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Yuki Sato

EDD PFL caregiving claim denied due to out-of-state doctor - appeal submitted but total silence

I applied for PFL caregiving benefits after taking care of my dad during his final weeks (April 15 - May 23, 2025). His cancer progressed quickly and I had to travel between California and Nevada to be with him. EDD initially approved my claim but then denied it because my dad's oncologist in Nevada 'wasn't on their approved provider list.' I immediately appealed and submitted documentation from THREE different medical sources: his Nevada oncologist, his primary care doctor in Nevada, and the hospice facility where he passed. I submitted all this paperwork over two weeks ago. The most frustrating part is I have ZERO visibility into what's happening with my appeal. Unlike unemployment or disability, there's nothing showing online about my PFL caregiving claim status. I've called EDD multiple times but can't get through to anyone who can tell me what's going on. I have no idea if they're reviewing my appeal, if they need more information, or if they've even received what I sent. Is this complete information blackout normal for PFL caregiving appeals? I'm getting really worried since I took unpaid leave to be with my dad and I'm counting on this payment. Has anyone successfully appealed a denial based on an out-of-state doctor not being on their list?

Carmen Ruiz

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First, I'm sorry for your loss. Unfortunately, the radio silence from EDD during PFL appeals is completely normal, especially for caregiving claims (they seem to prioritize baby bonding claims). When my mom was dying last year, I had a similar issue with her out-of-state doctor in Oregon. The good news is that you've done everything right by submitting multiple medical sources. The hospice documentation will be particularly important. Here's what you need to know: 1. PFL caregiving appeals typically take 3-4 weeks to process, sometimes longer. 2. They won't update you online during the process. 3. They're supposed to send you an acknowledgment letter when they receive your appeal paperwork, but half the time they don't. 4. They CAN approve out-of-state doctors, but the reviewer needs to manually verify their credentials. Keep trying to call them. Ask specifically for a PFL specialist who handles caregiving claims. Regular EDD representatives often don't know how to check on these specialized appeals.

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Yuki Sato

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Thank you for the reassurance. I had no idea the processing would take so long! Did you eventually get your appeal approved with the out-of-state doctor? It feels like I'm sending paperwork into a black hole with no confirmation.

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I work with PFL claims regularly, and yes, the lack of online visibility for PFL caregiving claims (especially appeals) is a major flaw in their system. Here's what's likely happening: your appeal is sitting in a specialized queue waiting for a medical eligibility reviewer to look at your documentation. If it's been more than 14 days since you submitted your appeal, I'd recommend trying to reach someone by phone ASAP. The appeal window has specific deadlines, and you want to make sure they received everything properly. One thing to note: for out-of-state providers, EDD has to verify their medical license manually in that state's system. This often causes delays, but doesn't mean automatic denial. The hospice documentation should be sufficient regardless of state lines.

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Yuki Sato

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Thanks for this insight. I'm at day 16 now so definitely need to call. Do you know the best number to reach the PFL department directly? The main EDD line just keeps disconnecting me after putting me on hold for 45+ minutes.

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I had the EXACT same thing happen!!! my dad passed in Ariozna too but in 2024 and EDD rejected my caregiving claim because his doctor was "out of network" or whatever. I appealed and then heard NOTHING for like a month!!! I was freaking out bc I took unpaid leave and needed that money. The worst part is theres literally no way to check status online for PFL caregiving stuff. its like they dont care about people taking care of dying parents but if its a baby suddenly they care 🙄 after calling like 50 times i FINALLY got thru to someone who told me my appeal was approved but the letter was "still being processed" whatever that means! got the money 3 days later. keep calling!!

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This is so infuriating! Why can't they at least put a simple status update online? Like how hard is it to add "appeal received" or "under review" so people aren't completely in the dark? Sorry you went through this too.

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Mei Wong

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I used to work for EDD (not anymore thank god) and the PFL system is a mess. The caregiving claims get way less attention than baby bonding. Your appeal is probably sitting in a pile and hasn't even been looked at yet. Keep calling!

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Yuki Sato

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That's really disheartening to hear. I've been trying to call but can't get through to anyone who seems to know anything about PFL caregiving claims specifically.

