Example

Tom's Story

Tom leaves his construction job early on an afternoon in December because of a really sharp pain in his side. He calls his doctor, who tells him he might have appendicitis, and needs to go to the Emergency Room. Tom ends up having an operation to have his appendix removed, and must stay in the hospital for a few days.

When it's time for Tom to go home from the hospital, his surgeon, Dr. Taylor, talks to him about how long it will probably take him to get better. She asks what kind of job he has and Tom explains that he works in construction, and does heavy lifting and manual labor. The doctor tells Tom he will probably not be able to work for two months or so while he heals.

“Taking that much time off work might be a problem," Tom tells Dr. Taylor. "I’ve used up all of my sick time and I don’t know what I’m going to do if I don’t have any money coming in for that long.”

“Don’t worry,” the doctor says reassuringly. “I think there’s a program that can help you. I'll have a social worker meet with you before you leave the hospital.”

A little while later, a social worker named James stops by, and Tom explains the situation to him. James asks Tom if he is covered by State Disability Insurance. Tom looks confused, so James asks him if he ever noticed something about “SDI” on his paystub.

“I’ve always wondered what that stands for,” Tom says. “Can you say it again?”

James explains that SDI is State Disability Insurance, a California program that replaces people’s income when they can’t work because of a disability.

“So,” Tom asks, “If I fall off my ladder at work, I get SDI?”

“No,” James explains, “SDI is for injuries or illnesses that don’t have to do with your job.”

“Like appendicitis?” Tom asks with a smile.

“Exactly,” James replies. “There’s a separate Workers’ Compensation program for on-the-job injuries.”

“Got it,” Tom says as he nods. “So, how do I get this SDI, and how much money will it pay me?”

“Well, to get it, you need to apply online at SDI Online, and then have Dr. Taylor submit medical details about your injury, including how long you might be out of work. You can only get SDI if you are going to be out of work for more than seven days” James said. "I could give you a paper form to mail in, but doing it online is faster,"

James explains how to start the application process online, and suggests that Tom can talk to Dr. Taylor about the SDI claim during Tom's follow-up appointment.

"How much you’ll get from SDI depends on how much money you make," James adds. "You’ll generally get 60-70% of your wages. It's a sliding scale. People with very low income get the higher percentage, but like most people you'll probably get the lower percentage of your income."

“But I make more money during certain times of the year,” Tom interrupted. “How do they figure out what my income is?”

James explains that SDI looks at a 12 month base period from roughly 17 months to roughly 5 months before the start of a disability. He shows Tom a simple breakdown of the rules so he could see that for disabilities that begin in December, the base period starts on July 1 of the previous year and ends 12 months later.

“They’ll divide those 12 months into quarters, and then use the quarter with the highest wages to calculate your benefit," James says. "But we’re getting ahead of ourselves here. You can't file your claim until 9 days after the start of your disability, but you shouldn't wait too long because you have to submit your claim within 49 days of the start of your disability or it will be too late. The first step is for you to register for an SDI Online account, fill out the online application, and write down your Form Receipt Number. Give that number to Dr. Taylor during your follow-up visit, so she can file your medical information with your claim."

“Are there any other programs that can help me while I can't work?” Tom asks.

“Well,” James answers, “ If anything happens that makes you or Dr. Taylor think you’ll be out of work for more than a year, you can apply for the federal Social Security Disability Insurance benefit. If it looks like that's going to happen, you should apply to SSDI as soon as possible. You may also want to talk to your company's human resources department to see if you are on any Short-Term Disability insurance. But for now, let’s get you on SDI.”

Tom thanks James for his help, and heads home. When the 9-day waiting period is up, Tom registers online and files his SDI claim. At his follow-up appointment a few days later he gives Dr. Taylor his Form Receipt Number. She estimates that Tom will not be able to work for two months, and files the required details with SDI.

Two weeks later, Tom starts getting a benefit of $600 a week. He remembers that James told him SDI pays 60-70% of his income, and that unless he earns a really low income, he'll get the lower percentage rate. For half of the past year he made $1,000 a week, so it makes sense to Tom that his benefit is $600 a week.

When the two-month recovery period that Dr. Taylor estimated on the SDI claim form is up, Tom is able to return to work full time, and his SDI benefits end.