Temporary Disability California: Workers’ Compensation Coverage, Benefit Limits, and Qualifying Conditions

Temporary disability in California pays part of your wages after a workplace injury confirmed by an approved medical provider. Eligibility, time limits, and payment amounts depend on work status, legal codes, employer options, and medical updates.

By Brad Nakase, Attorney

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Table of Contents

1. Introduction

2. Practice of Temporary Disability Benefits

3. For what length of time may I get benefits?

4. What data must be provided to you lawfully?

5. The Labor Code: What is it?

6. Labor Code 4661.5: What is it?

7. Supplementing Additional Benefits

8. Additional Considerations for Monetary Gains

9. Consideration of the Education Code

10. Advantages Exclusive to Public Safety Officers

11. Section 4650 of the Labor Code: What is it?

12. What about EDD Benefits for State Disability Insurance?

Introduction

Temporary disability benefits in California are intended to make sure that employees who sustain workplace injuries get the money they are entitled to. The purpose of these short-term benefits is to partially compensate for the wages that a worker would have earned had they not been injured. Only injuries sustained at work are eligible for benefits, and a certified physician must certify that you are either unable to work or have limitations on the type or quantity of work you may perform.

Practice of Temporary Disability Benefits

If a staff member who works as a receptionist in an office has accumulative, repetitive trauma damage to their wrists and is informed by their physician that they are unable to perform any recurrent hand tasks, for instance, they have the right to benefits concerning temporary disability in California if the company does not offer any work that meets these limitations.

However, if a worker sustains a back injury while working in a warehouse and their physician certifies that they are able to work but are unable to lift over twelve pounds, and the company is able to accommodate this restriction, the worker wouldn’t be eligible for benefits concerning temporary disability in California because the alternative duty doesn’t involve lifting more than twelve pounds.

For what length of time may I get benefits?

The work limitations imposed by your physician and the steps your employer can take to accommodate them will determine your eligibility for benefits concerning temporary disability in California.

California has also implemented some restrictions on the duration of temporary disability compensation.

You will probably no longer receive payments for temporary disability in California if you go back to work full-time. They may also terminate if your doctor certifies that you can resume work with restrictions and your employer agrees to such restrictions. Lastly, benefits can stop if your health improves enough that you qualify for long-term disability insurance.

Benefits of temporary disability in California must be given within five years of the date of the accident and are often limited to 104 weeks in total.

However, you are eligible to receive a maximum of 240 weeks of disability payments if you suffer from any of these conditions:

Chronic and Acute hepatitis C or B
Amputations
HIV
Severe burns
High-velocity injuries to the eyes
Pulmonary Fibrosis
Eye burns from chemicals
Acute Lung Disease

What data must be provided to you lawfully?

You must receive correspondence from the claims administrator on the Temporary Disability Benefits. In addition to explaining any delays or nonpayment, these communications will explain the process used to determine your payment amount, explain any changes, and provide information about the termination of payments for temporary disability in California. Additionally, you must receive a list of every temporary disability benefit that has already been paid out.

The Labor Code: What is it?

The Labor Code determines how much you get after you are eligible for temporary disability payments, or TTD disability. This code determines your compensation based on the date of the injury. TTD disability benefits and payments are based on the lowest and maximum amounts mandated by the Labor Code. With one significant exception, this sum usually stays the same while you’re unable to pursue employment.

Labor Code 4661.5: What is it?

Labor Code 4661.5 is a particular ruling found in the Labor Code. According to the verdict, the sum of temporary disability benefits that an individual receives for two years or longer following a working injury is determined by the Labor Code rates in effect at the point of every payment. The employee will still receive the greater sum they were previously entitled to if the calculation results in them receiving less money. You must have income (or be entitled to higher earnings) sufficient to sustain the higher temporary disability rate in order to be eligible for this higher rate.

This usually occurs when an individual sustains an injury and eventually undergoes surgery more than two years after being placed on reduced work, taking a full leave of absence. After your employment injury, you can still qualify for a greater temporary disability compensation according to your fresh earnings status if your prospective earnings increase or if you get a raise. This also applies to those who are members of a union. Your illness or injury won’t prevent you from earning more money if your union can negotiate an improved agreement within your two-year timeframe.

