California Disability Insurance (DI)
and Paid Family Leave (PFL)

Step 1: An employee should notify their employer of the need for a leave as soon as possible.

Step 2: An employee should file a claim up to 41 days in advance of the leave. If the leave is unforeseeable, claims may be submitted up to 41 days after the leave has begun.

Step 3: Proof may be required before the claim decision can be made. MetLife will gather any additional necessary details from the employer or employee and make a decision within 14 days of receiving all information, or the first day of leave, whichever is later.

Step 4: The employee will receive their first benefit payment within two weeks of receipt of the completed claim.

Step 5: If an employee’s claim is denied, they may appeal the claim by writing a letter to the state within 30 days of the denial letter. Instructions will be included with the denial notice.

Employees must provide specific documents for each claim. It is important to submit paperwork to the doctor as soon as possible. It might take the doctor’s office two weeks or more to complete the paperwork. In some cases, a statement confirming the relationship between the employee and the family member may also be requested.

For the employee's own disability (when the employee is sick or hurt and cannot work for an extended period):

• Certification of a Disability/Serious Health Condition form filled out by the employee and their healthcare provider, or
• A doctor’s note or Attending Physician Statement (APS) that includes the same information as the Certification form

For child bonding for a newborn:

• A copy of the child’s birth certificate, or
• A statement from the child’s healthcare provider stating the child’s date of birth, or
• A statement from the parent’s healthcare provider stating the child’s date of birth

For child bonding for adoption or foster care placement:

• A copy of adoption papers or court documents finalizing the adoption that includes child's date of birth and adoption date, or
• Documentation from the child’s healthcare provider, or
• Foster/adoption agency paperwork containing adoption or placement
• If the employee is not the parent named in the court documents (in loco parentis), the employee may also be asked to provide proof verifying their relationship to the in loco parentis named in the court documentation. This could be a marriage certificate, civil union papers, or something showing you are in a domestic partnership.

For leave to care for a family member with a serious health condition, including medical events related to pregnancy or childbirth:

• Certification of a Disability/Serious Health Condition form filled out by the employee and their family member’s healthcare provider, or
• A doctor’s note or APS that includes the same information as the Certification of Serious Health Condition form

For qualifying military exigency needs, the employee will need to verify their family member’s service:

• Covered family member’s active-duty orders, or
• Letter from the military unit documenting impending call or order to covered duty, or
• Documentation of military leave signed by the approval authority for the military member’s Rest and Recuperation
• If leave is requested to meet with a third party, such as a school official, counselor, or attorney, the employee must provide documentation of the meeting that includes:
  1. The name, address, and contact information of the individual or entity with whom the employee is meeting
  2. A description of the meeting

For caring for a family member who is a covered service member:

• Certification of a Disability/Serious Health Condition form filled out by the employee and their family member’s healthcare provider, or
• A doctor’s note or APS that includes the same information as the Certification of Serious Health Condition form
• An alternative form of certification can be an Invitational Travel Order (ITO) or Invitational Travel Authorization (ITA) issued by the Department of Defense to any family member to join an injured or ill service member at their bedside

Employees may be eligible for more than one leave.

Employees can use any combination of their available employer sponsored leaves (e.g. sick leave, vacation leave, other paid time off, or short-term/long term disability) together with their DI/PFL benefits. However, employees cannot receive more than 100% of their normal weekly pay. Effective January 1, 2025, an employer can no longer require an employee to take up to two weeks of earned but unused vacation time before receiving CA PFL benefits.

CA DI/PFL, CA Family Rights Act (CFRA), and federal FMLA benefits can and should be used at the same time when applicable.

If an employee works in San Francisco and is receiving CA PFL to bond with a child (newborn, foster or adopted), the San Francisco Paid Parental Leave Ordinance (SF PPLO) requires the employer to pay supplemental compensation (up to 100% of pre-disability earnings) for the full duration of the employee’s leave (up to 8 weeks). All San Francisco employees working for a covered employer are eligible for SF PPLO benefits.

MetLife’s claims team will reach out to the employee to coordinate dates of the company leave that directly overlap with the state leave.

MetLife representatives can help review employer paid benefits that may overlap with the state leave. They can help document overlaps and preferred contact and action when the overlap happens.

Note: There may be additional municipal or employer sponsored leaves that MetLife does not administer. Employers may be responsible for providing additional applicable leaves for their employees and should consult their own employment attorneys.