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!

I'm so sorry you're dealing with this - the system really fails people with mental health disabilities. I went through something similar with a different health plan and it's absolutely exhausting when you're already struggling. One thing that helped me was getting a detailed letter from my therapist (not just the psychiatrist) that specifically outlined my functional limitations - like how anxiety affects my ability to concentrate, make decisions, interact with patients, etc. Sometimes therapists who see you regularly have better documentation of day-to-day impacts than psychiatrists who you might only see monthly. Also, if you're in therapy through Kaiser, ask your therapist to communicate directly with the psychiatrist about your case. Sometimes internal advocacy from another provider can help push things through. You mentioned you work in healthcare - make sure any new provider understands the specific demands of your job (patient safety responsibilities, high-stress environment, need for quick decision-making) so they can clearly document why those tasks are currently impossible for you. Hang in there - you deserve proper support for your mental health recovery.

I'm going through something very similar right now and your post really resonates with me. The confusion between FMLA and SDI that others mentioned is exactly what I experienced too - I thought they were tied together when they're completely separate systems. One thing that's helped me is keeping a detailed symptom diary that I can show to providers. I write down specific examples of how my depression and anxiety prevent me from doing my job tasks - like being unable to focus during patient interactions, having panic attacks during stressful situations, or being too overwhelmed to make clinical decisions safely. This concrete documentation has been more persuasive than just saying "I'm depressed and anxious." Also, if you have any trusted colleagues in healthcare who understand mental health, they might be able to provide supporting statements about the demands of your specific role. Sometimes outside perspective helps providers understand why certain jobs are impossible when you're struggling with mental health issues. The system is so broken for mental health disabilities, but don't give up. You know your limitations better than any board, and you deserve the time you need to recover properly. Pushing yourself back too early will just make everything worse.

I'm so sorry you're going through this nightmare with Kaiser - their mental health department really seems to have systemic issues based on what others have shared here. The distinction between FMLA and SDI that everyone mentioned is crucial and I wish healthcare systems made this clearer to patients. One additional resource that might help: consider reaching out to the California Department of Fair Employment and Housing (DFEH) if you feel Kaiser is discriminating against you based on your mental health disability. They have a complaint process and can sometimes intervene when medical providers aren't properly accommodating disability needs. Also, since you mentioned you work in healthcare, your professional licensing board may have resources or advocacy services for healthcare workers dealing with mental health issues. Many state licensing boards now recognize that supporting healthcare workers' mental health is critical for patient safety. The stress of fighting for benefits while already struggling with depression and anxiety is absolutely brutal. Please be gentle with yourself during this process and remember that needing time to recover from mental health issues is just as valid as needing time for physical injuries. You're advocating not just for yourself but for all the other people who will face this same broken system.

I'm really glad you're getting some traction with HR on the CFRA protection and have a new psychiatrist appointment lined up! That's huge progress. One more suggestion based on your update - when you meet with the new psychiatrist, bring a written summary of your current symptoms, how they've worsened over the 14 weeks you've been off, and most importantly, specific examples of how these symptoms would create safety risks in your healthcare role. Having it in writing helps ensure you don't forget important details during the appointment, especially when anxiety can make it hard to articulate everything clearly. Also document any side effects from medications you're trying, sleep issues, concentration problems - anything that shows your condition is still actively interfering with your ability to work safely with patients. The more specific and job-related you can be, the stronger your case for continued disability benefits. You're doing everything right by advocating for yourself. Mental health recovery isn't linear and you deserve the time you need to get better without the added stress of fighting for basic support. Keep us posted on how the appointment goes!

I'm a fellow healthcare worker who went through a similar battle with my insurance company's mental health department last year. The advice here about separating FMLA from SDI is spot-on - that confusion almost cost me months of benefits. One thing that really helped my case was getting my direct supervisor to write a brief letter confirming the specific cognitive and emotional demands of my position. Having someone who understands the day-to-day reality of your job validate that your symptoms would create genuine safety risks can be powerful documentation for any provider. Also, when you see the new psychiatrist, ask them specifically about "functional capacity" language in their certification. Some providers default to general diagnostic language, but EDD and disability evaluators respond better to specific statements like "Patient cannot safely perform duties requiring sustained attention, rapid decision-making under pressure, or direct patient care responsibilities due to severe anxiety and concentration deficits." The system is absolutely broken for mental health disabilities, but you're doing everything right by advocating for yourself. Don't let them rush you back before you're truly ready - both for your own wellbeing and for patient safety. Healthcare workers deal with life-and-death decisions daily, and we deserve proper time to recover when we're struggling. Keep fighting and keep documenting everything. You've got this!

