EDD SDI claim denied despite submitting all paperwork - Appeal process help needed urgently

ya they denied me first too. u gotta call and ask exactly WHY u were denied. sometimes its just 1 checkbox the doc missed. dont waste time wl appeal til u know what went wrong!

I went through this exact situation last summer. The 'insufficient medical documentation' usually means one of three things: 1. Your doctor didn't complete all sections of the DE 2501 form (especially the parts about functional limitations and expected recovery time) 2. The medical evidence doesn't match the claimed disability period 3. They need additional medical records beyond just the form What worked for me: I called the medical certification unit directly (different number than the main SDI line) and asked specifically what was missing. Turns out my doctor needed to submit additional progress notes showing ongoing treatment. Once I knew exactly what was missing, I had my doctor submit those records with a cover letter referencing my claim ID, and it was approved within 10 days. Don't just blindly appeal - find out exactly what's missing first!

When they denied my claim, I couldn't get through on the phone for WEEKS! I ended up using a service called Claimyr (claimyr.com) that got me connected to an actual EDD representative within 25 minutes. They have a video demo showing how it works: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd It was worth it because when I finally spoke to someone, they told me my claim was denied for a completely different reason than what the letter said! The real issue was that my doctor accidentally marked my condition as pregnancy-related (I'm male lol) which auto-flagged it. Once I knew that, I had my doctor submit a corrected form and my claim was approved without needing a formal appeal. Saved me weeks of waiting!

I HATE THE EDD!!!! This happens to like 40% of claims I swear!!! They are DELIBERATELY denying valid claims hoping people give up. I worked for them as a temp 2 years ago and let me tell you what's happening. They have QUOTAS for claim processing and if an examiner can't figure something out in under 4 minutes they just DENY IT rather than look more closely. THEY DON'T EVEN READ THE MEDICAL NOTES most of the time!!!! The appeals dept is different people who actually take time to review. FILE THE APPEAL IMMEDIATELY and also try calling but expect to wait 3+ months for your money. This system is DESIGNED to make disabled people suffer.

my husband got denied the first time too but his doctor just sent in a new form with more details and they approved it without an appeal actually. sometimes its faster to just fix whatever was wrong then do the whole appeal process thing. good luck!

Here's the exact process I recommend: 1. Use the Appeal Form (DE 2501) and submit it within 30 days of your denial notice 2. At the same time, call the SDI Medical Certification Unit at 1-855-481-3646 to find out exactly what documentation was insufficient 3. Have your doctor write a detailed letter addressing the specific issue (include your claim ID number, name, and date of birth at the top) 4. Submit any additional medical evidence that supports your disability (imaging reports, specialist consultations, physical therapy notes) 5. Include a brief personal statement describing your limitations and why you cannot perform your job duties Also, make copies of EVERYTHING before you send it in. The SDI system regularly loses documents, so having proof of what you submitted is critical. About 65% of initial denials are overturned on appeal when properly documented, so don't give up!

btw make sure ur doctor filled out the right form sometimes they use old versions and edd rejects those automatically

UPDATE: I finally got through to EDD this morning after 3 days of trying! The rep told me the denial was because my doctor marked my disability as 'temporary' but didn't provide a specific expected recovery date. They said I need my doctor to submit an updated medical certification with a projected return-to-work date, even if it's just an estimate. I've already contacted my doctor's office and they're sending in a corrected form today. The rep said once they receive that, they can reprocess my claim without a formal appeal. Fingers crossed this works! Thanks everyone for your help!

So glad you got through and found out the real issue! This is such a perfect example of why calling first is so important - you saved yourself weeks of appeal processing time. The missing return-to-work date is actually a really common reason for denial that doesn't get explained clearly in the denial letters. Hope your doctor gets the corrected form submitted quickly and your claim gets approved! Keep us posted on how it goes.

I'm so sorry you're going through this - the stress of being denied when you clearly need the benefits is awful. Reading through all these responses, it sounds like you're on the right track now that you found out the specific issue with the missing return-to-work date. I had a similar experience last year where my initial denial was for something completely different than what the letter indicated. One thing I'd add - when your doctor submits the corrected form, ask them to include a brief cover letter referencing your original claim number and specifically mentioning that this is a "corrected medical certification addressing the missing projected return-to-work date." This helps the processor understand exactly what they're looking at and can speed up the review. Also, if possible, have your doctor fax it rather than mail it - faxed documents seem to get processed faster in my experience. Really hoping this gets resolved quickly for you! The financial stress on top of dealing with a back injury is just terrible.

