Options When Worker’s Comp Stops Paying …..

What are my options when the workers compensation checks stop?

Injured workers are paid wage loss when they are off work. To start payments, you have to be taken off work by a medical doctor due to your work injury.  The first three days are unpaid, unless you are

TEMPORARY DISABILITY (WAGE LOSS) ONLY LASTS UNTIL YOU ARE EITHER: 

(1) Found to be Permanent and Stationary (P&S)

(2) Released to Modified Work/Regular Work that is available at your Employer

The maximum number of weeks you can receive temporary total disability is 104 total, for the life of your claim. (2 years)

(TTD = off work completely) and/or temporary partial disability is paid at 2/3rds of your wages (66% of your pre-tax salary).   Temporary disability  is stopped, either because you have been offered modified work (work restrictions) or returned to regular work (no work restrictions) by your doctor, you may be entitled to permanent disability (PD).

Whether you received PD after TTD/TPD, ends will depend on if you are working and if there are medical reports which establish that you have permanent disability.  If you do have a report indicating PD, and you are not working, the claims adjuster should be providing you PD. Keep in mind that TTD is 2/3 of your average weekly wage (average of 52 weeks of earnings prior to the date of injury) and PD is paid out at a much lower rate, depending on your level of disability and your date of injury.  While this rate varies, it is in the $230 range.  As you can see, usually much lower than the TTD rate.  Also keep in mind that if you are a part time worker or you do not make more than about $300 a week, you may not be entitled to even $230 per week. (for example 2/3 of $300 = $200 a week). Either way, not enough money to live.

If you are in financial need, anywhere in California, you can call 2-1-1, a clearing house for benefits which will direct you to local resources available to you. It is a free service.

IF TEMPORARY DISABILITY ENDS, AND YOU CANNOT GO BACK TO WORK, FILE FOR EDD (State Disability Benefits).

You cannot receive both TTD and EDD at the same time.  Therefore, if TTD has ended, regardless of whether you are getting PD, you can apply for EDD. They may supplement your PD rate to get you up to your TTD rate.  This benefit from EDD will generally not last more than one year and if you received EDD for the claim previously, there may not be enough money in your EDD account to pay you more money.

The benefits that EDD pays you will often be filed as a lien claim against your settlement, if the insurance carrier failed to pay you required benefits. If you receive both TTD and EDD for the same time, you will be responsible for the duplicate payment. Often EDD will pay a “supplement”, only a portion of what you are due.

YOU WILL ALWAYS MAKE MORE MONEY WORKING THAN BEING OFF WORK, IF YOU CAN FIND A JOB WITHIN YOUR CAPABILITIES, TAKE IT

We always encourage our clients to look for work if possible.  We understand that many of our clients are physically, emotionally, or limited by their skill set from returning to work. The fact is that workers’ compensation benefits will never be sufficient to live on and get healthy and thus we encourage clients to do whatever they can to find even light work with hopes of getting private health insurance, if at all possible.

SOCIAL SECURITY BENEFITS AND MEDICARE:

Social Security Disability Benefits (SSDI)- If you do not believe you can return to work, and you have been off work for more than 12 months, or expect to be, SSDI may be an option. It can bring both money and right to Medicare (health coverage).  YOU ARE NOT ALLOWED TO USE MEDICARE FOR WORK RELATED INJURY TREATMENT.

Keep in mind that obtaining SSDI is a long process.  If you want to apply for SSDI, we encourage you to apply through their website and wait for a response.  We understand almost 90% of applicants are initially denied. You have a short time to appeal.   At that point it is time to obtain a Social Security attorney that will help with the appeal and hearing process.  Social Security appeals are handled on a contingency basis, so like workers’ compensation, you pay your attorney from the award and not a hourly rate up front.  The attorney only is paid if you receive a favorable award.

MEDICARE SET ASIDE REQUIREMENTS:

In order to protect Medicare from injured works settling their cases for “too little” and using Medicare for their work injury treatment, there are special rules that need to be followed by both the injured worker and defense. Once you have applied for Social Security, even if you haven’t been awarded it yet, Medicare’s interests have to be taken into account.  All settlements of worker’s compensation benefits where the injured party expects to receive Social Security benefits within the next 30 months is subject to this requirements.

Any money in your WC settlement designated for Future Medical Care has to be set aside in a separate account, controlled by you.  Receipts for all medical treatment related to your work injury must be kept and provided to CMS – Center for Medicare Services on a yearly basis until the funds are exhausted.  Medicare will set the amount that must be provided for your future medical care.  This is called a Medicare Set Aside. We recommend that you speak with a workers’ compensation attorney about these rules if you are thinking about agreeing to a lump sum settlement that will close your future medical (Compromise and Release).

OTHER STATE, COUNTY AND FEDERAL PROGRAMS:

Medi-Cal (medical treatment), Food Stamps, Section 8 Housing, SSA – There are many programs available  for those with low to no income.  We encourage you to check with local, state and federal government programs to determine if you are entitled to any of these, or other, low income/need based benefits.  Keep in mind you can lose these benefits if you agree to a lump sum workers’ compensation settlement that brings your “income” above the needs based level.

If you are in financial need, anywhere in California, you can call 2-1-1, a clearing house for benefits which will direct you to local resources available to you.