I'm so sorry you're dealing with this - the mental health system really fails people when they need support most. Reading through all the responses here, it's clear you've gotten some excellent advice about the FMLA vs SDI distinction and your options with Kaiser. One thing I wanted to add that hasn't been mentioned yet: if you do end up needing to see a provider outside of Kaiser for an independent evaluation, many psychiatrists and psychologists offer sliding scale fees for disability evaluations, especially if you explain your financial situation while being off work. Some also offer payment plans since they understand how challenging it can be to pay out-of-pocket when you're not earning income. Also, when you're preparing for your appointment with the new Kaiser psychiatrist, consider bringing a trusted friend or family member who can advocate for you if you're having trouble articulating your symptoms. Sometimes having someone there who's witnessed your struggles can help provide additional context about how your condition has impacted your daily functioning. The fact that your symptoms have worsened over the 14 weeks you've been off work is actually significant documentation that you're not ready to return yet. Make sure any provider understands that this isn't about wanting to stay off work - it's about genuine deterioration that makes you unsafe to care for patients. You're being incredibly strong by advocating for yourself through this broken system. Don't give up - you deserve proper care and support.

I'm so glad to see you're making progress with HR and getting that new psychiatrist appointment! Reading through everyone's advice here, it's clear you've got a solid plan moving forward. One thing I wanted to add based on my own experience with mental health disability claims - when you meet with the new psychiatrist, ask them specifically about partial disability options if that might be relevant later in your recovery. Sometimes there's a middle ground between "completely disabled" and "ready for full duty" that can help with a gradual return to work when you're ready. Also, since you mentioned your condition has actually gotten worse over the 14 weeks (which is unfortunately common when dealing with the stress of fighting for benefits), make sure to document any new symptoms or changes. Things like increased panic attacks, worsening sleep, changes in medication effectiveness - all of that shows your condition is still active and evolving. The system is absolutely broken when it comes to mental health disabilities, especially for healthcare workers who face such high-stakes environments. But you're doing everything right by advocating for yourself and prioritizing both your recovery and patient safety. Your future patients will benefit from you taking the time you need to get properly well. Keep us posted on how the appointment goes - this community is rooting for you!

I'm really sorry you're going through this - the mental health disability system is incredibly frustrating and confusing, especially when you're already struggling. Reading through all the excellent advice here, it sounds like you have a solid plan moving forward with the new psychiatrist appointment and HR support for CFRA protection. One thing I wanted to add that might help: consider requesting your complete psychiatric treatment records from Kaiser before your appointment with the new psychiatrist. Having a comprehensive history of your treatment, medication trials, therapy notes, and especially any documentation of symptom progression can really strengthen your case. Sometimes there are details in your file that you might have forgotten but that clearly show the severity and persistence of your condition. Also, if you have any coworkers or supervisors who've witnessed how your mental health has affected your work performance (before you went on leave), their observations about changes in your functioning could be valuable supporting documentation. Healthcare environments are particularly demanding cognitively and emotionally, so having colleagues who understand those specific pressures validate your concerns about patient safety could be powerful. The fact that you're prioritizing both your own recovery and patient safety shows incredible integrity. Don't let anyone make you feel guilty for taking the time you need - rushing back before you're ready helps no one and could actually set back your recovery even further. You're doing the right thing by advocating for yourself through this broken system.

