You’re hurt at work and you file a claim. Your claim is finally accepted, and you enter the healing phase of your workers’ compensation case. You start receiving Temporary Disability Benefits and then one the day, you were expecting your TD check and it’s not there. Why?
There are several reasons why an injured worker is receiving temporary disability checks and then, suddenly, they stop. Briefly, let’s define what are Temporary Disability Benefits. TD benefits are equivalent to two-thirds of someone’s average weekly wage. It is a benefit available to injured workers during the healing phase of a work-related injury.
Now we will discuss three of the reasons why Temporary Disability Benefits stop.
- Missed doctor’s appointments. Doctors provide work restrictions in their medical reports. If an employer cannot accommodate the work restrictions, or if the doctor decides to take the injured worker off work completely, then the injured worker can get the benefit of Temporary Disability. One reason why an injured worker can have their Temporary Disability discontinued is by missing a doctor’s appointment. Each doctor report that is generated provides work status, e.g., modified work. Each report is valid for 45 days. So, let’s say the injured worker has a follow-up appointment, their child becomes sick, they become sick, or they forget about the appointment. Once the 45 days pass, the claim’s adjuster can discontinue the injured worker’s Temporary Disability because they don’t have a current doctor’s report to substantiate work status. It is imperative that an injured worker get to a doctor as soon as possible and then make every doctors’ appointment throughout the process. If the injured worker is seriously hurt, a good workers’ compensation attorney can call the claims adjuster and say, “They missed their appointment. This is the earliest the injured worker can make an appointment; would you be willing to start Temporary Disability now as a gesture of goodwill?” Quite often the adjuster will.
- A doctor may have designated the injured worker MMI. MMI stands for Maximal Medical Improvement. Another term for this in the workers’ compensation arena is Permanent and Stationary. When a doctor says that an injured worker has reached the point of Maximal Medical Improvement (or Permanent and Stationary), this means that the healing phase of the injury is over. The injury has essentially plateaued. It’s not getting any better or any worse. When a doctor gives an injured worker either of these designations, MMI or P&S, the Temporary Disability will stop because Temporary Disability Benefits are only paid during the healing phase.
It is important that once a designation of MMI has been made that a Medical Legal Evaluation is scheduled so the injured worker can be evaluated for any Permanent Disability.
If the doctor designates an injured worker at Maximal Medical Improvement, and the injured worker has not gone back to work, they can file for State Disability Benefits. State Disability Benefits are like Temporary Disability Benefits but are not contingent on being injured at work.
- Temporary Disability has fallen “off-cycle”. When claims adjusters get medical reports, they will often look at a medical report that says the doctor anticipates that the injured worker will have modified work restrictions for 3 months. Remembering that a medical report is only good for 45 days, a lot of claims adjusters, nevertheless, will set up a cycle of Temporary Disability payments, especially if the injury is serious, so they don’t have to manually issue a check every 2 weeks. This is called putting the claim “on cycle”. So, in the example, the cycle was set for 3 months. If, after 3 months, the claim’s adjuster hasn’t made the time to get updated medical reports and further adjust the cycle, the 3 months will pass and the TD checks will stop.
When that happens, a good workers’ compensation attorney can get updated medical reports, send them to the claims adjuster, and remind them that they need to be paying temporary disability to the injured worker. Insurance companies in this situation are required by law to add a 10% penalty to the late checks. (Example: If the missed check was for $800, they must add $80 for a total check amount of $880.)
Sacramento Workers’ Compensation Lawyer
Hope this answers some questions you may have about why Temporary Disability Benefits suddenly stop in California. For any additional questions please call The Law Office of Alice A. Strömbom at 916-444-7557 for your free consultation. We’re here for you.
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