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Can you get SDI and workers' comp at the same time

Usually not for the same weeks, but there are three exceptions EDD applies. State Disability Insurance (SDI) will pay when the workers' comp claims administrator has delayed or denied your claim, when your temporary disability rate is lower than your SDI rate (SDI pays the difference), or when workers' comp is covering only medical treatment. If the claim is later accepted, EDD files a lien and is repaid from the workers' comp benefits.

Two programs with different jobs

Temporary disability (TD) and State Disability Insurance (SDI) both replace wages when you cannot work, which is why they get confused, but they come from different places and cover different things. TD is paid by your employer's workers' compensation claims administrator for an injury or illness caused by work. SDI is run by the Employment Development Department (EDD), funded by the deduction on your pay stub, and covers disabilities that are not work-related. In an ordinary claim you receive one or the other, not both.

The exceptions exist because workers' comp claims take time to decide and sometimes pay less than SDI would. EDD's rule is practical: if you are unsure whether you qualify, file an SDI claim and let EDD decide.

When SDI pays despite a work injury

EDD will pay SDI to a worker with a work injury in three situations.

The claim is delayed or denied. The claims administrator has up to 90 days after you file the claim form to accept or deny the claim (Labor Code §5402(b)), and TD is often not paid during the investigation. SDI can pay for those weeks. If the claim is then denied, SDI continues as long as you are eligible, and you can pursue the denial at the Workers' Compensation Appeals Board separately.

The TD rate is lower than the SDI rate. TD is two-thirds of average weekly earnings between the year's minimum and maximum (Labor Code §4653, §4453). SDI uses its own formula and maximum. Where the SDI weekly benefit would be higher, EDD pays the difference between the two.

Workers' comp is paying for medical treatment only. If the claims administrator has accepted the injury for medical care but is not paying TD, for example because it disputes that you are unable to work, SDI can pay while that dispute is resolved.

What the adjuster does with an EDD lien

When SDI has paid during a delay, EDD files a lien in the workers' comp case for the weeks it covered. Once the claim is accepted, the adjuster calculates the TD owed for those weeks, pays EDD its lien out of that amount, and pays you any difference, for example when the TD rate was higher than SDI. The practical effect is that you are made whole for the period but not paid twice. The lien is routine and is not a mark against the claim.

How EDD gets repaid

If SDI pays while a workers' comp case is pending, EDD files a lien to recover those benefits from the workers' comp case when it is accepted or settled. The claims administrator pays EDD directly from the temporary disability owed for the overlapping period. You do not write a check. If the workers' comp claim is denied and stays denied, there is nothing to recover and the SDI is yours.

What to do in practice

If you are hurt at work, report it to your employer and file the DWC-1 claim form first, because that starts the workers' comp clock and the employer's duty to authorize treatment. If two weeks pass without a TD payment or a delay letter, or you receive a delay letter, file an SDI claim through your myEDD account and answer the question about whether the condition is work-related honestly. EDD will process the claim and, if it pays, file its lien. Keep the workers' comp claim moving at the same time; SDI is a bridge, not a substitute, and it does not pay for medical treatment of a work injury or for permanent disability.

When workers' comp pays after SDI already has

The reverse problem comes up when a condition was first treated as non-work-related and SDI paid, and a doctor later connects it to work. File the workers' comp claim as soon as the connection is made; for a cumulative injury the date of injury is the first day you had disability and knew or should have known work caused it (Labor Code §5412), which is often the day the doctor said so. EDD's lien then covers the SDI already paid for the overlapping weeks, and the claims administrator settles it from the temporary disability it owes. Tell both agencies about the other claim; each asks, and the forms are designed to catch the overlap.

Unemployment insurance

Unemployment insurance is a third program and is generally not available while you are receiving temporary disability, because it requires that you be able and available to work. It becomes relevant when a doctor releases you to work with restrictions, your employer has no work within them, and TD has ended; at that point a worker who is able to do some work and is looking for it can apply. EDD decides eligibility; the DWC has no role.

Social Security disability

Social Security disability insurance is a separate federal program for a disability expected to last at least a year. Workers' comp benefits reduce it under a federal offset, so a worker receiving both does not receive the full amount of each. It is worth applying for when TD has ended under the 104-week limit and the condition is long-term; the Social Security Administration, not EDD or the DWC, decides eligibility.

Questions people ask

Should I apply for SDI while my workers' comp claim is being investigated?

EDD's own guidance is yes, if you are unsure, file the claim and let EDD decide. A delayed workers' comp claim can take up to 90 days to be accepted or denied, and SDI can cover that gap. EDD recovers what it paid through a lien if the claim is accepted.

Will I have to pay SDI back?

Not out of pocket. EDD files a lien in the workers' comp case and is reimbursed from the temporary disability benefits the claims administrator later owes for the same period. You are not paid twice for the same weeks.

My workers' comp claim was denied. Can I still get SDI?

Yes, if you are otherwise eligible for SDI. A denial of the workers' comp claim is one of the situations in which EDD pays, and you can pursue the workers' comp denial at the appeals board at the same time.

Does getting SDI hurt my workers' comp case?

No. The two systems have different eligibility rules. Applying for SDI is not an admission that the injury was not work-related, and EDD asks whether the condition may be work-related so it can file its lien.

Sources

  1. EDD: Workers' Compensation and Disability Benefits, EDD, current. Manifest S74.
  2. EDD: Workers' Compensation FAQs (Disability Insurance), EDD, current. Manifest S75.
  3. DWC: I was injured at work - Temporary disability benefits, DIR / DWC, 2023-03. Manifest S06.
  4. Labor Code 4650: Timing of TD/PD payments; 10% self-imposed increase, California Legislature via california.public.law (cites leginfo), current. Manifest S102.
  5. Labor Code 4653: TD rate: two-thirds of AWW, California Legislature via california.public.law (cites leginfo), current. Manifest S103.
  6. Labor Code 4453: AWW min/max; SAWW indexing, California Legislature via california.public.law (cites leginfo), current. Manifest S104.
  7. Labor Code 4656: 104-week TD cap; 240 weeks for listed injuries, California Legislature via california.public.law (cites leginfo), current. Manifest S105.
  8. Labor Code 5401: Claim form within one working day; $10,000 treatment, California Legislature via california.public.law (cites leginfo), current. Manifest S123.
  9. Labor Code 5402: 90-day presumption of compensability, California Legislature via california.public.law (cites leginfo), current. Manifest S124.
  10. Labor Code 5412: Cumulative injury date of injury, California Legislature via california.public.law (cites leginfo), current. Manifest S127.
  11. DWC glossary of workers' compensation terms for injured workers, DIR / DWC, 2024-10. Manifest S09.
  12. DWC: FAQ about workers' compensation for employees, DIR / DWC, 2024-10. Manifest S08.
Richard Vaughn
Richard Vaughn CPCU, ARM, AIS

Richard Vaughn spent 35 years in commercial property and casualty insurance, most of it in workers' compensation: running a self-insured group, auditing premiums, and implementing claims systems for carriers and third-party administrators. He is not an attorney. dickvaughn.com