California Code of Regulations › Title 22 - Social Security › Division 1 - Employment Development Department › Subdivision 1 - Director of Employment Development › Division 1 - Unemployment and Disability Compensation › Part 2 - Disability Compensation › Chapter 2 - Disability Benefits › Article 4 - Filing, Determination and Payment of Disability Benefit Claims › Section 2706-1 - Filing a First Claim for Disability Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Any person or his or her authorized
						  representative may file a first claim for disability benefits who has been
						  continuously unemployed and disabled for a period of eight consecutive days,
						  provided that a claimant has been examined by or under the care of a physician
						  or practitioner during some portion of such period.
(b) "First claim" means the claim initially
						  filed on a form prescribed by the department with respect to a period of
						  disability. By filing the first claim, the claimant establishes his or her
						  disability period and the department computes the weekly benefit amount and
						  maximum benefits potentially payable for the disability period.
(c) Any individual who is unable to work and
						  has a wage loss due to any of the causes specified in Section
						  2626 of the code for a period of
						  eight days, may file a claim for benefits.
(d) A "properly completed first or continued
						  claim" means a claim containing all the required items as prescribed in
						  subdivisions (e) and (f).
(e) The
						  claimant shall file the first or continued claim and shall provide his or her:
(1) legal name, and any other last name(s)
						  used by the claimant.
(2) social
						  security account number, and any other names and social security account
						  numbers by which the claimant is or was known.
(A) The department may require the claimant
						  to verify the social security account number as being the one issued to the
						  claimant by the Social Security Administration if the information available to
						  the department indicates that the social security account number presented by
						  the claimant may belong to another individual, is not a valid social security
						  account number, or was never issued by the Social Security Administration, or
						  that the wages in the base period of the claim may belong to another
						  individual.
(B) If the department
						  requires a verification of the social security account number which the
						  claimant has provided to the department during the claim application, the
						  claimant must submit verification of his or her social security account number
						  directly from the Social Security Administration, or submit to the department a
						  copy of his or her annual statement issued by the Social Security
						  Administration.
(3) date
						  of birth.
(4) gender.
(5) mailing address and residence address if
						  different from mailing address.
(6)
						  driver license number or identification card number, provided that the driver
						  license or identification card was issued by a local, state, or federal agency,
						  or a foreign government.
(7) date
						  disability began.
(8) last day
						  worked at his or her last job and date returned to work, if any.
(9) reason why he or she is no longer working
						  at his or her last job.
(10)
						  name(s) and address(es) of his or her most recent employer(s).
(11) name and location of each facility where
						  he or she has been incarcerated or otherwise in custody of law enforcement
						  authorities upon adjudication or conviction at any time during his or her
						  disability.
(12) facility name,
						  address and phone number if he or she is residing in an alcoholic recovery home
						  or a drug-free residential facility.
(13) Workers' Compensation claim information
						  as follows, if he or she has filed or intends to file for Workers' Compensation
						  benefits:
(A) dates of injury on the job as
						  shown on his/her Workers' Compensation claim.
(B) Workers' Compensation carrier name and
						  address.
(C) Workers' Compensation
						  claim number.
(D) adjuster's name
						  and telephone number.
(E)
						  employer's name and telephone number identified on the Workers' Compensation
						  claim.
(F) if the claimant is
						  represented by counsel or other legal representative, provide the name, address
						  and telephone number of such representative; and
(G) Workers' Compensation Appeals Board case
						  number, if applicable.
(14) authorization for the claimant's
						  treating physician, practitioner, hospital, or workers' compensation insurance
						  carrier to furnish and disclose to the department all facts concerning the
						  claimant's disability.
(15)
						  signature certifying to his/her disability.
(16) authorization for the department to
						  disclose the claimant's information as listed herein from (e)(1) to (e)(10) to
						  the claimant's treating physician, practitioner, hospital, vocational
						  rehabilitation counselor, or workers' compensation insurance carrier.
(17) such other information within the scope
						  of eligibility requirements as the department may require.