Getting CA disability forms for elective surgery in Mexico - will EDD cover it?

You need what's called a DE 2501 form (Claim for Disability Insurance Benefits). You can get it directly from the SDI website under "Forms and Publications" but its kinda buried in there. As for Mexico doctors... I THINK they'll accept it but the doctor needs to be licensed. The form asks for their license number and contact info. My friend had surgery in Canada last yr and got approved but Mexico might be different????

I can provide some clarification on this. For out-of-country medical procedures, EDD does accept medical certifications from licensed physicians in other countries, including Mexico. However, there are important requirements to meet: 1. Your doctor must complete the standard DE 2501 Claim form and Part B of the form (the Physician/Practitioner Certification) 2. The doctor's medical license number must be provided 3. All documentation must be translated to English if originally in Spanish 4. The procedure must be medically necessary (even if elective) You can find the form by logging into your SDI Online account, clicking on "Forms and Publications," then selecting "Disability." The DE 2501 should be listed there. You'll need to print it out for your doctor to complete by hand.

my cousin did something like this in tijuana last summer and edd gave her the runaround for like 2 months saying they needed more info from her doctor... she finally got paid but it was a huge hassle. good luck!

yeah she got approved but only after her doctor sent like 3 different letters with more medical details. they kept saying they needed clarification on why the surgery was necessary even tho it was all on the original form

I went through this exact situation last year with a specialized treatment in Mexico. You need to do the following: 1. File your claim online through SDI Online (easiest way) 2. Download and print the DE 2501 form 3. Have your Mexican doctor complete Part B with their license info 4. Make sure ALL documentation is translated to English (this is critical) 5. You can upload the completed forms through your SDI Online account Most important: get detailed medical notes explaining WHY this procedure is medically necessary. EDD scrutinizes international claims more closely. My claim took 5 weeks to process because they kept requesting additional documentation from my doctor.

Wouldn't it be easier to just have the surgery in California? Then you don't have to deal with the foreign doctor paperwork hassle. Just saying...

Have you tried calling EDD directly to ask? Oh wait, don't bother - you'll be on hold FOREVER and probably get hung up on multiple times. I tried calling with a similar question last month and never got through after 8 attempts over 2 days. I ended up using a service called Claimyr (claimyr.com) that got me connected to an actual EDD rep in about 20 minutes. They have a video showing how it works: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd. Way better than waiting on hold for hours only to get disconnected. The rep I spoke with was able to explain exactly what forms I needed for my specific situation.

BTW another thing to consider is that CA has a 7-day waiting period for SDI benefits. So you don't get paid for the first week you're out. Keep that in mind when planning your trip and recovery time!!!!

One more important detail: make sure your claim is filed within 49 days of your disability beginning (your surgery date). If you file late, you may lose benefits. Also, when you have your Mexican doctor complete the form, double-check that they've filled in ALL fields, including: - Their complete address (international address is fine) - Their license number - ICD-10 diagnosis code - Dates of disability (beginning and estimated return to work) - Their signature and date Missing information is the number one reason these claims get delayed. And yes, as someone mentioned, remember the 7-day unpaid waiting period at the beginning of your claim.

my sister just got back from having surgery in mexico and EDD totally denied her claim said something about the procedure not being "medically necessary" even tho her doctor wrote a whole letter... now shes appealing but its been 2 months with no money... just be prepared it might not work out

I found that having my US doctor also submit a note helped my case with my international treatment. They basically confirmed the diagnosis and necessity of the procedure, which seemed to give EDD more confidence in approving my claim. Might be worth asking your regular doctor here to provide supporting documentation if possible!

Just wanted to add one more tip from my experience - when you're getting your documents translated to English, make sure to use a certified translator if possible. EDD sometimes questions unofficial translations. Also, keep copies of EVERYTHING - the original Spanish forms, the English translations, and any supporting letters. If they request additional documentation later (which they often do for international claims), you'll have everything ready to go. Good luck with your surgery!

One thing I haven't seen mentioned yet is that you should also check if your surgery requires pre-authorization from EDD before you travel. Some procedures, especially elective ones, may need approval beforehand. I learned this the hard way when my friend's claim was initially denied because EDD said she should have gotten pre-approval for her procedure in Costa Rica. She eventually won on appeal, but it added months to the process. You might want to call EDD (or use that Claimyr service someone mentioned) to ask if your specific type of surgery requires pre-authorization for international treatment. Better to find out now than after you've already had the surgery!

Adding to what everyone else has shared - I just went through the SDI process for my surgery in Guadalajara last year. One thing that really helped my case was having my Mexican doctor include specific recovery timelines and work restrictions in the medical certification. Don't just have them write "patient will be disabled for X weeks" - ask them to be detailed about things like "no lifting over 10 pounds," "cannot sit for extended periods," etc. EDD seems to approve claims faster when they can see exactly how your condition prevents you from doing your normal job duties. Also, if you're planning to do any medical tourism, I'd recommend joining some Facebook groups for people who've had the same procedure in Mexico - they often share which doctors are familiar with US insurance forms and which clinics have staff who can help with the paperwork process. Good luck with everything!

