Kaiser FMLA board refusing to extend mental health disability certification - what are my options?

You absolutely have options! Kaiser's FMLA board isn't the final authority on your disability eligibility. First, you should know that FMLA (12 weeks) and SDI (up to 52 weeks) are different programs with different certification requirements.\n\nRequest an urgent appointment with your psychiatrist and explain your deteriorating situation. Bring documentation of your symptoms and how they prevent you from working. If your current psychiatrist won't help, ask for a second opinion from another Kaiser mental health provider. Also, request a copy of your complete medical records including the FMLA board decision.\n\nIf Kaiser still refuses to extend your certification, consider seeing a non-Kaiser psychiatrist for an independent evaluation (might have to pay out-of-pocket). EDD accepts certifications from any licensed physician or mental health professional.\n\nHave you also filed for an SDI extension? That's separate from FMLA and requires form DE 2525XX. The key is documenting why you cannot perform your regular or customary work.

Thank you for this. I didn't realize FMLA and SDI were completely different programs - I thought I needed FMLA approval to get SDI benefits. I'll request an appointment with my psychiatrist tomorrow. Do you know if I can just directly ask for a different mental health provider at Kaiser if my current one is going along with the FMLA board?

omg kaiser did this to me last yr too!!! their mental health dept is horrible n always rushing to get ppl back to work. my anxiety was so bad i couldn't leave the house but they said i was \

That's awful and exactly what I'm afraid of. Did you find any way to fight their decision or get more time off?

The key problem here is that you're confusing FMLA (which is job protection for 12 weeks) with SDI (which is wage replacement for up to 52 weeks). They're completely separate programs.\n\nKaiser's FMLA board only determines if you qualify for job-protected leave under FMLA. They're saying you've exhausted your 12 weeks, which is probably correct. However, that has NOTHING to do with your eligibility for continued SDI benefits.\n\nFor SDI, you need a medical provider to certify your disability on DE 2501 form. If your current provider won't do it, you need to:\n\n1. File a grievance with Kaiser (which you did)\n2. Request a different mental health provider\n3. Ask for a peer-to-peer review where your doctor discusses your case with another specialist\n4. Consider seeing a non-Kaiser provider (check if your insurance allows this)\n\nAlso, call EDD directly to explain your situation and ask about your options for continued certification. Sometimes they can guide you through alternative certification methods.

This makes so much more sense now. I thought I needed their ongoing FMLA approval to continue getting SDI payments. I'm going to push harder for a different provider - my current one seems more concerned with following Kaiser's protocol than my actual health.

Try calling EDD directly and explaining the situation. Good luck getting through though - their phone system is TERRIBLE!! I spent 3 weeks trying to reach someone about my mental health disability claim last month and kept getting disconnected after waiting for hours.\n\nI finally found a service called Claimyr that got me through to an EDD representative in about 20 minutes. It costs money but was worth it for me since I was about to lose my mind dealing with the phone system. Their website is claimyr.com and they have a video that shows how it works: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd\n\nWhen I got through, the EDD rep was actually super helpful and explained exactly what documentation I needed from my doctor. They also told me I could request a different doctor for my certification if needed.

does this actually work? ive been trying to call edd for 2 weeks about my mental health disability claim and keep getting hung up on after waiting forever

Yes, it worked for me. I was skeptical too but was desperate after trying for weeks. Got through in about 20 minutes and the EDD rep helped me sort everything out with my claim that had been pending for almost a month.

Kaiser is NOTORIOUS for this!!!! Their mental health department is currently under investigation by the state because they keep doing this to patients. Their FMLA board is run by admin people NOT doctors who actually see you. I had to threaten legal action before they would extend my certification. \n\nYou have rights!!! Print out all the EDD guidelines about mental health disability and bring them to your next appointment. DEMAND to speak to a patient advocate in person. Document EVERYTHING. Record names, dates, times of everyone you talk to. \n\nAlso - your employer can't fire you even after FMLA expires if you're still disabled. That would violate ADA laws. Don't let them bully you!!!

I didn't know Kaiser was under investigation for this, but it doesn't surprise me. Their mental health services have been stretched so thin. I'll definitely start documenting everything better. Did you eventually get your certification extended after threatening legal action?

YES I did!! But it was a FIGHT. I basically had to get my therapist to advocate for me with the psychiatrist, then had to file a formal grievance, then had to mention that I was

I work in HR and deal with this frequently. Here's what you need to know:\n\n1. FMLA and SDI are completely separate programs. FMLA is federal job protection for 12 weeks. SDI is California wage replacement for up to 52 weeks.\n\n2. Once your FMLA is exhausted, you may still qualify for CFRA (California Family Rights Act) which provides additional job protection. Ask your employer's HR department about this.\n\n3. For continued SDI benefits, you need medical certification from a licensed provider stating you cannot perform your regular work. This doesn't have to come from Kaiser.\n\n4. Request your complete medical records from Kaiser immediately.\n\n5. If your condition qualifies under ADA (Americans with Disabilities Act), you have additional protections and may be entitled to reasonable accommodations when you return to work.\n\nYour immediate priority should be finding a provider who will properly document your disability for SDI purposes. If Kaiser won't do it, seek an outside psychiatrist or psychologist who can evaluate your condition.

This is incredibly helpful, thank you. I didn't even know about CFRA. I'll talk to HR today. One question - if I go to an outside psychiatrist, will EDD accept their certification even if they're not my regular treating doctor?

Yes, EDD will accept certification from any licensed physician or mental health professional who can evaluate your condition, even if they aren't your regular provider. The key is making sure they thoroughly document why you're unable to perform your regular work functions. They should be specific about your symptoms and functional limitations rather than just stating general diagnoses. Make sure they understand the physical and mental requirements of your job so they can explain why you can't perform those duties currently.

my cousin had same problem with kaiser last year and he had to switch to a different health plan during open enrollment. kaiser mental health is terrible they just want to give pills and send you back to work. maybe try calling your insurance directly to see if you can get a referral outside kaiser?

Just checking back - were you able to make any progress with Kaiser or finding another solution? The suggestion about calling EDD directly is really good, as they can sometimes provide guidance specific to your situation. Hope you're hanging in there.

Thanks for following up. I've made some progress - I spoke with my HR department about CFRA protection and they're being helpful. I also managed to get an appointment with a different psychiatrist at Kaiser next week. I'm documenting everything carefully now and focusing on explaining specifically why I can't perform my job duties. I'll update once I know more!