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QuantumQuasar

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I had a similar nightmare with EDD when my father was ill. After weeks of trying to get through on the phone with no success, I discovered Claimyr (claimyr.com) and it saved me so much frustration. It got me connected to an actual EDD representative within 25 minutes when I'd been trying for days. The agent was able to tell me exactly what was happening with my PFL caregiving appeal and what additional documentation they needed. They have a video showing how it works: https://youtu.be/DOLxZQb92wM?si=6N1iCQ3a8Cdb2Ay5 For PFL caregiving appeals specifically, you need to talk to a specialist. Regular EDD reps often can't see the details of these claims, which is why getting through to the right person is so important.

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Yuki Sato

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Thank you for the suggestion! At this point I'm willing to try anything. Does Claimyr work specifically for the PFL department? I need to talk to someone who can actually see my appeal status.

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QuantumQuasar

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Yes, it connects you to the same EDD phone system but bypasses the long queue. Just make sure to tell the automated system you need the PFL department specifically for caregiving benefits, not regular unemployment or disability. Once you're connected, immediately ask for a PFL appeal specialist.

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this is so typical of edd!!!! they act like caregiving claims dont matter as much as baby bonding. my sister waited TWO MONTHS after appeal with zero communication. she finally got approved and back pay but seriously the stress was unreal. the absolute worst part is no online status updates for PFL caregiving claims. its like were still in 1995 or something

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OMG TWO MONTHS????? I can't wait that long! Did she do anything special to finally get it approved?

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she had her state rep's office call edd on her behalf!!! suddenly magically her appeal was "found" and processed within 48 hrs after 2 months of silence. might be worth trying if u keep hitting walls

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Carmen Ruiz

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Just checking back - any updates on your situation? Were you able to get through to anyone at EDD about your appeal?

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Yuki Sato

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Actually yes! After reading everyone's suggestions, I used Claimyr to get through to EDD yesterday. I was connected to a representative in about 20 minutes. She confirmed they received my appeal documentation but said it hadn't been assigned to a reviewer yet. She put a note on my file to expedite it since it's been over two weeks. I also learned that out-of-state doctor verification is a common issue with caregiving claims, but the hospice documentation should be sufficient. I'll update when I hear anything definitive.

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Carmen Ruiz

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That's good progress! The note to expedite should help. Keep us posted - and make sure to call back in a week if you still haven't received any communication. Sometimes those notes magically "disappear" from the system.

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Liam McGuire

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if their reviewing three drs notes and still giving u a hard time thats crazy. I only need to submit one form for my twins bonding time and got approved right away. maybe cuz bonding is more common than caregiving? either way edd is flakey and inconsistent. good luck!

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Yuki Sato

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Yeah, from what I'm gathering in this thread, it seems like baby bonding claims get processed much faster and more efficiently than caregiving claims. Really frustrating when you're dealing with the loss of a parent and financial stress at the same time.

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Just wanted to add a quick update to this thread for anyone finding it later - the EDD has actually updated their policies regarding out-of-state medical providers for PFL caregiving claims as of March 2025. They're supposed to have a more streamlined verification process now, but it's clearly not working well yet. For caregiving claims with out-of-state providers, make sure you submit: 1. The regular DE-2501F form completed by the out-of-state doctor 2. A copy of the doctor's state medical license 3. The medical facility's contact information including the main phone number (not just the doctor's direct line) This helps EDD verify credentials more quickly. And remember that hospice documentation is considered priority evidence for PFL caregiving claims.

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Yuki Sato

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This is really helpful information! I didn't include a copy of the doctor's actual license, just filled out the form. That could be part of the delay. If they need additional documentation, I hope they actually tell me instead of just denying the claim again.

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I'm so sorry for your loss and the additional stress EDD is putting you through during this difficult time. Reading through this thread, it's clear that the lack of transparency in PFL caregiving appeals is a widespread issue that needs to be addressed. I went through something similar when my grandmother was in her final days in Arizona. The complete information blackout from EDD during the appeal process is absolutely maddening, especially when you're already dealing with grief and financial pressure from taking unpaid leave. Based on what others have shared here, it sounds like you're on the right track with having multiple medical sources documented. The hospice documentation should carry significant weight in your appeal. I'd definitely recommend following up on the suggestion to include a copy of the doctor's medical license if you haven't already - that seems to help speed up their verification process. One thing that helped me was keeping a detailed log of every call I made to EDD, including dates, times, and what each representative told me. This became crucial when I finally got through to someone who could actually help, as I could reference specific previous conversations and show the timeline of my attempts to get information. Hang in there - from what I'm reading, most of these out-of-state provider appeals do eventually get approved, it just takes way longer than it should. The system is clearly broken when it comes to caregiving claims compared to bonding claims.