Of course, you will probably profit from this exclusion if you happen to be a union employee.

Supplementing Additional Benefits

It’s essential to remember that benefits for temporary disabilities are not intended to replace a complete salary. Two-thirds of your typical weekly salary on the day of your injury is the basis for your weekly temporary disability compensation rate. This cannot be higher than the annual maximum rate set by the labor code.

A two-thirds rate will still be less than the amount you used to make, even though it is likely to fluctuate annually due to inflation, particularly for high-paid personnel. However, by collaborating with your employer to use accumulated leave credits, such as sick or vacation time, you can still augment your temporary disability payments up to a level that almost equals your entire salary. By doing this, you may be able to bridge the gap between your earnings and what you would otherwise be getting from a temporary impairment.

Additional Considerations for Monetary Gains

Additionally, there are several circumstances in which you can be eligible for extra benefits that are greater than the standard rate. When a worker is a member of a union that bargains for contractual provisions that provide them the right to receive more than the applicable rate, this is one of the most prevalent scenarios.

Consideration of the Education Code

Additional benefits are available to both authorized (teachers and some administrators) & classified (such as teaching assistants, assistants, and custodians) school district employees, according to the Education Code. The majority of workers only receive short-term disability benefits, but a school district staff who sustains an occupational accident while out of work may be compensated in full.

This is due to the fact that the Education Code offers unique payments, which include the standard Workers’ Compensation benefits combined with 60 days of paid holidays, vacation time, sick leave, industrial illness/accident leave, and “differential leave.”

Thus, in addition to temporary disability benefits, a school district worker is entitled to a maximum of 60 days of full wage replacement, which can be augmented by using their sick, holiday, and vacation leave.

A school district personnel who misses five months or less of work may be granted differential leave, which limits the amount withheld from their pay from exceeding the amount provided to the person who filled the role in their place.

Advantages Exclusive to Public Safety Officers

Under Section 4850 of the Labor Code, the majority of public safety workers are also eligible for supplementary benefits. After an occupational injury, these designated fire & public safety workers receive their full salary instead of the standard two-thirds pay for a maximum of one year. For the duration of their disability, individuals get temporary disability benefits at the regular rate following that year.

Section 4650 of the Labor Code: What is it?

When managing an injury at work, it is better to be as knowledgeable as possible about the chapters of the Labor Code that cover you. One important piece of information about temporary disability is Section 4650. Guidelines for what takes place if a health insurer fails to pay employees with disability benefits promptly are provided by Labor Code Section 4650.

According to Section 4650, insurance firms are required to increase the employee’s payment by 10% when the payments are made beyond the due date. If a payment fails to arrive every two weeks or within fourteen days of the specified due date, it is considered late. Anyone who gets disability benefits is covered by this. Police officers and firefighters are likewise subject to this rule.

What about EDD Benefits for State Disability Insurance?

You might be eligible to apply for the California Employment Development Department’s (EDD) State Disability Insurance (SDI) plan if there is any delay or disagreement in your Workers’ Compensation case when you are trying to obtain temporary disability payments. Only if you have already contributed to the program may this be the situation.

Workers’ Compensation will reimburse SDI to you at no cost if it turns out that they were really in charge of paying benefits at the time SDI was paid. Rarely, you can be eligible to receive payments from both sources simultaneously if your SDI rate is above your Workers’ Compensation temporary disability rate. You might still be eligible to apply for and receive a maximum of one year of SDI benefits if you are still disabled after using up all of your 2 years of Workers’ Compensation benefits.

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Temporary Disability California: Workers’ Compensation Coverage, Benefit Limits, and Qualifying Conditions

Introduction

Practice of Temporary Disability Benefits

For what length of time may I get benefits?

What data must be provided to you lawfully?

The Labor Code: What is it?

Labor Code 4661.5: What is it?

Supplementing Additional Benefits

Additional Considerations for Monetary Gains

Consideration of the Education Code

Advantages Exclusive to Public Safety Officers

Section 4650 of the Labor Code: What is it?

What about EDD Benefits for State Disability Insurance?

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