I'm really following your story and hoping things work out with the new psychiatrist appointment! Reading through all the advice here, I wanted to add one more thing that helped me when I was dealing with a similar situation. Consider asking the new psychiatrist about getting a "fitness for duty" evaluation rather than just a standard disability certification. This type of evaluation specifically assesses whether you can safely perform your essential job functions, which is exactly what you need documented. For healthcare workers, this would include things like ability to make rapid clinical decisions under pressure, maintain focus during lengthy procedures, handle emergency situations without panic responses, etc. The language in fitness for duty evaluations tends to be more specific about functional limitations and safety concerns, which is what EDD and disability reviewers are really looking for. It also frames the conversation around patient safety rather than just your personal symptoms, which sometimes carries more weight with medical boards and insurance companies. Also, since you mentioned your symptoms have actually worsened over the 14 weeks - that's called "deterioration during leave" and it's actually strong evidence that you're not ready to return. Make sure any provider documents this clearly, as it shows your condition is still active and uncontrolled despite time off and treatment. You're being such a strong advocate for yourself through this nightmare. Don't give up - you deserve proper support and your future patients deserve you at your best, not struggling through when you're not ready.

I'm really glad to see how much support and practical advice you've gotten from this community! As someone who works in disability advocacy, I wanted to add a few additional resources that might help: The California Department of Mental Health has a specific ombudsman program for situations where health plans aren't properly supporting mental health disabilities. They can sometimes intervene directly with Kaiser on your behalf. You can reach them at (916) 654-3565. Also, since you're a healthcare worker, the California Nurses Association (if you're a nurse) or your respective professional association often has legal resources or advocates who specialize in protecting healthcare workers' rights during mental health crises. They understand the unique pressures of healthcare environments and can sometimes provide guidance or even representation. One more thing - document every single interaction you have with Kaiser moving forward. Names, dates, times, what was said, what was promised. If they continue to deny proper certification after your new psychiatrist appointment, this documentation becomes crucial for any appeals or complaints you file. The system is absolutely broken when it comes to mental health disabilities, especially for essential workers like healthcare professionals. But you're doing everything right by advocating for yourself and prioritizing both your recovery and patient safety. Keep fighting - you deserve proper support, and your persistence is helping other people who will face this same situation in the future. Sending you strength for your upcoming appointment!

I'm so sorry you're going through this exhausting battle with Kaiser - your story really hits home as someone who's dealt with similar mental health disability issues. The advice you've gotten here about FMLA vs SDI being separate systems is absolutely crucial and something I wish I'd understood earlier in my own journey. One thing that really helped me when I was preparing for appointments was creating a "day in the life" document that outlined exactly what a typical day looked like with my symptoms - things like "woke up at 3am with panic attack, couldn't get back to sleep," "tried to read medical journals but couldn't concentrate past first paragraph," "had to cancel grocery trip because leaving house felt overwhelming." Having these concrete examples really helped providers understand the functional impact beyond just diagnostic labels. Also, since you mentioned working in healthcare with high-stress patient interactions, make sure to emphasize the safety-critical nature of your role. Mental health symptoms that might be manageable in other jobs become genuinely dangerous when you're responsible for patient care decisions. Any provider should understand that returning before you're cognitively and emotionally stable could put vulnerable patients at risk. The fact that your symptoms have worsened during this 14-week period is actually important evidence that you're not ready to return - stress from fighting for benefits often exacerbates underlying mental health conditions, which is sadly common but medically significant. Keep advocating for yourself - you deserve proper support and your future patients deserve you at your best. This community is rooting for you!

I'm so glad you found this community and are getting such solid advice! As someone who's been through the mental health disability maze myself, I want to echo what others have said about documentation being absolutely key. One thing that really helped me was keeping a simple daily log on my phone - just a few bullet points about symptoms, sleep, ability to concentrate, any panic episodes, etc. When I finally got in front of a supportive provider, having weeks of concrete data showing the pattern of my limitations was incredibly powerful. It's much harder for review boards to dismiss "patient reports panic attacks 4-5 times per week preventing focus on complex tasks" versus "patient feels anxious." Also, since you mentioned you're in healthcare - I'm wondering if you've considered reaching out to your employee assistance program (EAP) if your employer has one? They sometimes have mental health advocates who understand the specific pressures healthcare workers face and can help navigate these systems. The fact that you're prioritizing patient safety by not returning before you're ready shows incredible professional integrity. Don't let anyone make you feel guilty for that - both you and your future patients deserve you to be mentally and emotionally prepared for the demands of patient care. Sending you strength for your upcoming psychiatrist appointment. You're doing all the right things by advocating for yourself through this broken system!