Form DE 2501, Claim for Disability Insurance (DI) Benefits, is a form to request, by mail, worker-funded benefits to eligible workers who have a full or partial loss of wages due to disabilities that are not work-related.
Your employer will be notified if you submit a DI claim, but your personal information is confidential and will not be shared. The California Unemployment Insurance Code (CUIC) states that any illness or injury - either physical or mental - that prevents you from doing regular work is a disability. This also includes surgeries and complications related to pregnancy or childbirth.
The California Disability form was issued by the Employment Development Department in April 2019. A printable DE 2501 Claim Form is available for download below.