Tom left his construction job early on a Friday afternoon in December. He had a sharp pain in his side that didn’t feel right, and he wanted to make sure that nothing was seriously wrong. He called his doctor and described his symptoms. The doctor told him that he might have appendicitis, and that he needed to get to the emergency room right away. The doctors at the ER confirmed the diagnosis, and Tom went straight to the operating room to have his appendix removed. The surgery went well, but Tom had to stay in the hospital for a few days.

Before he was released, his surgeon, Dr. Taylor, talked to him about his recovery period. She asked Tom about his job, and he told her that it required heavy lifting and manual labor. She told him that he would probably have to miss work for 2 months or so while he healed. She noticed that he didn’t look happy about that, and asked him if taking that much time off would be a problem.

Tom said, “It’s just that I’ve used up all of my sick time this year and I don’t know what I’m going to do if I don’t have any money for that long.”

“Don’t worry, this happens all the time,” the doctor said reassuringly. “I’ll have a social worker come and see you before you leave. I think there’s a program that can help people in your situation. I’ll see you for your follow-up appointment next week. Feel better!”

Five minutes after the doctor left, a social worker named James came and talked to Tom. Tom explained the situation to him. James asked whether Tom knew if he was covered by State Disability Insurance. At first, Tom looked confused. But when James asked him if he ever noticed something about “SDI” on his pay-stub, Tom immediately remembered.

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

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

“So,” Tom asked, “if I fall off my ladder at work, I get SDI?”

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

Tom smiled and said, “Like appendicitis?”

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

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

“Well, to get it, you and Dr. Taylor need to fill out this claim form,” James said, as he pulled the form out of his briefcase. You can only get SDI if you are out of work for more than 7 days. I would suggest that you fill out your part of the form while you’re home, and bring it back for Dr. Taylor to fill out during your follow-up appointment. How much you’ll get depends on how much money you make. You’ll generally get 60-70% of your wages and…”

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

James explained that SDI looks at a twelve month base period that starts roughly 17 months before you become disabled, and ends roughly 5 months before then. He showed 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 twelve months later.

James went on to say, “They’ll divide those 12 months into quarters, and then use the quarter with the highest wages to calculate your benefit. But we’re getting ahead of ourselves here. The first step is for you to fill out this form, bring it back, and then mail it in no earlier than 9 days after you became disabled.”

Tom asked, “Are there any other programs I’m eligible for?”

“Well,” James answered, “if you were going to be disabled for more than a year, you could apply for the federal Social Security Disability Insurance benefit. If there are any complications with your recovery that make you or Dr. Taylor think you’ll be out of work for over a year, you should apply to that program as soon as possible. You may also want to talk to your human resources department to see if you are on any Short-Term Disability insurance. But for now, let’s get you on SDI.”

Tom thanked James for his help, took the form, and headed home. He filled out the claim, and when he returned to the hospital the next week, gave it to Dr. Taylor to fill out and send in. She estimated that he would need to miss work for 2 months and indicated that on the form. Two weeks later, Tom began to receive a benefit that amounted to $700 per week. This made sense to Tom because for half the year, he made $1,000 a week. A benefit that replaces 70% of his income would come to $700.

Tom was originally supposed to be out of work for two months, but a month into his recovery, he felt like he could make it through half a day. He called Dr. Taylor, who said that she thought that would be fine. He then called his workplace, and they agreed that he could come back to work half-time for as long as he needed to recover. Tom then called the SDI phone line to see if his SDI benefit would continue. He explained his situation to the SDI representative, who told him that it seemed like he would be able to keep a reduced benefit. The representative explained that if they didn’t adjust the benefit, Tom would have $400 in part-time wages every week and $700 in SDI each week. Since this $1,100 a week was more than the $1,000 Tom was making just before becoming disabled, his SDI benefit would be adjusted. Once he returned to work, he would get a $600 benefit and receive $400 in wages each week, which equals the $1,000 he made before his disability. The representative went on to explain that they would send him a form to fill out that asked him how much he was making in wages.

Tom was able to return to work part-time for the month, and when the two month recovery period that Dr. Taylor indicated on the claim form was up, he was able to return to work full-time.