Benefits in Case of a Temporary Disability
I’m Ed Smith, a Sacramento Workers’ Compensation Lawyer. If you have been hurt in an accident and must take time off to recover from your injury, you may be eligible for temporary disability benefits. Navigating the complex and often overwhelming claims procedure can be daunting, but an experienced attorney can help you get through your recovery and return to your life and work.
What are Temporary Disability Benefits?
Temporary disability benefits refer to payments you receive from the claims administrator in a situation where you are unable to perform your usual job while you recovery from an injury or illness. These benefits are non-taxable.
During recovery, if you can perform some work but earn less than what you did prior to the injury, you will be entitled to partial temporary disability benefits. If you are totally unable to work while recovering, you will receive total temporary disability benefits.
Some employers have salary continuation plans under which they will pay your full wage for all or part of the time while you had a temporary disability. Some of the salary continuation plans use your sick leave or vacation leave to supplement the temporary disability payments to be made under state law. You should check with your employer to know whether they have covered you in one of these plans. You can also reach out to me, Sacramento Workers’ Compensation Attorney, Ed Smith, for free, friendly advice. I can be reached at (916) 921-6400 or (800) 404-5400.
Computation of Temporary Disability Benefits
The general rule is that you will receive two-thirds of your pre-tax (gross) wages at the time of injury or illness. Maximum and minimum rates are set by law. Your wage will be determined by taking into account all types of income you receive from work. These may include wages, overtime, commissions, bonuses, tips, food, and lodging.
Wages may also include income from any work you performed at any other job at the time of your injury. Provide the proof of all such earnings to the claims administrator to ensure you receive the rightful temporary disability benefits. The maximum and minimum rates will be adjusted on an annual basis.
Schedule of Temporary Disability Payments
Your temporary disability payments will start once your doctor determines that you are unable to perform your usual work for over three days or you are hospitalized overnight. The payments will be disbursed every two weeks. Temporary disability payments typically end once you return to work, or when your doctor declares you fit for work, or determines that your injury or illness has improved as far as it can.
If your injury occurred on April 19th, 2004, to January 1st, 2008, the payments for your temporary disability would not last for more than 104 weeks for most injuries, starting from the first payment. If you sustained the injury on or later than January 1st, 2008, you would be entitled to 104 weeks of payments within a period of five years. This period will be counted from the date you were injured.
For certain types of injuries or illnesses, such as a chronic lung disease or severe burns, the payments can continue for a period longer than 104 weeks. The payments may go on for up to 240 weeks within a period of five years.
You also have the right to file a claim for state disability insurance with the Department of Employment Development. Even when your workers’ compensation case gets accepted, you should still file this claim. This will enable you to receive state disability insurance payments beyond the 104 weeks of temporary disability payments in case you are still not in a condition to return to work.
While receiving temporary disability benefits, you will be entitled to you few additional benefits. First and foremost, you will have the right to receive immediate medical treatment. Even while the claims administrator may choose to investigate your disability claim before determining whether to accept it, they must still approve appropriate medical treatment within one working day following your submission of the claim form DWC 1.
The medical treatment you receive should be according to the treatment guidelines put in place by the state. The aggregate cost of treatment you receive while you claim is under investigation, however, cannot exceed $10,000. You are also entitled to reimbursement for the costs of transport including mileage, tolls, and parking for visits to and from the physician’s office. The costs of prescription drugs, physical therapy sessions, and other medical expenses will also be borne by the claims administrator.
Importance of the Claim Form – DWC 1
You must fill out the claim form – DWC 1 – if you want to ensure you qualify for full benefits. You may not receive the benefits if you fail to file this form within one year of your injury or illness. Your employer is required to provide you the claim form within a day of knowing about your injury.
Your workers’ compensation case gets opened once you fill out the DWC 1 form. Under the state law, you may also get benefits other than the basics you might qualify for after you have filed the DWC 1 claim form with your employer. These benefits may include the following, in addition to any other benefits:
- Presumption that only work caused the injury or illness if your claim does not get denied within 90 days after submission of the filled out claim form to the employer.
- Medical treatment of up to $10,000 while the claim is under consideration by the claims administrator.
- An increase in amount in case of a delay of disability payments.
- Possibility of resolution for any disagreement that may arise between the claims administrator and you over whether work caused your injury or illness, the type of medical treatment to be received, and whether you may be entitled to permanent disability benefits.
In case you do not receive the claims form DWC 1 from your employer, you can contact the claims administrator to receive it. You may also download the form from the Division of Workers’ Compensation website at www.dwc.ca.gov.
Addressing the Problems related to Benefits
If you have an issue with your temporary disability benefits, you need to let others know about this. You can speak to your employer or get in touch with the claims administrator to try and resolve the concern. Mistakes or a misunderstanding can occur at times, but it is possible to resolve them in most cases by discussing this situation with the claims administrator. In case this does not help, you may try the following steps:
Contact an Officer of the DWC Information and Assistance
The officers of I&A will address your concerns and provide answers to your questions. They will give you the necessary information as well as forms and will help resolve the concerns regarding your claim. I&A officers also conduct free workshops to guide injured workers about their legal rights and responsibilities.
Consult with a Lawyer
You can consult with an applicant’s attorney, who is a lawyer specializing in workers’ compensation issues for injured workers. The attorney will plan an appropriate case strategy for you, collect relevant information to support your claim, maintain a track of the necessary deadlines, and will be your representative before a workers’ compensation judge. The fee charged by the legal counselor will be taken out of the benefits you may receive, and the fee amount will have to be approved by a judge.
You may be required to present yourself before a workers’ compensation judge in case you have a major issue with your claim. In such case, you will have to complete an application requesting adjudication of the claim. You are normally required to file this form within a year from the injury date or the last date when you received benefits.
Delay in Payments for Temporary Disability
In some cases, the first payment for temporary disability may get delayed. If the claims administrator is unable to decide whether workers’ compensation covers your injury, they could delay the first payment as the investigation continues. The delay is normally not more than 90 days. The claims administrator is required to send you a letter informing you of the delay.
The letter must spell out reasons why you are not receiving the temporary disability payments, whether the claims administrator needs any additional information, and when a decision is likely to be made. Additional letters will have to be sent by the claims administrator in case of further delays.
If you fail to receive a letter stating denial of your claim within a period of 90 days from the date you filed the DWC 1 form, your claim is usually considered accepted. If you had submitted your claim form at least two weeks prior to the payment becoming due, and the payment is delayed by the claims administrator, they are required to pay you as a penalty an additional 10 percent of the amount.
If your payments for temporary disability are stopped without any explanation, you may speak to your employer or contact the claims administrator. If you are not satisfied, get in touch with your local I&A officer. For more information contact an experienced Sacramento Workers’ Compensation Attorney.Experienced Sacramento Workers’ Compensation Lawyer
I’m Ed Smith, a Sacramento Workers’ Compensation Lawyer. Do you or someone you love need an experienced workers’ compensation lawyer to help you navigate the complexities of a disability claim? Please contact me right away at (916) 921-6400 or (800) 404-5400 for compassionate, free and friendly advice. I can also be reached online via my website, AutoAccident.com.
I am honored to be recognized by the Million Dollar Advocates for my work securing verdicts and settlements for my clients worth one million dollars or more.
: br rey bw [cs 1692]