I went through a similar situation with surgery in Tijuana about 8 months ago. Here's what I wish I had known from the start: 1. Download the DE 2501 form early and review it with your Mexican doctor BEFORE your surgery date - some doctors aren't familiar with US disability forms and need time to understand what's required. 2. Ask your doctor to provide extra medical documentation beyond just the basic form. I included surgical notes, pre-op assessments, and detailed recovery instructions. The more comprehensive your medical file, the less likely EDD will request additional information later. 3. Consider having your Mexican doctor coordinate with a US physician if possible. I had my primary care doctor here review my case and provide a supporting letter confirming the medical necessity - this seemed to really help with approval. 4. File your claim online as soon as your disability period begins. Don't wait until you're back from Mexico. You can upload all the completed forms through SDI Online once you have them. The whole process took about 6 weeks for me, which was actually pretty reasonable for an international claim. The key is being overly thorough with documentation upfront rather than having to provide additional info later. Good luck with your surgery!

I had a very similar experience with surgery in Mexico City last year and want to share a few additional tips that really helped my case get approved without delays: 1. Make sure your Mexican doctor includes their medical school information and year of graduation on the form - EDD sometimes requests this for international providers to verify credentials. 2. Have your doctor use the exact ICD-10 codes that match your condition. I printed out the relevant codes beforehand and gave them to my surgeon to ensure accuracy. 3. If your surgery involves any implants or medical devices, get documentation about those too. EDD wanted to know specific details about the materials used in my procedure. 4. Consider getting a letter from your employer's HR department stating your normal job duties and physical requirements. This helps EDD understand why your specific type of work is incompatible with your recovery restrictions. 5. Take photos of all your completed paperwork before submitting - I had to resubmit some documents when EDD claimed they never received my original forms. The whole process took me about 4 weeks total, and I think being extra thorough with documentation upfront really made the difference. Also, don't stress too much about the international aspect - EDD processes these claims regularly and the staff seemed familiar with the requirements once I had everything properly documented.

I just want to add one more crucial tip that saved me a lot of headache - make sure you understand California's SDI benefit calculation before you travel. Your weekly benefit amount is based on your highest quarter earnings in your base period, and there's a maximum weekly benefit (around $1,540 for 2024). Also, something I learned the hard way: if you're planning to be out longer than the initial estimate your doctor provides, you'll need to file for an extension with updated medical documentation. My recovery took 2 weeks longer than expected, and I had to scramble to get my Mexican doctor to complete additional forms while I was still healing. One last thing - consider purchasing travel insurance that covers medical complications. While SDI will cover your lost wages, if you need additional medical care while in Mexico due to complications, regular health insurance often doesn't cover international treatment. I was lucky nothing went wrong, but it would have been expensive if something had! The Facebook groups for medical tourism that someone mentioned earlier are gold mines for this kind of practical info. Good luck with everything!

I just wanted to chime in as someone who's been following this thread - wow, this is probably the most comprehensive guide to international SDI claims I've ever seen! I'm not dealing with surgery in Mexico myself, but I've been struggling with EDD for months on a different issue and the tips about documentation and being overly thorough really resonated with me. @Nora Brooks - it sounds like you've gotten some amazing advice here. The checklist approach that several people mentioned seems like the way to go. One small addition from my own EDD experiences: when you're uploading documents to SDI Online, the system sometimes times out or fails during upload. I always recommend uploading documents one at a time rather than trying to batch upload everything, and double-check that each file actually went through before moving to the next one. Also, if you do end up needing to call EDD for any reason, try calling right at 8 AM when they open - you'll still be on hold but usually not as long as later in the day. Good luck with your surgery and recovery!

This thread has been incredibly helpful! I'm in a similar situation planning surgery in Costa Rica next year and had no idea about most of these requirements. A few questions based on everyone's experiences: 1. For those who had success with international claims - did you find certain types of procedures get approved more easily than others? I'm having orthopedic surgery which seems pretty clearly medically necessary. 2. Has anyone dealt with the situation where your Mexican/international doctor doesn't speak English well? I'm wondering if I should bring a translator to the appointment when we review the DE 2501 form. 3. @Genevieve Cavalier mentioned the 5-week processing time - is that typical, or did some of you experience faster/slower approval times? I'm definitely going to start preparing way in advance after reading about everyone's experiences. The level of documentation required is way more extensive than I expected, but it sounds like being thorough upfront really pays off in terms of avoiding delays and appeals. Thanks to everyone for sharing such detailed real-world advice!

As someone who works in medical administration and has helped several patients navigate international SDI claims, I want to add a few professional insights to this excellent discussion: 1. **Medical Necessity Documentation**: The key phrase EDD looks for is "prevents the claimant from performing their regular or customary work." Make sure your Mexican doctor uses this exact language and connects your specific job requirements to your recovery limitations. 2. **Physician Licensing**: EDD has a database they use to verify international medical licenses. Your Mexican doctor's license number will be checked, so ensure they provide their complete, current license information including the state/region where they're licensed in Mexico. 3. **Translation Requirements**: Any document not in English must be translated by a certified translator - this includes medical records, surgical notes, and even prescription information. Keep the originals and certified translations together. 4. **Filing Timeline**: The 49-day rule mentioned earlier is critical, but it starts from your first day of disability, not your surgery date. If you're disabled for pre-operative preparation, that counts toward your claim period. 5. **Appeal Statistics**: About 15% of international SDI claims get initially denied, usually for insufficient documentation. However, 70% of those denials are overturned on appeal when proper documentation is provided. The thorough approach everyone's describing here is absolutely the right strategy. Better to over-document than face months of appeals!