One issue that arises in almost every single California workers' compensation case is the question of what to do once temporary disability payments end.
The most common reason temporary disability ends is that the injured worker's primary treating physician returns that employee back to work -- either full duty or with modified duties. The employee must report back to work at this point, and if they do not they risk termination as well as being cut off from workers' comp TD payments.
Another reason TD ends is the injured worker reaches the 104-week cap on payments. With very limited exceptions, once 104 weeks (2 years) has been paid, defendants do not have to pay any further TD on that claim.
Another reason TD ends is when a doctor declares the injured worker has plateaued -- the legal term being "permanent and stationary" or "maximum medical improvement." Once this final report comes out (called a PR-4) report, the insurance company will stop making TD payments.
So what is an injured worker to do for income once this happens? The most common and easiest solution is to apply for California State Disability. If the injured worker has paid taxes in California and put money into this system, they will have money to take back out when an injury or illness prevents them from working (State Disability, or SDI for short). The injury or illness does not even have to be work-related. The injured worker only needs a doctor to certify their disability to the EDD. One may not receive TD and SDI at the same time.
Sometimes the 104-week cap on TD is not fair. For example, when the insurance company takes 2 years to approve a reasonable and necessary surgery, but then they finally do approve the surgery right around the 2-year mark. The injured worker must get the surgery done in order to recover from their injury, but then there are no more TD payments to be had during recovery. There is no WC income. This is not fair, but it is the way our system is at this time.
Often injured workers are furious when a workers' comp doctor (controlled by the TPA and insurance industry) returns them to work without limitation, or without enough limitations, and the injured worker knows they are unable to even get to work in their current condition. The legal process to fight this doctor's opinion is a lengthy one, so the injured workers' most practical recourse is to either attempt to go back to work if at all possible and inform the supervisor of the difficulties or simply stay home and attempt to obtain EDD SDI. The injured worker does face possible termination if they do not return to work once cleared by a doctor.
Finally, when the injured worker is nearing the end of their working career and their work injury has made it nearly impossible for them to ever work again, they need to consider applying for Federal Social Security Disability, regardless of their age. This system is similar, but different, and our firm will refer our clients to work with a specialist in the SSD system.
As you can see this one topic of temporary disability can become quite complicated, so it is best to have an experienced professional on your side. Call Piper & Piper: Trial Lawyers today at (661) 747-9100 if you need help with your workers' comp legal issues.