Can a medical facility refuse to extend my disability certification after 6 months despite EDD eligibility?

yep, happened to me last yr. My primary doc's office had the same policy! they wont extend beyond 6months no matter what. so frustrating. had to find a specialist willing to do the paperwork, took FOREVER to get an appt tho

Unfortunately, many medical facilities have implemented internal policies like this, but it has nothing to do with EDD eligibility. If you medically qualify, you qualify - however, physicians do have discretion over what they're willing to certify and for how long. The clinic is likely doing this to avoid what they see as disability dependence or to limit their administrative burden. You have several options: 1. Ask your doctor for a referral to a specialist who can take over your disability certification 2. Request your doctor document in your medical records that you're still disabled but they're refusing to certify due to clinic policy (this helps with appeals if needed) 3. Find a new primary care physician who doesn't have this restriction 4. If you have a specialist already involved in your care (orthopedist, neurologist, etc.), ask if they can take over certification Do this ASAP as you don't want a gap in your benefits.

This is completely BS! The clinic cant just make up rules that go against your rights when you're legitimately disabled! Your doctor even AGREES you're still disabled but won't sign the form?? That's ridiculous and probably illegal. I'd file a complaint with the medical board AND talk to an attorney. These clinics think they can just push disabled people around and it's NOT RIGHT.

I hit the same wall with Kaiser last year. Their policy is 6 months max for most conditions, then they push you to apply for long-term disability instead. What worked for me was getting my specialist (in my case rheumatologist) to take over the certification. My advice - call EDD directly to explain the situation and ask for guidance. They deal with this ALL the time. I spent days trying to get through to EDD with no luck - constant busy signals or disconnects. Then I found Claimyr (claimyr.com) which got me through to an actual EDD agent in about 25 minutes. They have a video showing how it works: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd. The agent told me exactly what to do to avoid interruption in my benefits while switching providers. Totally worth it when you're dealing with time-sensitive certification issues.

this is actually pretty common with bigger medical groups they dont want liability for extended disability claims my doc told me they had the same policy but she helped me anyways by referring me to pain management who took over my certification no problems have u asked ur doc if they can refer u somewhere?

What about going to a different primary care doctor? Can't you just switch doctors and get a new one to sign off? Seems like an easy fix.

I wanted to follow up on this thread - for anyone facing this issue, the most important thing is to prevent gaps in your certification. EDD allows for certification up to 20 days before your current certification expires. So even if you're looking for a new provider, have your current doctor complete one final certification form that covers at least 20-30 days into the future to give you time to establish with a new provider. Also, if you can't get an appointment in time, go to the ER if necessary - they can sometimes provide bridge certification if you explain your situation.

That's great news that your orthopedist was able to help! For future reference, if anyone else runs into this situation, you can also check if your insurance covers urgent care visits for disability certification reviews. Some urgent care centers have providers who are experienced with disability paperwork and can serve as a bridge while you're transitioning between doctors. Just make sure to bring all your medical records and previous certification forms to help them understand your case quickly.

I'm so glad you were able to get this resolved with your orthopedist! This whole situation highlights how frustrating the healthcare system can be when you're already dealing with a disability. It's ridiculous that medical facilities can have arbitrary policies that potentially leave disabled patients without income, especially when the doctor agrees you're still medically unable to work. Your experience will definitely help others who face the same issue - knowing to contact specialists directly and explain the urgency seems to be key. Hope your recovery continues to progress and you don't have to deal with any more certification hassles!

This is such an important thread for anyone dealing with disability certification issues! As someone new to the SDI process, I had no idea that medical facilities could have these kinds of internal policies that override a doctor's medical judgment. It's concerning that so many people are experiencing this same problem with larger medical groups. What really stands out to me is how proactive you have to be - calling specialists directly, explaining the urgency, asking about referrals, and even considering urgent care options. It seems like the key is having multiple backup plans and not waiting until the last minute. I'm definitely saving this thread for future reference, and I hope your recovery continues to go well, Natalie. Thanks to everyone who shared their experiences and practical solutions - this kind of community knowledge is invaluable when navigating these complex systems!

This thread really highlights a systemic issue that needs more attention. I'm dealing with a similar situation right now - my medical group has the same 6-month policy, and it's incredibly stressful when you're already struggling with a disability. What bothers me most is that these policies seem designed more around administrative convenience than patient care. For anyone currently facing this, I'd also suggest documenting everything - get the policy in writing if possible, and make sure your medical records clearly state that you remain disabled but certification was refused due to clinic policy. This documentation could be crucial if there are any issues with your benefits or if you need to file appeals. It's unfortunate that we have to become experts in navigating these systems when we should be focusing on recovery, but threads like this are so valuable for sharing knowledge and supporting each other through these challenges.

This situation is unfortunately becoming more common with larger healthcare systems trying to limit their administrative burden. I went through something similar last year with my work comp case - the medical group had a policy against certifying beyond certain timeframes even when patients clearly needed continued care. One thing that helped me was asking my doctor to write a detailed letter explaining my continued disability status and the clinic's policy refusal, then submitting that with my EDD paperwork along with a brief explanation. EDD was actually pretty understanding about the situation since they deal with this frequently now. Also, if you're still having trouble finding a provider, some independent physicians who specialize in disability evaluations can take over your case. They're used to working with disability certifications and don't usually have these arbitrary time limits. You might pay out of pocket initially, but it could be worth it to avoid gaps in benefits. Hope you get this sorted out quickly - the stress of potentially losing benefits while still disabled is the last thing you need when trying to recover!

My dr. Won't even extend past 2 months. I have a feeling they don't want to fill out additional paperwork which is exactly what is needed to extend my benefits. If they won't certify after me sending my thorough message, I'm going to my primary. I'm entitled to time off if I haven't fully recovered. It's not my problem it's a lot of paperwork. Maybe do some OT?

This thread has been incredibly helpful! I'm currently dealing with a similar situation where my medical group is pushing back on extending my disability certification beyond 4 months for a chronic condition that clearly isn't resolved yet. Reading everyone's experiences and solutions has given me a roadmap for what to do next. What really resonates with me is how many people mentioned the importance of being proactive and having backup plans. I'm going to start reaching out to specialists now rather than waiting until I hit their arbitrary deadline. The suggestion about getting documentation in writing about the clinic's policy refusal is brilliant - I hadn't thought about creating that paper trail. It's frustrating that we have to become advocates and navigate these administrative hurdles when we're already dealing with the physical and emotional challenges of being disabled. But seeing how this community shares knowledge and supports each other gives me hope that I can get through this process. Thanks to everyone who shared their experiences - you're helping more people than you probably realize!

I'm new to this community and just went through something very similar! My doctor's office had a 6-month policy too, but I found out that many medical groups are implementing these blanket policies to reduce their administrative workload, not because of any medical or legal requirement. What worked for me was being very direct about the timeline urgency. I called my orthopedist's office and explained that I needed disability certification continuation and my primary care couldn't do it due to their internal policy. They were able to squeeze me in within a week specifically for this issue. One tip that really helped: when I called, I mentioned that I had all my previous disability forms and medical records ready to bring, which made the appointment more efficient for them. They seemed more willing to help when they knew it wouldn't be a complicated evaluation from scratch. The whole situation really opened my eyes to how much self-advocacy is required in the disability system. It's exhausting when you're already dealing with a medical condition, but having backup plans and being proactive seems to be the key to avoiding benefit interruptions.