Why Did My Workers’ Compensation Checks Stop and What Should I Do?
The statutory maximum number of weeks to receive temporary total disability (TTD) and/or temporary partial disability (TPD) is 104 weeks, depending on the date of the injury. (Pre-2005 dates of injuries have a different way of calculating the maximum entitled, so checking with an attorney is recommended.) Once the TTD 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/$264.50/$270/$290 range. As you can see, usually much lower than the TTD rate depending on your earnings at the time of injury. 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.
As indicated in FAQ, 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.
We always encourage our clients to look for work if possible. We understand that many of our client’s are physically, emotionally, or blocked by the down economy 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 client’s to do whatever they can to find even light work with hopes of getting private health insurance, if at all possible.
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 (see forms and links section of our website) and wait for a response. We understand almost 100% of applicants are 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.
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. We recommend that you speak with a workers’ compensation attorney about these rules if you are thinking about agreeing to a lump sum settlement (Compromise and Release).
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. We recommend that you speak with a workers’ compensation attorney about these issues if you are thinking about agreeing to a lump sum settlement (Compromise and Release).
If you are receiving Permanent Disability Advances (settlement advances which will be deducted from the settlement usually at a rate of $230/$264.50/$270/$290 week, depending on the date of injury, etc.), these payments may be stopped if you have reached 85% of the estimated amount of permanent disability. The carrier withholds 15% if you have an attorney for the attorney fee. They will look to any existing disability provided in a permanent and stationary report.
