In the state of California, you may be eligible for caregiver leave if you need to care for a seriously ill family member.

A qualifying family member is defined by California as one of the following: a child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner.

If you have paid taxes in the state of California for a qualifying period, you may be eligible to receive benefits from the California Employment Development Department (EDD) during the duration of your caregiver leave. You will need to submit a Claim for Paid Family Leave (PFL) Benefits.

The CA EDD requires all claims and medical provider certifications to be on the original paper claim. This means that you will need to have a copy of the claim with you before you leave the country to care for your loved one. The CA EDD will not accept scans or photocopies!

While the CA EDD does have an online application form, medical provider certifications can only be performed online by California based medical providers. This means that if your medical provider is not in the state of California, you will need your claim certified by paper.

In addition, we strongly recommend filing by paper for any intermittent leaves. Intermittent leaves need a letter detailing the dates of the leave, and paper claims have a higher rate of successful filing with the required additional documentation.

Under FMLA, an employer is allowed to require that an employee submit a timely, complete,

and sufficient medical certification to support a request for leave due to a serious health condition. Medical providers are health care professionals that can certify leave. These include: doctors, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, nurse practitioners, nurse-midwives, clinical social workers and physician assistants.

This information is filled out by the recipient of care’s (your loved one’s) medical provider who is attesting to the caregiver leave. For official government information regarding the Medical Provider Certification, please see here.

You can request the paper claim from the EDD website. Start by selecting “Step 1: Get Your Claim Form” and select the link “form online” to have the form mailed to you.

Search by keyword: “Claim for Paid Family Leave”

Scroll down to claim form DE 2501F and add 1-2 to cart (if you’d like to have any extra).

Follow the final steps to “checkout” by adding your mailing address and submitting the request.

While Cocoon cannot handle the facilitation of your caregiver leave claim, we are here for you to provide guidance and answer any questions you may have. Please refer to the step by step guide on how to fill out your claim:

Part A:

A1: Your personal social security number

A2: Your own date of birth

A3: Select “English”

A4: Your First Name, Middle Initial, Last Name

A5: Your gender for the purposes of filing the claim

A6: Your own phone number

A8: The mailing address you wish to receive payment

A9: Name of your employer and their mailing address

A10: The last day you worked before going on caregiver leave

A11: The day you want to start getting paid

A12*: The day you plan to return to work (please note, that this is NOT the last day of your leave as you will not be paid for this day). If you require more time beyond the time your medical provider has certified, this requires a new certification.

A13: Select “No” as this may be grounds for the EDD to deny payment

A14: Select “care for family member”

A15: Your occupation (ie “Engineer” or “Salesperson”)

A16: Cocoon recommends selecting “check”

A17: The legal first and last name of the loved one you are caring for

A18: Select the applicable loved one

A19: Select “No” to avoid any chance of claim denial

A20: Select “No”

A21: Select what is applicable

A22: If your employer is not paying you during your leave, input “N/A”

A23: Select “Yes”

A24: Select what is applicable

A25: Remember to sign and date!

Part B:

Skip Section B as this section is only applicable for parental leaves.

Part C:

The information in this section relates to the recipient of care.

C1: The recipient of care’s date of birth

C2: The recipient of care’s telephone number

C3: The recipient of care’s gender for the purposes of filing the claim

C4: The recipient of care’s first and last name

C5: The recipient of care’s address: This can be your address or a different address based on whether the receipient is residing with you

C6: The recipient of care’s signature and date of signing

Section D: Medical Certification

The main difference between a caregiver leave and parental leave for claims purposes is that a caregiver leave requires a medical certification from the recipient of care’s (your loved one’s) medical provider.

Please note that even if you are leaving the country to care for a loved one, the certification must be in English. The EDD may have follow up requests for those leaving the country on caregiver leave. Cocoon is happy to assist you with how to respond to any follow up questions.

The claim will pay out based on the dates the medical provider certifies that your loved one is under your care.

Letter for Intermittent Claims

For an intermittent leave, you must include a letter that details the start date and return-to-work date for each leg of leave

All claims, on the original form you received in the mail, must be shipped to:

Paid Family Leave - EDD

PO Box 989315

West Sacramento, CA 95798-9315