How to Fill Out and Submit the California DE 8501 NDI Claim Form

To file for California Nonindustrial Disability Insurance, you use the DE 8501 NDI claim form, a three-part paper document completed by your employer, you, and your treating physician, then mailed together to the Employment Development Department’s Stockton office within 49 days of the date your disability began. NDI is entirely paper-based, so a form that arrives incomplete gets sent back, and the clock does not stop while it travels.¹

Where to Get the Form

Ask your personnel specialist or payroll officer for the First Claim for Nonindustrial Disability Insurance (DE 8501). Your personnel office should keep copies on hand, and a PDF version is available through the EDD website.¹ You can file any time after your disability begins, but the completed form must reach the EDD no later than 49 days after the first day you were unable to work.² Unlike SDI, there is no online filing option.

Confirm You Qualify Before You Start

NDI only covers state employees who are not under the regular SDI program. Coverage depends on your bargaining unit: NDI applies to excluded employees and rank-and-file units 2, 5, 6, 7, 8, 9, 12, 13, 16, 18, and 19. Units 1, 3, 4, 10, 11, 14, 15, 17, 20, and 21 fall under SDI and use a different claim process.¹

You also need to be an active state employee (not on a formal leave of absence) when the disability starts. Full-time permanent or probationary employees must be CalPERS or CalSTRS members; Legislature employees are exempt from that rule. Permanent part-time and intermittent employees need at least six monthly pay periods of service in the 18 months before the disability. The condition must keep you off your regular job for at least eight consecutive calendar days, you must be under the care of a licensed physician, practitioner, or accredited religious practitioner starting within those first eight days, and you must be losing wages. There are no employee contributions, enrollment fees, or medical exams; if you meet the criteria, coverage is automatic.¹

Part A — Employer Information

Your attendance clerk or payroll officer completes Part A. It captures the employment facts the EDD needs to verify your claim: name, Social Security number, position number, gross monthly salary, last day physically at work, appointment type, time base, department or campus, and the payroll specialist’s contact information. Part A also asks whether you are exempt, whether sick leave has been exhausted, and whether you participate in the Annual Leave Program. A separate section covers workers’ compensation if that applies.²

Hand this off to payroll as soon as you can. Payroll offices juggle a lot of requests, and Part A can take a few business days to come back. The 49-day deadline runs from the date your disability began, not from the date you picked up the form, so any delay here cuts into your window.

Part B — Claim Statement of Employee

Part B is your section, completed after you stop working. You provide your Social Security number, date of birth, mailing and home addresses, any other names you have used, and your occupation. You then enter the first day you were too sick or injured to work, the last day you actually worked, and the reason you stopped. If you have filed or plan to file a workers’ compensation claim for the same condition, you have to disclose it here.²

Part B also asks whether you want to elect the Annual Leave supplement and whether you have recovered or returned to work. Near the bottom is a HIPAA authorization that lets the EDD obtain medical records relevant to your claim; sign and date it. Then sign and date the declaration at the end. An unsigned form counts as incomplete and will be returned.

Part C — Physician/Practitioner Certificate

Give the form to your treating physician or licensed practitioner for Part C. The medical section asks for dates of attendance, medical history, objective findings, diagnosis with ICD codes, treatment and medication details, whether you were hospitalized or had surgery, and the expected date you can return to work. For a pregnancy-related claim, the physician enters the estimated date of confinement and notes any complications.²

If you are being treated by an accredited religious practitioner rather than a physician, that practitioner should complete and sign a separate Practitioner’s Certificate (Form DE 2502) instead of Part C. Your claim is not complete until the EDD has the signed medical certification together with the rest of the form. If the two pieces arrive separately, the EDD may delay or return the claim.¹

Where to Mail the Completed Form

Once all three parts are filled in and signed, mail the DE 8501 to:

State of California
Employment Development Department
NDI
PO Box 2168
Stockton, CA 95201-2168³

A pre-addressed envelope comes with the form. Use it; the address is already formatted to route to the right processing center. Print clearly in uppercase on the form itself. Keep every part of the claim, including the physician’s certificate, in the same envelope. Sending Part C under separate cover is one of the most common reasons claims get flagged incomplete and returned.

What Happens After You File

The EDD generally processes NDI claims within 14 days of receiving a complete form.⁴ The NDI office reviews the medical certification, confirms your eligibility, and determines the covered period of disability. Once authorized, your employer’s personnel office requests payment from the State Controller.

Your claim carries a waiting period of either 7 or 10 days before benefits start, depending on your job status and bargaining unit. Excluded employees may waive the seven-day waiting period, and confinement in a hospital or nursing home also allows waiver of the waiting period starting on the first full day of confinement. Your bargaining unit’s memorandum of understanding spells out which rule applies to you.⁵

You also have to use up accrued sick leave before NDI payments begin. On your final day of sick leave, if you use four hours or fewer, NDI can start that same day; if you use five or more hours, NDI starts the next day. Vacation and compensatory time off work differently: using them is optional, but if you do elect to use them, you must exhaust the balance before NDI starts, and if you choose not to use them, you cannot touch that time until you return to work for at least one full workday.

NDI benefits are payable for up to 26 weeks (182 calendar days) for any single disability. Two consecutive periods of disability from the same or related cause, separated by no more than 14 days, count as one benefit period.¹

If the EDD Denies Your Claim

The EDD can deny an NDI claim if the medical certification is insufficient, the disability does not meet the eight-day minimum, the form arrived after the 49-day deadline, or you are otherwise ineligible. You can appeal to the California Unemployment Insurance Appeals Board, which is the designated appeals body for NDI disputes under the Government Code.⁶ Read the denial notice carefully for the appeal deadline. Missing that date forfeits your right to a hearing on the claim.

1
Employment Development Department. Nonindustrial Disability Insurance for State Employees
2
Employment Development Department. First Claim for Nonindustrial Disability Insurance DE 8501
3
Employment Development Department. Nonindustrial Disability and Family Care Claim Process
4
Employment Development Department. Claim for Nonindustrial Disability Insurance – Family Care Leave
5
CalHR. Non-Industrial Disability Insurance (NDI)
6
California Legislative Information. California Code Government Code GOV 19878