TD payments extend beyond 104 week? (California) (California

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TD payments extend beyond 104 week? (California) (California

Postby cawcinfo on Thu May 07, 2020 3:47 pm

Passed around to 4 different doctors in 18 months. The first doctor after 8 months of trying to get to a specialist suddenly says they no longer are accepting workers compensation. Then wait 5 months to get another specialist (2nd doctor) and that specialist retires after 3 months of treatment, the third doctor states my injury isn't their area of expertise, which led me to the the 4th doctor that found a treatment and the treatment/surgery was approved March 2020. 20 months; roughly 80 weeks of 104 allowable weeks of TD payments. The surgery was then delayed due to COVID-19 pandemic and surgery centers in California not allowing non essential surgeries. In this situation with delayed treatment with doctors and delayed surgery out of everyones control; has anyone heard that they will extend TD benefit payments? This particular surgery once received and scheduled will be a recovery of 9-12 months. Months after TD benefits are to stop. Any relief with this? Also, no light duty job offered.
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Re: TD payments extend beyond 104 week? (California) (California

Postby 4anewusers on Sat May 09, 2020 9:21 am

I am not sure on the extension TD due to covid.

You can apply for CA State Disability, and if approved you may be able to receive SDI for up to one year after WC TD is exhausted.

https://www.edd.ca.gov/disability/


You can also get a second opinion on the surgery that your doctor is recommending. I highly recommend getting a second opinion before agreeing to any surgery.
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Re: TD payments extend beyond 104 week? (California) (California

Postby 4anewusers on Sat May 09, 2020 9:36 am

I just read your other post. I am not familiar with CDCR and don't know if you are eligible for SDI. This is some basic info on CDCR injuries.

I recommend calling and I&A officer or consulting with an attorney. Best to you.


http://www.wellswellslaw.com/index.cfm? ... orney-cdcr
Patient Advocate for medical device safety and ethics. •Modern medicine offers important benefits, yet it also has the capacity to cause harm;•Those harms arise from three central failings: the overuse, underuse, and misuse of medical services.
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Re: TD payments extend beyond 104 week? (California) (California

Postby cawcinfo on Sat May 09, 2020 9:38 am

Already at 99 weeks of TD and surgery hasn't been scheduled yet delayed due to COVID. Could get another opinion but already have seen 3 other doctors that went thru the motions of Physical therapy and injections.
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Re: TD payments extend beyond 104 week? (California) (California

Postby 4anewusers on Sat May 09, 2020 9:51 am

Can I ask what type of surgery? If it is a spinal fusion I highly recommend getting another opinion.
Patient Advocate for medical device safety and ethics. •Modern medicine offers important benefits, yet it also has the capacity to cause harm;•Those harms arise from three central failings: the overuse, underuse, and misuse of medical services.
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Re: TD payments extend beyond 104 week? (California) (California

Postby 50Cal20 on Sun May 17, 2020 7:10 pm

What is your injury? What is your surgery? Many people often forget there are 9 exceptions to the 104-week TD rule. California Labor Code Section 4656(c)(3) allows for up to 240 weeks of temporary disability within 5 years of injury if the injury involves any of the following 9 injuries: high velocity eye injury, amputations, acute/chronic hepatitis B, acute/chronic hepatitis C, severe burns, HIV, chronic lung disease, chemical eye burns and pulmonary fibrosis. if your situation involves any of these 9 injuries then the door has been opened to entitle you to up to 240 weeks TD, even if the current cause for TD is unrelated to these nine causes. Once the 240 week door has been opened, it remains open for all conditions of TD attributed to the industrial injury. On the other hand, if the 204-week exception does not apply and if you are therefore limited to 104 weeks of TD, then go ahead and file for California SDI benefits. Be sure to tell them you are filing a retroactive claim dating back to your date of injury. Explain you have been on workers' compensation and TD benefits are now ending due to exhaustion of benefits. Again, it is vital to mention you are filing a retroactive claim. Otherwise SDI will only look at your wages over the past 18 months which will show no earnings and therefore, there will be no money in your account to establish your SDI disability rate.

As for your work comp claim, once TD benefits end and you are still unable to work, the claims administrator will begin paying you Permanent Disability Advances at the rate of $290 per week. This too must be reported to State Disability who will take a dollar-for-dollar offset against your state disability benefits. For example: if you are entitled to $1,000 per week SDI benefits, they will subtract $290 and will pay you the difference of $710 per week. Normally SDI benefits end after 52 weeks, except where a work comp offset was applied. If you remain disabled after 52 weeks, SDI will continue paying weekly benefits to you until all the money they have withheld as an offset has been used up.
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Re: TD payments extend beyond 104 week? (California) (California

Postby cawcinfo on Sun May 17, 2020 7:51 pm

Knee injury, missing cartilage, from trauma of a fall. Procedure is called the MACi Procedure. Two part surgery, first surgery takes a piece of cartilage, then grows in a lab for up to 2 months, then second surgery consists of 9months to 12 months full recovery time. End of TD is mid June, first Surgery was February. Second surgery has been approved but put off by COVID. I don't believe CDCR corrections pays into SDI so $290 just wont cover the bills.
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Re: TD payments extend beyond 104 week? (California) (California

Postby 50Cal20 on Mon May 18, 2020 8:57 am

Thank you for clarifying your injury and surgery. Your injury unfortunately does not fall under one of the 9 exceptions to the 104-week TD rule. You need to check with HR to see if the CDCR is enrolled under state SDI or has an alternate equivalent disability benefit program for those who cannot work due to injury or illness. By reviewing an old check-stub you can quickly verify if there was a CASDI deduction from your paycheck. If so, you have coverage. But like I said, check with HR to see if another disability benefit may be available to you similar to SDI.

Yours is a case that can be used as an example calling for a temporary expansion of the 104 week TD rule during the COVID-19 pandemic. I am hoping some assemblyperson or state senator will sponsor a bill covering this matter. You may want to write to your representative.
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