Disability Benefits under the California UI Code

The California Unemployment Insurance Code in Division 1, Part 2, Chapter 2, Article 1 deals with eligibility for disability benefits. Section 2625 states that unemployment compensation disability benefits are payable from the Disability Fund to individuals who are eligible to receive benefit payments under this part.

Section 2626 specifies that an individual is to be deemed disabled on any day in which, because of his or her physical or mental condition, he or she is unable to perform his or her regular or customary work. The terms “disability” and “disabled” includes four categories.

Section 2626.1 provides that an individual who is a resident in an alcoholic recovery home pursuant to referral or recommendation by a physician is eligible for disability benefits for a period not in excess of 30 days in any disability benefit period while receiving resident services, if an authorized representative of the alcoholic recovery home certifies that the individual is a resident participating in an alcoholic recovery program which has been certified by the State Department of Health Care Services.

Section 2626.2 specifies that an individual who is a resident in a drug-free residential facility pursuant to referral or recommendation by a physician to be eligible for disability benefits for a period not in excess of 45 days in any disability benefit period while receiving resident services, if an authorized representative of the drug-free residential facility certifies that the individual is a resident participating in a drug-free residential facility which has satisfied a program review by the State Department of Health Care Services.

Section 2627 makes a disabled individual eligible to receive disability benefits equal to one-seventh of his or her weekly benefit amount for each full day during which he or she is unemployed due to a disability only if the director finds that one of six specified criteria is met.

Section 2628 provides an individual is not eligible for disability benefits with respect to any period for which the director finds that he has received or is entitled to receive unemployment compensation benefits or under an unemployment compensation act of any other state or of the Federal Government.

Section 2629 specifies that an individual is not eligible for disability benefits under this part for any day of unemployment and disability for which he or she has received, or is entitled to receive, “other benefits” in the form of cash payments. The term “other benefits” is defined.

Section 2629.1 states that nothing is to be construed to authorize the delay of payment of unemployment compensation disability benefits except where the claimant is currently in receipt of other benefits or where the department has received notice that the claimant’s employer or insurer has agreed to commence the payment of other benefits.

Section 2629.5 provides that excludable restitution payments and excludable settlement payments may not be applied to reduce the amount of disability benefits to which an individual may otherwise be entitled under law.

Section 2630 requires the Department of Child Support Services to periodically notify the department of individuals who are certified as having support obligations and notify the department of any changes in the status of these individuals to ensure that the department has a current record. If the department determines that an individual has a claim for unemployment compensation disability benefits with an approved voluntary plan, it must notify the voluntary plan payer.

Article 2 deals with computation, including amount and duration. Section 2652 states that an individual cannot establish a valid claim unless he or she has during his disability base period been paid wages for employment by employers of not less than $300.

Section 2653 provides that the maximum amount of benefits payable to an individual during any one disability benefit period is to be 52 times his or her weekly benefit amount, but in no case is the total amount of the benefits payable be more than the total wages paid to the individual during his or her disability base period.

Section 2655 states that an individual’s “weekly benefit amount” is to be the amount appearing in column B in the table set forth in this subdivision on the line of which in column A of the table there appears the wage bracket containing the amount of wages paid to the individual for employment by employers during the quarter of the individual’s disability base period in which wages were the highest. An individual’s “weekly benefit amount” cannot exceed the maximum workers’ compensation temporary disability indemnity weekly benefit amount..

Section 2656 says that an individual eligible to receive disability benefits who receives wages or regular wages from his or her employer during the period of his or her disability or period of family care leave will be paid disability benefits for any seven-day week or partial week in an amount not to exceed his or her maximum weekly amount which together with the wages or regular wages does not exceed his or her weekly wage, exclusive of wages paid for overtime work, immediately prior to the commencement of his or her disability or period of family care leave.

Section 2657 provides that, if the remuneration of an individual is not based upon a fixed period or duration of time or if the individual’s wages are paid at irregular intervals or in such manner as not to extend regularly over the period of employment, the wages for any week or for any calendar quarter for the purpose of computing an individual’s right to disability benefits are to be determined pursuant to authorized regulations.

Section 2658 specifies that, in determining the benefit rights of any person who was involved in a trade dispute during the disability base period, then there is excluded from the disability base period those quarters during which the person performed no services in employment for 60 days or more as a result of a trade dispute.

