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What you can do when temporary disability benefits stop and you have not fully recovered from your injury?

If you are unable to work at your job while you are recovering from an industrial injury, you are entitled to temporary disability (TD). The insurance industry had their way with the legislature in 2004 (SB-899), so now  there is a two-year cap on this  benefit.  For injuries after January 1, 2008, TD can be paid out in broken periods for up to five years. There are a few very narrow exceptions to the two-year cap that simply don’t apply to the vast majority of injured workers. You must make plans in the event that your condition prevents you from quickly reentering the work force. What happens if  you are at the end of your two-year limit on TD, not finished with your medical treatment, and still unable to work?

A very important tip for your journey:

I heartily recommend that you file for State Disability Insurance (SDI) while you are on TD. Just do it! You can get an additional year of wage replacement if you qualify. It always amazes me how many people do not  know about this benefit. Those          deductions for “SDI” that have been withheld from your paycheck for all those years are finally going to pay off. 

Normally you can’t get TD and SDI at the same time (unless the rates are different). But, by filing for SDI as soon as possible (and informing them that you are currently receiving TD), you can lock in the date you applied.

The Employment Development Department (EDD) normally denies your claim if  you are getting  TD, but if you need to reapply when your workers’ compensation benefits terminate, your qualification will be determined by  the date you applied for SDI. Eligibility for SDI is determined from previous work history. While you are on TD, you could fall out of your “insured status” period for SDI. In that case, you might be out of luck, as you would have no SDI benefits to fall back on.  If  you timely file for SDI, you can preserve your rights to collect SDI benefits when your TD shuts down. 

The standard rule of thumb is that you must have paid into the SDI system for 17 months prior to your disability to draw the benefit.  Take a look at your old pay stubs; do they note a deduction for SDI? If you paid this deduction for 17 months, you are golden!  It is a huge  tax-free infusion of cash that a lot of people simply do not think about. Get on your computer and go to the website for the California Employment Development Department (edd.ca.gov) to get the application process started. You can also find your “payment” history to see if you have paid into the program long enough to receive benefits.              

Be careful here. You do not want to get paid TD and EDD benefits at the same time. If someone at the EDD is not paying attention, this could happen. You cannot “double dip” (get TD and SDI benefits at the same rate at the same time). Someone who knowingly does so commits fraud. But you are entitled to the “differential” if your EDD weekly benefit is higher than your TD benefit.

The irony is that the insurance industry found a way to pawn off a legitimate expense of the workers’ compensation system on the state and federal governments by setting up this two year limit.  As a consequence, it forces people to file for SDI and Social Security Disability (SSD) early. Injured workers have found themselves hung out to dry if they have a serious injury that will take longer    than two years to recover from. With the new medlegal procedures and the powerful tools the insurance companies have been given to delay or deny medical treatment, it is it almost guaranteed that some cases will take a long time to settle.

If you are a state employee, you need to think about filing for PERS disability, the website is calpers.ca.gov (STRS for                teachers-calstrs.com).   If you have a policy of short/long term disability provided as part of your benefits, you need to put applying for this benefit high on your “to do” list.        

If it appears that your injury is serious enough to preclude you from doing any work, you need to consider an application for SSD/SSI. Application for these benefits requires claims within a specific time period and therefore requires prompt action on your part. 

Thomas Ledgerwood
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Proprietor Ledgerwood Law Group