Disability: Types of Benefits
Know your rights about disability in the California workers’ compensation system.
Know your rights and fight for your entitlement to workers’ compensation benefits. Educate yourself about the types of disability available in the State of California.
The biggest concern for most injured workers, usually secondary only to making a good recovery, is maintaining income during recovery. In the California workers’ compensation (“WC”) system, you cannot depend on the WC insurance carrier or employer. Do NOT assume that the WC insurance carrier or employer will advise you of your rights, or will correctly administer your claim(s). The WC system is an increasingly adversarial litigation process. This means that you must be your own advocate for your WC case.
Can I receive Temporary Total Disability (TTD)?
You may be entitled to WC benefits if your WC claim(s) for injury(ies) are admitted and/or accepted by the WC insurance carrier (or in some situations a permissible self-insured employer for WC), and the WC insurance carrier agrees with your WC doctor. These benefits may be in the form of a wage loss replacement WC benefit of temporary total disability (“TTD”). In order to be potentially eligible for TTD benefits, your WC doctor needs to state in their report(s) that you are off work TTD due to your work injury(ies). He may also provide you with work restrictions that your employer cannot accommodate.
For dates of injury of 1/1/08 and later, TTD payments are good for a maximum of 104 weeks (or two years) within a five-year period from the date of injury(ies). TTD is calculated based on two-thirds of your gross average weekly wages. This is commonly averaged over a 52-week period going back one year from the date of injury(ies). TTD is paid every two weeks. It is limited to a maximum and minimum weekly rate set by statute by the California state legislature. For example, for a 2019 date of injury, the maximum TTD rate was $1,251.38 per week; while the minimum was $187.71 per week. In 2020, the TTD rate is a maximum of $1,299.43 per week; while the minimum is $194.91 per week.
How long does Temporary Total Disability (TTD) last?
Keep in mind that TTD payments do not go forever. TTD benefits will end when any of the following events occur:
1. You reach the 104-week TTD cap, or it is beyond five years from your date of injury for the admitted/accepted injury(ies).
2. You are a seasonal worker, the reported season has ended, and you historically did not work in the off season.
3. Your WC treating doctor and/or a neutral doctor, of either an Agreed Medical Examiner (“AME”) or Panel Qualified Medical Examiner (“PQME”) in the WC system releases you back to work.
4. You return to work, and/or your WC treating doctor and/or a neutral AME or PQME in the workers’ compensation system finds your medical condition(s) have medically reached a status known as permanent and stationary (“P&S”) or maximum medically improved (“MMI”). P&S or MMI means you have “good days” and “bad days” for your medical condition(s). This means that medically, there is no expectation of much change in your overall medical condition(s) over the next six months to a year. Additionally, P&S or MMI is a medical status based on a doctor’s judgement call about your level of medical improvement and disability from the injury(ies). There is no grace period as to when you become declared P&S or MMI by the WC doctor(s).
Can I receive Permanent Disability (PD)?
A WC doctor(s) may release you as plateaued status of P&S or MMI with some level of ratable whole person impairment (“WPI”) for your disability. If this happens and you are unable to return to work, then you may be entitled to a WC benefit payment of permanent disability (“PD”). PD is a monetary benefit paid as compensation for a lifelong permanent injury(ies). It is based on the rating of a WC doctor’s report that finds whole person impairment. The permanent disability benefit is calculated based on two-thirds of your average weekly wages (“AWW”), subject to a statutory maximum and minimum, set by the State of California’s legislature. For a 2019 date of injury, the maximum PD weekly rate is $290; the minimum PD weekly rate is $160.
The permanent disability payment is generally not enough to support you or your family. Most WC cases end up settling. The WC system is typically a slow process, involving healing the human body. There is no guarantee of settlement. Additionally, your WC case may require going to hearing(s) and trial(s) at the Workers’ Compensation Appeals Board. The best outcome is if you are medically able to return to work. You always have the most options if you can work.
Am I eligible for Social Security Disability (SSD), or Social Security Income (SSI)?
When you are unable to medically return to work, and have been off work for at least six months due to your injury(ies), you may be eligible for Social Security Disability (“SSD”)/Medicare benefits. These benefits are through the federal government. You may qualify for Social Security Income (“SSI”)/Medicare benefits based on an income needs basis. Depending on your age, you may quality for Social Security/Medicare benefits. Our experienced workers’ compensation attorneys can refer you to reputable attorneys that specialize in SSD/SSI/Social Security/Medicare benefits.
Benefits may be available through the Employment Development Department (EDD).
If you are not receiving TTD, and your doctor still has you off work due to your injury(ies), you may be eligible for state disability benefits. State disability benefits are through the State of California’s Employment Development Department (“EDD”). Your doctor will need to fill out the EDD state disability paperwork. The doctor must certify you for state disability benefits as being medically unable to work due to your body part(s)/medical condition(s). However, if you are unemployed, and ready, willing, and able to medically work, you may be able to apply to EDD for unemployment benefits.
Other potential sources of income may be available.
Furthermore, there may be other monetary benefits available through private short or long-term disability plans. In addition, collective bargaining agreements/union contracts may provide benefits such as paid vacation time or sick leave. There may be potential sources of income through county welfare assistance, social services programs, non-profit community organizations, religious affiliations, and other benefits available in your community.
Ford & Wallach fights for workers’ rights.
Ford & Wallach’s experienced WC attorneys are dedicated to upholding the dignity of labor and advocating for workers’ rights. We will help you smoothly transition through the WC system. Above all, your primary focus should be recovering from your injury(ies). Our job is to fight for you to ensure you receive fair and just compensation in the WC system! Ford & Wallach offers a free consultation and is here to help. Contact us by email or call 213.380.3140.