Article 3 deals with disqualifications. Section 2675 disqualifies an individual from receiving benefits under this part if he or she has willfully, for the purpose of obtaining benefits, either made a false statement or representation, with actual knowledge of the falsity thereof, or withheld a material fact in order to obtain any benefits under this part.

An individual disqualified under a determination transmitted to him or her by the department, is ineligible to receive benefits from the date the disqualifying determination was issued and for not less than seven nor more than 35 subsequent days for which he or she is otherwise eligible for benefits under this part.

Section 2676 provides that an individual who is disqualified from receiving unemployment compensation benefits are to be presumed to be ineligible to receive disability benefits under this part for the same period or periods unless he or she establishes to the satisfaction of the director that he or she is suffering a bona fide illness or injury or claiming a period of family care leave and the director finds that there is good cause for paying disability benefits.

Section 2677 states that an individual who is otherwise eligible for benefits under this part cannot be disqualified from receiving such benefits because of a disqualification from receiving unemployment compensation benefits.

Section 2678 requires an individual to be disqualified from receiving benefits under this part while he is confined, pursuant to commitment or court order or certification, in an institution or other place, as a dipsomaniac, drug addict or sexual psychopath.

Section 2679 says that an individual who is otherwise eligible cannot be disqualified for benefits under this part for the day on which he or she or a family member for whom the individual is providing care, died.

Section 2680 states that an individual is ineligible for benefits under this part for any day during which he or she is incarcerated in any federal, state, or municipal penal institution, jail, medical facility, public or private hospital, or in any other place because of a criminal violation of a federal, state, or other municipal law or ordinance. The term “incarceration” is defined.

Section 2681 says that any individual who commits a crime is ineligible for benefits under this part if the individual is disabled due to an illness or injury caused by, or arising out of the commission of, arrest, investigation, or prosecution of any crime that results in a felony conviction.

Article 4 deals with the filing, determination, and payment of disability benefit claims. Section 2701 says that disability benefits are to be paid by the department through public employment offices or other agencies approved by the director. The department must provide a person entitled to receive disability benefits or family temporary disability insurance benefits the option to receive payments by direct deposit, as regulated under the federal Electronic Fund Transfer Act into a qualifying account of the recipient’s choice.

In addition, the following terms are defined: “insured depository financial institution,” “prepaid account,” and “qualifying account.”

Section 2701.5 requires the department to issue the initial payment for unemployment compensation disability benefits to a monetarily eligible claimant who is otherwise determined eligible by the department under applicable law and regulation within 14 days of receipt of his or her properly completed first disability claim.

Section 2702 says that minors who are eligible for disability benefits may be paid and receive the benefits in their own right and a receipt signed by a minor are to be valid and binding in all respects.

Section 2703 provides the establishment of a disability benefit period for unemployment compensation disability benefits does not establish a benefit year for unemployment compensation benefits and the filing of a valid claim for one does not establish a valid claim for the other.

Section 2705.1 states that, where an individual who would be eligible to receive disability benefits is mentally unable to make a claim, the director must, in accordance with authorized regulations, allow the filing of a claim for these benefits by the spouse or domestic partner of the individual, in the absence of any other legally authorized representative of the individual.

Section 2706 requires claims for disability benefits to be made in accordance with authorized regulations of the Director of Employment Development. Each employer must post and maintain in places readily accessible to individuals in his service printed statements concerning regulations and make available to each individual copies of printed statements, regulations or matters relating to claims for disability benefits.

Section 2706.1 provides that a first claim, accompanied by a certificate on a form furnished by the department to the claimant, must be filed not later than the 41st consecutive day following the first compensable day of unemployment and disability with respect to which the claim is made for benefits, which time is extended by the department upon a showing of good cause.

Section 2706.2 requires any continued medical certification to be submitted to the department within 20 days of the date the claimant is issued a notice of final payment or departmental request for additional medical certification. The 20-day time limit is to be extended by the department upon a showing of good cause.

Section 2707 requires the department to give a notice of the filing of a first claim for each disability benefit period to the employing unit by which the claimant was last employed immediately preceding the filing of such claim.

Section 2707.1 provides that, within two working days after receipt of the notice, or if there has been a termination of the claimant’s service within five days after such termination, whichever is the later, the last employer has to notify the department of any information known to him which may bear upon the eligibility of the claimant.

