< Back to California Disability

Toot-n-Mighty

EDD denied my claim after all documents submitted - fighting back with appeal!

Just opened my mail to find my SDI claim was DENIED despite submitting EVERYTHING on time! I'm absolutely livid right now. I've been off work for 6 weeks following my back surgery, can barely walk, and these people have the nerve to deny my claim when my doctor sent all the medical certification forms properly. The denial letter says something about 'insufficient medical documentation' which is complete BS because my surgeon literally detailed everything about my procedure and recovery time. I'm not taking this lying down. I've already downloaded the appeal form (DE 2501D) and I'm compiling a folder with: - Copy of original claim - NEW detailed letter from surgeon - Physical therapy schedule - MRI results they apparently 'didn't see' - Highlighted copies of all previous submissions I've also contacted my state assembly member's office today and have an appointment next week. Has anyone successfully appealed a denial? Any tips on what specifically helps win these appeals? I paid into this system for 12 years and now when I actually need it, they're trying to avoid paying me what I'm entitled to!

I successfully appealed a denial last year! The key is documentation, documentation, documentation. Make sure your doctor explicitly states why you cannot perform your "regular or customary work" - those exact words matter to EDD. Also, when you submit your appeal, request a hearing immediately rather than just the paper review. My denial was overturned within 3 weeks after I submitted my appeal with additional medical documentation. Make sure to keep copies of EVERYTHING you send them, and send it certified mail so they can't claim they never received it.

0 coins

Thank you!! That's really helpful. I didn't know I could request a hearing right away. Did you attend your hearing in person or was it over the phone? My surgeon is willing to provide additional documentation but he's charging me $75 for each form he has to fill out now...

0 coins

dont give up!! they denied me 2x before finally approving my claim. the EDD system is designed to make ppl give up cuz they know most ppl wont fight back. keep pushing and dont let them win!!!

0 coins

Thanks for the encouragement! Did you do anything specific on your successful attempt that you think made the difference?

0 coins

This is unfortunately very common with EDD SDI claims right now. From my experience helping clients with appeals, here are the most important things to focus on: 1. Make sure your medical provider specifically addresses your inability to perform your SPECIFIC job duties - generic statements about disability aren't enough 2. The appeal form (DE 2501D) has limited space - attach a detailed letter explaining point-by-point why the denial reason is incorrect 3. Include a clear timeline of your condition, treatment, and documentation submitted 4. If you have any communication records with EDD (phone calls, messages in your SDI Online account), document those too 5. Submit BEFORE the 30-day deadline - preferably 5-7 days early The appeals process is currently taking about 30-45 days on average, so prepare financially for that wait period if possible.

0 coins

This is incredibly helpful, thank you! I'm definitely going to write that detailed letter addressing each point. When you mention job duties - should I get my employer to provide a letter detailing my normal work responsibilities and why I can't perform them right now?

0 coins

The EXACT same thing happened to me!!! They denied me saying my doctor didn't provide enough evidence even though he filled out all their stupid forms!! I think they do this on purpose hoping people will just give up. I ended up having to get my doctor to write a super detailed letter specifically saying I couldn't do my job duties. Make copies of EVERYTHING and send it certified mail so they can't lie about not getting it.

0 coins

This is a great point about sending certified mail. I'd add that you should also fax everything if possible - this gives you confirmation of receipt and a timestamp. Keep every receipt, confirmation number, and tracking info organized.

0 coins

If you're having trouble reaching EDD to discuss your appeal (which is very likely), I'd recommend trying Claimyr. I was trying for WEEKS to get through to EDD about my denied claim with no luck. Claimyr connected me to an agent within about 20 minutes when I'd been trying for days on my own. It saved me so much frustration and I was able to get clarification on exactly what additional documentation they needed. You can see how it works here: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd and their website is claimyr.com. Sometimes just speaking to the right person at EDD can resolve things faster than the formal appeal process.

0 coins

Oh wow, I hadn't heard of this service before. I'll definitely check it out because I've been trying to call EDD for days and either get disconnected or told the call volume is too high. Thanks for the tip!

0 coins

they always deny the first time. its how they save money. my cousin works for the state (not edd but another agency) and she says its standard practice to deny first claims hoping people give up. KEEP FIGHTING!!!

0 coins

While I understand the frustration, I want to clarify that there isn't an official policy to automatically deny first-time claims. Denials happen for specific reasons that should be stated in the determination letter. That said, the appeals process does exist because mistakes happen and additional evidence can change the outcome. It's always worth appealing if you believe the decision was incorrect.

0 coins

Make sure youre not confusing SDI (State Disability Insurance) with SSI (Supplemental Security Income). They're completely different programs with different requirements. Which one exactly denied you?

0 coins

No, it's definitely SDI through California EDD. I'm not applying for any federal benefits, just the state disability that I've been paying into through my paychecks.

0 coins

I went through this exact situation in February. After my denial, I contacted my state assembly member's office as well, and it made ALL the difference. Their constituent services staff contacted EDD directly, and suddenly my case was "under review" again. Two weeks later, I got approved and received backpay for the entire period. When you meet with the assembly member's office, bring a signed authorization form allowing them to inquire about your case (they'll probably have this form). Also bring a clear, brief timeline of everything that's happened and copies of all documentation. The fact that you're taking multiple approaches (formal appeal + assembly member + in-person office visit) is smart. One of these channels will work. Don't get discouraged!

0 coins

That's really encouraging to hear! I have my appointment with my assembly member's office next week. I'll make sure to bring all the documentation you suggested. Did you continue with your formal appeal while the assembly member was helping, or did you focus on that route?

0 coins

im sorry this is happening to you EDD is THE WORST!!!! my claim got denied to i just gave up and went back to work early even tho my doctor said not to but i couldnt fight with them anymore

0 coins

I'm sorry you had that experience. This is exactly why EDD needs to improve their processes - people who genuinely need and deserve these benefits shouldn't have to choose between their health and financial survival. For anyone reading who's in a similar situation, please don't give up - use the appeal process and reach out to your state representatives as the original poster is doing.

0 coins

One thing I want to add - when you submit your appeal, call the Appeals Board 7-10 days after sending it to confirm they received it. Don't assume they received and processed it, even if you sent it certified mail. Getting a confirmation number for your appeal is crucial. I'd also recommend keeping a detailed log of every interaction with EDD - who you spoke with, date/time, what was discussed, any confirmation numbers. This documentation can be invaluable if your case drags on.

0 coins

Thanks for this tip! I wouldn't have thought to call and confirm. Do you have the direct number for the Appeals Board? I only have the general EDD number which never seems to connect to a real person.

0 coins

California Disability AI

Expert Assistant
Secure

Powered by Claimyr AI

T
I
+
20,087 users helped today