KP Disability Claims Process

1 Disability Claims The Release of Information (ROI) Department s standard is to Process your form within three (3) five (5) business days from the date the forms were submitted to their office. In order to do so, it is very important that all the necessary documentation/forms be submitted at the time the request to Process is made. You must obtain a work status note from your provider before submitting your request. For your convenience, ROI accepts information via their department e-mail address Applying for Disability or FMLA? A Work Status Note is required and is provided by the treating physician at the time of your appointment or contact your provider. Contact your employers Human Resources Department to obtain paper work for private Disability or FMLA. Submit FMLA, private insurance forms to Kaiser Disability Claims for processing with your WORK STATUS NOTE. An authorization form is needed to disclose medical information to Process FMLA and private forms.

2 The authorization form can be downloaded at under forms and Publications . STATE DISABLITY-EDD INITIAL Claims : STEP 1: File an initial claim for Disability benefits on-line through the Employment Development Department, EDD website: STEP 2: E-mail the ROI department at with your receipt number that begins with RI . Include the information indicated below with you e-mail. The doctor s portion of your claim will be processed electronically by the ROI department. Medical Record Number EDD Receipt number (begins with an R ) Last name that the claim is filed under Date of Birth Last four (4) digits of social security number STATE Disability - EDD Disability EXTENSION: Email the ROI department at with your claimant number that begins with DI . Include the information indicated below with your e-mail. The doctor s portion of your claim will be processed electronically by the ROI department.

3 Medical Record Number DI Number Last Name that the claim is filed under PAID FAMILY LEAVE (PRL) Claims : STEP 1: File for paid family leave on-line through the Employment Development Department (EDD) website STEP 2: E-mail the ROI department at Include the information indicated below in your e-mail. The doctor s portion of your claim will be processed electronically by the ROI Department. Medical Record Number EDD Receipt number (begins with an R ) Last name that the claim is filed under A copy of authorization form DE 2501FC. The original should be mailed directly to the EDD as instructed within 10 days of filing your claim. FAMILY MEDICAL LEAVE OF ABSENCE (FMLA) REQUESTS: Kaiser Permanente uses the standard US Department of Labor FMLA form. The form is completed electronically and then electronically signed by the provider.

4 In this case, you do not need to bring the form that your employer gives you to have completed. Simply send an email to Include the information indicated below in your e-mail. To avoid delay, please ensure that the provider has already ordered the time off in patient s chart before you send the email to the ROI. Medical Record Number Employer s Name Name of Caregiver and Relationship, applicable. Name of third party insurance processing the FMLA, if applicable. For example, Sedgwick, Metlife, Prudential, Cigna Mission Trails Business Park 7385 Mission Gorge Road San Diego, CA 92120 Hours: M F 8:30 5:00 Phone: 619-528-5280 Fax: 619-229-7542 E-mail.