Section 2707.2 requires the department to consider the facts submitted by the employer and make a determination as to the eligibility of the claimant for benefits. The department must promptly notify the claimant of the determination and the reasons therefor. The claimant may appeal to an administrative law judge within 30 days from service of the notice of determination. The 30-day period may be extended for good cause.

Section 2707.3 states that, upon the filing of a claim for unemployment compensation disability benefits, the EDD is required to promptly make a computation on the claim which will set forth the maximum amount of benefits potentially payable during the disability benefit period and the weekly benefit amount. The EDD must promptly notify the claimant of the computation.

Section 2707.4 says that the claimant may, within 30 days after the service of the notice of computation or recomputation, protest the accuracy of the computation or recomputation. The 30-day period may be extended for good cause. The department is required to consider any protest and promptly notify the claimant of the recomputation or denial of recomputation. The claimant may appeal from a notice of denial of recomputation in the manner prescribed.

Section 2707.5 authorizes the department for good cause to reconsider any determination provided for in this part prior to the filing of an appeal, or within 30 days after an appeal to an administrative law judge is filed. The department is required to promptly notify the claimant of any reconsidered determination, and the claimant may appeal.

Section 2707.6 requires notices, protests, and information required under this article to be submitted in accordance with authorized regulations.

Section 2707.8 requires an administrative law judge, after affording a reasonable opportunity for fair hearing, to affirm, reverse, modify, or set aside any determination that is appealed under this article.

Section 2708 requires a claimant to establish medical eligibility for each uninterrupted period of disability by filing a first claim for disability benefits supported by the certificate of a treating physician or practitioner that establishes the sickness, injury, or pregnancy of the employee, or the condition of the family member that warrants the care of the employee. In addition, the terms “warrants the participation of the “physician” and “practitioner” are defined.

Section 2708.1 states that, where an individual is entitled to receive unemployment compensation disability benefits reduced by the amount of temporary workers’ compensation received for any day, it is not necessary that he or she obtain a certificate of a physician as required to receive the reduced amount of disability benefits for that day, provided that the claimant submits evidence to the department of receipt of temporary disability benefits under a workers’ compensation law for that day.

Section 2709 provides that, if any individual in good faith adheres to the teachings of any bona fide church, sect, denomination or organization and in accordance with its principles depends for healing entirely upon prayer or spiritual means, no medical examination is to be required.

Section 2712 states that, whenever an individual is entitled to benefits under this part but there is a dispute whether benefits are payable from the Disability Fund or from one or another voluntary plan, benefits are to be paid to the individual, pursuant to authorized regulations, from the source against which his claim was first filed, at not less than the Disability Fund rate, pending the determination of the dispute.

Section 2712.5 says that, if a final decision of an administrative law judge or of the appeals board finds that an employer or insurer must reimburse the Disability Fund and the employer or insurer fails to pay all or any part of the reimbursement within 15 days after the decision of an administrative law judge or of the appeals board becomes final, the director must assess the unpaid amount against the employer or the insurer.

Section 2713 provides that, in proceedings under this part the claimant, upon a showing of good cause, may request a closed hearing except that the last employer and each base period employer of the claimant is entitled to participate in any such hearing.

Section 2714 says that all medical records of the department obtained under this part, except to the extent necessary for the proper administration of this part, or as provided elsewhere in law must be confidential and not be published or be open to public inspection in any manner revealing the identity of the claimant or family member, or the nature or cause of his or her disability.

Article 5 deals with overpayments.” Section 2735 provides that any person who is overpaid any amount as benefits under this part is liable for the amount overpaid unless the overpayment was not due to fraud, misrepresentation or wilful nondisclosure on the part of the recipient, and the overpayment was received without fault on the part of the recipient, and its recovery would be against equity and good conscience.

Section 2735.1 states that, if the director finds that an individual has been overpaid unemployment compensation disability benefits because he or she willfully, for the purpose of obtaining unemployment compensation disability benefits, either made a false statement or representation, with actual knowledge of the falsity thereof, or withheld a material fact, the director must assess against the individual an amount equal to 30% of the overpayment amount.

Section 2735.5 provides that no claim of overpayment is to be based upon the disallowance by the Workmen’s Compensation Appeals Board of a claim of lien filed, or the allowance of the lien for less than the amount claimed, or upon the approval by the appeals board of a compromise and release agreement providing for the allowance of the lien in an amount less than the claim.