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Emily Sanjay

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Thank you so much for sharing your experience and the practical advice about keeping a detailed log of calls. That's actually brilliant - I've been so frustrated with getting different information from different representatives that I hadn't thought to document everything systematically. I'm definitely going to start doing that moving forward. It's reassuring to hear that most out-of-state provider appeals do get approved eventually, even though the process is unnecessarily stressful. I really appreciate everyone in this thread sharing their experiences - it helps to know I'm not alone in dealing with this bureaucratic nightmare during an already difficult time.

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Kristin Frank

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I'm really sorry for your loss and what you're going through with EDD right now. This thread has been incredibly eye-opening about how poorly the PFL caregiving system works compared to other benefits. I'm actually going through something similar - my mom is currently in hospice care in Oregon and I'm terrified about having to deal with this exact same situation with out-of-state doctors if I need to take PFL caregiving leave. Reading everyone's experiences here, it sounds like the system is fundamentally broken for caregiving claims. The fact that there's zero online visibility for appeals is absolutely unacceptable in 2025. Like others have mentioned, if you can get baby bonding approved quickly with online tracking, why can't they provide the same basic functionality for people caring for dying family members? It honestly feels discriminatory. Thank you to everyone who shared their experiences and practical advice - I'm bookmarking this thread and taking notes on the documentation requirements and phone strategies. The suggestion about getting your state representative involved after extended delays is something I hadn't considered but makes total sense. Yuki, I hope your appeal gets resolved soon and you get the benefits you deserve. You did everything right by being there for your father, and EDD's bureaucratic failures shouldn't add to your grief.

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Sofia Morales

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I'm so sorry you're going through this with your mom right now. Having read through everyone's experiences here, I'd strongly recommend getting all your documentation prepared ahead of time if possible. Based on what people have shared, make sure you have copies of your mom's doctor's medical license, the hospice facility's full contact information, and multiple medical sources if available. The fact that caregiving claims get treated as second-class compared to bonding claims is really disheartening, especially when people are dealing with end-of-life situations. I hope your mom's situation stabilizes and you don't have to navigate this broken system, but if you do, at least now we have a roadmap from everyone's hard-won experiences.

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Sophia Clark

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I'm so sorry for your loss and the additional stress you're dealing with during this already difficult time. The complete lack of transparency in EDD's PFL caregiving appeal process is absolutely unacceptable - it's 2025 and they can't even provide a basic "appeal received" status update online? I went through something similar last year when my uncle was in his final stages in Texas. EDD initially denied my caregiving claim because his oncologist wasn't in California, even though I had all the proper documentation. The appeal process was a nightmare - weeks of complete silence with no way to check status online. What finally worked for me was getting my state assemblymember's office involved after about 5 weeks of no communication. Their constituent services team called EDD directly and suddenly my "lost" appeal was magically found and approved within 72 hours. It's ridiculous that it takes political intervention to get basic customer service, but that's the reality with EDD's broken system. Keep detailed records of every call you make and every document you submit. If you haven't heard anything by the 3-week mark, definitely consider reaching out to your local representative's office. They deal with EDD issues all the time and know exactly who to contact. The system is clearly designed to prioritize baby bonding claims over caregiving claims, which is infuriating when you're dealing with end-of-life care for a parent. You shouldn't have to fight this hard while you're grieving.

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Omar Zaki

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Thank you for sharing your experience and I'm sorry you had to go through that with your uncle. It's really helpful to hear that getting your assemblymember involved actually worked - I hadn't thought about reaching out to my local representative's office but that might be my next step if I don't hear back soon. The fact that your "lost" appeal was suddenly found within 72 hours after political intervention really shows how broken their system is. It shouldn't take that level of escalation just to get basic information about an appeal status. I'm definitely going to keep better records moving forward and will consider contacting my rep if this drags on much longer. The disparity between how they handle baby bonding vs caregiving claims is really disheartening, especially when you're already dealing with grief.

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