WCAB
and your attorney’s name is not listed on the
EDD
lien form, please provide us with his/her name and address.
If you receive any payments from your employer or your employer’s insurance company, please notify us immediately.
PFL Program Representative
PO Box
997017
Sacramento, Ca 95799-7017
1-877-238-4373
Enclosure
DE 2578BF (7-04)
(INTRANET)
Email Address:
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