Section 2736 requires the EDD to determine the amount of the overpayment and notify the recipient of the basis of the overpayment determination. In the absence of fraud, misrepresentation or willful nondisclosure, notice of the overpayment determination is to be served on the recipient within two years after the beginning of the disability benefit period for which the overpayment was made.

Section 2737 states that, within 30 days from the date of mailing or serving of the notice of overpayment determination, the person affected may file an appeal to an administrative law judge. The director is required to be an interested party to this appeal. The administrative law judge, after affording reasonable opportunity for a fair hearing, is required to, unless the appeal is withdrawn, affirm, reverse, modify, or set aside the findings set forth in the notice of overpayment determination.

Section 2738 requires the Appeals Board to review an appeal from an overpayment determination and determine what amount, if any, is to be recovered.

Section 2739 authorizes the EDD to do any of the specified actions for the recovery of overpayments of disability benefits.

Section 2739.1 provides that an abstract of judgment obtained may be recorded with the county recorder of any county. From the time of recording, the judgment must constitute a lien against all real or personal property of the liable person in that county owned by the liable person at the time, or which the liable person may afterwards, but before the lien expires, acquire. The lien has the force, effect, and priority of a judgment lien and will continue for 10 years from the time of recording of the abstract of judgment obtained, unless sooner released or otherwise discharged.

Section 2739.2 provides that, if an abstract has been recorded and the lien, including any interest, costs, and penalty has been satisfied in full, the department must file an acknowledgment of satisfaction of judgment with the court, serve the acknowledgment of satisfaction, and record of judgment on the claimant.

Section 2739.5 requires the Franchise Tax Board to aid the director in the recovery of overpayments of disability benefits through the exchange of information.

Section 2740 prohibits any person from being liable for the amount of benefits received where the benefits were paid pursuant to an administrative law judge’s decision which affirmed an initial determination or in accordance with a final decision of the appeals board, regardless of any further appeal.

Section 2741 provides any claim of lien filed with the Workmen’s Compensation Appeals Board to be be fully discharged and satisfied by payment of the amount of the lien allowed by the appeals board or the amount specified in any compromise and release agreement filed and approved by the appeals board.

Section 2742 requires the director to enforce collection of any judgment obtained by him or her. Amounts collected under this section are to be deposited in the fund from which the overpayment was made.

Article 6 deals with rights of trainees. Section 2765 provides that the benefit rights of trainees are to be determined in accordance with the provisions of this article for the periods and with respect to the matters specified in this article. 

Section 2766 defines the term “military service.”

Section 2767 defines the term “trainee.”

Section 2768 says that, when any trainee has an unexpired benefit year for disability benefits at the time of induction into the armed forces, the unexpended balance of disability benefits remaining to his account is to be reestablished beginning with the first day of the first week succeeding the date of his termination of service. The balance is to be paid at a weekly rate.

Section 2769 states that the filing of a valid claim for disability benefits by a trainee will establish a disability benefit period.

Section 2770 specifies that, in determining the benefit rights of trainees, the disability base period is to exclude those quarters during which the trainee was in military service 60 days or more. For all quarters so excluded there is substituted an equal number of quarters immediately preceding the trainee’s entry into military service.

Section 2771 specifies that no disqualification is to be applied to any trainee after the termination of his military service, by reason of any act or course of action on his part prior to the date of his entry into such service.

Section 2772 provides that any trainee who was a resident of this state at the time of his or her entrance into the military service, who is a resident of this state at the time he or she applies for disability compensation benefits under this section, and who has been disabled in the military service and is eligible to receive disability compensation from the federal government for such disability, is eligible, upon their discharge from the military service, to receive disability compensation benefits from the time they are determined by the federal government to be eligible for disability compensation payments from the federal government until such time as they begin to receive his disability compensation payments from the federal government.

Section 7 deals with the rights of industrially disabled persons. Section 2775 provides that the benefit rights of industrially disabled persons are to be determined in accordance with the provisions of this article for the period and with respect to the matters specified in this article.

Section 2776 defines the terms “industrially disabled person” and “industrial disability.”

Section 2777 states that, in determining the benefit rights of any industrially disabled person, the disability base period excludes those quarters during which those persons were industrially disabled for 60 days or more. For all quarters excluded, there is substituted an equal number of quarters immediately preceding the commencement of his or her industrial disability.

Section 2778 specifies that no disqualification is to be applied to any industrially disabled person after the termination of his industrial disability, by reason of any act or course of action on his part prior to the date on which his industrial disability commenced.