When individuals sustain an injury on the job, their case is evaluated and assigned a specific permanent or temporary disability category. If the person is hurt but not permanently disabled or their limitations for doing their regular tasks are partial, they are assigned temporary disability benefits. These payments may be total or partial. Or they may change as the person heals and begins returning to work. They are designed to supplement the income that the employee loses due to the inability to work. However, it can be pretty complex, and you may find you have some questions about qualifying for benefits, how long they last, and how much your payments will be. This guide will help. People filing worker’s compensation claims in California often find it is much easier to hire an attorney to help them with the process. There’s a lot that comes with a worker’s comp claim. There are medical payments, denied claims, settlements, and more. An experienced temporary disability lawyer can help ensure that the employee’s rights are protected and that they are fully compensated for the loss they experience. It is never a good idea to try and handle a worker’s comp claim on your own. An attorney can be a tremendous help in getting what you deserve.

QUALIFYING FOR TEMPORARY DISABILITY BENEFITS IN CALIFORNIA

Any employee who is legally working in California and is injured on the job may qualify for temporary benefits. Three criteria must be met:

• The injury must occur while the person is working, on a job site, or in the regular operation of their job description.
• The injury leaves them unable to work at all or the way they did before getting hurt.
• The worker is kept at the hospital overnight due to their injuries, or they are not able to work for a minimum of three days.

If the person can work but has limitations and can’t perform their regular job duties the way they did so they don’t earn as much as they did, they may be eligible for partial disability payments. If they are not able to work at all or the employer cannot place them or does not have a position available that will allow them to perform assigned job functions with their limitations. They may qualify for temporary total disability payments.

HOW TEMPORARY STATUS IS DETERMINED

When determining permanent or temporary status, the work restrictions provided by the person’s doctor hold a lot of sways. These restrictions are vital to deciding, so it is essential to keep all appointments and communicate all issues to the doctor so they will be in the best position to help. If the doctor says that a person can’t work or have specific restrictions, then the employer will review the information and weigh it against their own assessment. If the doctor sets certain restrictions, the employer must comply with them. However, if they don’t have tasks that can accommodate those restrictions, then the person cannot work, so temporary disability is the next step. Once on temporary benefits, the employee will be reassessed by their doctor every 45 days. This is mandatory, and failure to comply can result in disqualification. The doctor will check the person at each visit, review their injuries, and determine if they are healing. If the person does heal, then the restrictions for work will be lifted. If they do not heal, the doctor may determine that the disability is permanent.

HOW TEMPORARY DISABILITY PAYMENTS ARE CALCULATED

Disability payments are based on whether the person can work or not. If they cannot work at all, they may be eligible to receive total disability. If they can work part-time, then the compensation will be based on the difference between their work hours and the hours they usually work. For instance, if the person is a full-time employee but can only work part-time due to their injury, their benefit payments will comprise the wage difference between full-time and part-time pay. The payments are not the worker’s total wage but are two-thirds of their average weekly wage. This is true for both total disability and partial disability. The compensation is based solely on lost hours. Medical payments are separate. These payments compensate for lost time at work that results in lost pay.

TEMPORARY DISABILITY BENEFITS SCHEDULE AND TERMS

California employees who receive temporary benefits due to a work injury can receive those payments for 104 weeks over five years after they sustained the injury. Those 104 weeks do not have to be consecutive. Some conditions are not subject to the 104-week term and may go longer. While receiving payments, the employee must see their doctor every 45 days to reevaluate their illness or injury and work status. These appointments are mandatory, and if the employee fails to keep them, it could result in disqualification. These appointments are essential and intended to protect the employee and ensure the integrity of the worker’s comp system. During the meeting, the doctor will assess the individual, review their case, and discuss any progress that they have made. Then they will determine if the person’s condition remains the same or if their status has changed to either able to return to work or permanently disabled. Keeping the appointments also helps with other aspects of the case. If a settlement is awarded, the doctor’s reports will undoubtedly play a role.

CHALLENGING THE DOCTOR’S DIAGNOSIS AND GETTING A SECOND OPINION

Sometimes the employee will disagree with the doctor’s assessment of their injury, limitations, or ability to return to their job. Sometimes the doctor will clear the person to return to their position, but the person feels that they are not physically able to perform the required tasks. In these cases, the employee may choose to seek a second opinion. When that happens, they will need to make an appointment with a Qualified Medical Examiner (QME), or an Agreed Medical Examiner (AME), to be evaluated. This is where having a temporary disability lawyer is extremely helpful because they can help with finding the QME, setting up an appointment, and keeping up with the appointment results. The QME or AME is a real, board-certified doctor who is fully qualified to assess on-the-job injuries. They will review the person’s case and examine them at the appointment. They may require the person to go through some tests or gauge any improvement, and they may ask the employee to perform specific tasks to assess their abilities and restrictions better. Once they complete their examination, they will provide their opinion on whether the person should continue to receive the payments or not due to their ability to do their job. They will report on whether the person can perform their regular assigned tasks, to what degree they can do them, or if they cannot do them. Getting injured on the job is hard. There’s a lot of worry and many things to consider when applying for and receiving temporary disability payments. It requires talking with doctors, keeping appointments, therapy, and more. It can be a lot to remember and a lot to keep up with, especially when you are under stress and pressure from being hurt and out of work. If you have been hurt on the job, you are probably feeling a little overwhelmed. You have a lot on your plate right now, so let us ease the burden. At the Law Offices of Hussain & Gutierrez, we understand the stress and frustration of a worker’s compensation case, and we want to help. We’ll take over your case, so you have one less thing to worry about, and you can focus on the things that matter – your family and your recovery. Call today, and let’s talk about how we can help you get the compensation you deserve. Don’t wait to see what happens, or take the first settlement offer the insurance company sends to you. Let us handle your case so we can make sure that you don’t get cheated. This is your life, and you deserve to live it at its very best. Let us help you. Call today.