I've been lurking on this forum for months dealing with my own EDD nightmare, but your story finally motivated me to create an account and share my experience. I went through almost the exact same situation with a work-related back injury (L3/L4 in my case) and got denied initially for "insufficient medical documentation" even though I had MRI results, doctor's notes, the works. Like others have mentioned, the key is definitely finding out the SPECIFIC reason for denial rather than relying on the generic denial letter. In my case, it turned out my doctor had accidentally left the "work restrictions" section blank on the DE 2501 form, which was an automatic denial trigger even though he had detailed my limitations in the narrative section. One tip I haven't seen mentioned yet - if you're having trouble getting through on the phone, try calling the Spanish language line even if you speak English. I speak fluent Spanish and found their wait times were significantly shorter (like 15-20 minutes vs 2+ hours). They can handle English-speaking callers too and were actually more helpful than some of the English reps I spoke with. Also, document EVERYTHING - dates you called, who you spoke with, what they told you. I ended up needing those notes later when there were discrepancies in my file. This whole system is so broken but don't give up - you clearly have a legitimate claim and deserve those benefits!

I'm so sorry you're dealing with this! I just went through something similar last month with my own SDI claim. The stress of being denied when you clearly need the benefits is just awful, especially when you're already dealing with a serious injury and financial pressure. Reading through all the responses here, it sounds like you got some really solid advice - especially about calling to find out the specific reason for denial rather than just appealing blindly. That approach saved me weeks of waiting. In my case, it turned out to be a tiny checkbox my doctor missed on the form, nothing to do with the actual medical evidence. One thing that helped me was keeping a detailed log of every phone call attempt, including the time I called and how long I waited before giving up. I noticed that calling right at 8:00 AM on Tuesdays seemed to have the shortest wait times, though that might just be coincidence. Also, if your doctor's office has a patient portal or secure messaging system, I'd recommend reaching out to them that way about submitting the corrected form. My doctor's office was really responsive through their portal and could confirm exactly when they faxed the updated paperwork to EDD. Hang in there - from everything I've read here and experienced myself, these initial denials are unfortunately super common but often get resolved once you know exactly what needs to be fixed. Your L4/L5 herniation with MRI evidence sounds like a very legitimate claim that should definitely be approved once they get the proper documentation!

I'm going through almost the exact same situation right now - work injury, back problems, got denied even with all my paperwork submitted correctly. Reading through everyone's experiences here has been incredibly helpful! I've been trying to get through to EDD for over a week with no luck, but seeing that others have successfully gotten answers gives me hope to keep trying. @Aaliyah Jackson - I'm so glad you were able to get through and find out the real reason for your denial! The missing return-to-work date issue seems to be super common based on what everyone is saying. Definitely going to try some of the phone tips people mentioned here, especially the Spanish line suggestion from @Nora Bennett and calling on Tuesday mornings like @Malik Johnson suggested. This whole thread is proof that this community is so valuable - without all these shared experiences, I would have just blindly filed an appeal and waited months for nothing. Now I know to call first and get the specific reason for denial before doing anything else. Thank you to everyone who shared their stories and tips!

I'm dealing with a very similar situation right now and this whole thread has been incredibly eye-opening! I got denied for SDI last week for what they called "incomplete medical documentation" even though my doctor filled out everything and I have clear imaging showing nerve compression. Reading everyone's experiences here, it sounds like I need to stop panicking and start calling to find out the EXACT reason for denial rather than just assuming the worst. @Aaliyah Jackson - your update about the missing return-to-work date is so helpful! It's crazy how something that specific can cause a complete denial but not be clearly explained in the denial letter. I'm definitely going to try calling first thing tomorrow morning using some of the strategies people mentioned here (especially the Tuesday 8 AM tip and possibly the Spanish line if I can't get through). This community is amazing - without reading all these shared experiences, I would have wasted weeks on an appeal for potentially the wrong reason. Thank you to everyone who took the time to share their stories and practical advice. It's giving me hope that this can actually get resolved relatively quickly once I know what needs to be fixed!