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Works´ Comp stopped my benefits

San Diego, CA |

Under what circumstances can a works´ comp stop the money, when I didnt voilent anything. they stopped so simply to send me my benefits for TTD.
Can they do that? What can I do in this situation?

Attorney Answers 5


  1. Best answer

    (1) CAN THEY DO THAT? Yes, they can do that.

    That said, the adjuster is supposed to send a notice within 14 days with the reason why the checks stopped.

    (2) WHAT CAN YOU DO? First FAX the adjuster (if you call, you can't prove the details of the call to a judge). FAX THE WORK STATUS report from the doctor showing you are still Totally Temporarily Disabled. WRITE a note that you need your TTD payment to resume immediately or your will request a hearing.

    IF you don't have the Work Status Report from the doctor showing you remain Temporarily Totally Disabled, check with the doctor. MAKE CERTAIN THE DOCTOR DELIVERED THE REPORT TO THE ADJUSTER!!!

    Did he write you can perform Modified Duty so you're now only Temporarily PARTIALLY Disabled so you should report for work?

    Did you report for Modified Work and the boss refused to let you work? Write THAT to the adjuster and FAX THAT note with the doctor's report.

    Quite often, a doctor writes that the worker can do modified duty and the boss won't find modified work, but the secretary falsely reports to the Insurance Adjuster that the employer DID offer modified duty and you didn't show up.

    So be sure your fax makes it clear you showed up for modified duty and the employer refused to provide modified duty.

    NEXT: you can apply for State Disability Insurance (SDI) from the Employment Development Department (EDD) ; I'll attach the form for you (i hope! my computer skills are limited).

    YOu'll have to take the SDI Application to the Doctor to get the Doctor's Certified completed and signed; if you leave it there, the doctor might delay or refuse because it will anger the adjuster. So you might have to switch doctors.

    THEN carefully interview CERTIFIED SPECIALISTS ATTORNEYS and make certain the attorney -- and not the paralegal or the new guy --- will be answering all the activity on your claim.

    AVOID TV ATTORNEYS like the plague ... too often they have secretaries handling the claim because of the volume they have to get through to pay for the TV ads. Maybe there's a good attorney who advertises on TV in San Diego, but be very careful: I've NEVER met an injured worker happy that they found their attorney on TV.


  2. It happens. If the doctor does not specifically say TTD, or does not report timely, the checks stop. If you have already received TTD for 104 weeks, you are done. If the doctor says MMI or P&S, they convert to Permanent Disability. The Ins Company sends a letter of Termination/Delay of benefits, so look out for it.

    Legal analysis is for general information, based upon the limited facts provided. Comments are not intended to constitute binding legal advice.


  3. Because I am licensed in Florida, I can only answer this question as if it were a Florida workers' compensation case.

    If the treating physician(s) has opined you reached overall maximum medical improvement ("MMI"), all temproary total disability ("TTD") and temporary partial disability ("TPD) for that matter stops and the workers' compensation carrier will begin paying permanent impairment benefits (assuming the treating physician has assigned an impairment rating).

    Also, indemnity benefits will terminate after the workers' compensation carrier has paid 104 weeks of TTD or TPD. The 104 weeks does not have to have been paid in consecutive weeks. If 104 weeks of indemnity benefits has been paid and the treating physician still has an injured employee off work, a determination as to permanent total disability should be made.

    Most commonly, TTD benefits will terminate when the treating physician informs the employer/workers' compenastion carrier that an injured employee is capable of returning to work. Often, the physician will state that although the injured employee can return to work, he/she can only do so in a modified capacity with physical restrictions (i.e., no lifting greater than 10 pounds, no repetitive use of the upper extremities, etc.). If the physician opines that the injured employee can return to "modified duty work" but has not reached MMI, TPD benefits may be owing. In such a situation, the injured employee should contact his/her employer immediately, inform the employer of the work restrictions assigned, and inquire whether the employer can accomodate the restrictions. If not, TPD benefits should be paid. If the employer can accomodate the restrictions and the injured employee returns to modified duty work but does not earn at least 80% of his/her pre-injury average weekly wage ("AWW"), TPD benefits may be owed depending on the circumstance of the inability to earn at least 80% of the AWW. If the employer can accomodate the restrictions and the injured employee refuses to accept the modified duty work offer, chances are the workers' compensation carrier will not pay the TPD benefits.

    Hope this helps.

    Legal disclaimer: Legal analysis is for general information, based upon the limited facts provided. Comments are not intended to constitute binding legal advice. There is no attorney-client relationship formed as a result of this communication. The response provided shall not be relied upon as legal advice from the responding attorney and it is based solely upon the limited facts being provided to the responding attorney by the person posing the question. To the extent additional or different facts may exist, the response provided by the responding attorney might change. Responding attorney is licensed to practice law only in the State of Florida. As such, the response provided is based solely upon Florida law unless otherwise herein stated. If you find this information helpful, please check the "Up" arrow box below. If you wish to discuss your question(s), the response provided, or hiring me in a confidential setting, call (813) 413-8700.


  4. They could have ceased your TTD benefits for a variety of reasons, as the other two attorneys before me have stated. You will receive a benefit notice from the insurance adjuster soon which explains exactly why they have stopped benefits.

    If you disagree with their decision, I recommend contacting an attorney right away. An attorney will be able to guide you through the process, and if it's possible to have your benefits reinstated, they will help you through the process.

    Good luck!

    This response is not legal advice and does not create an attorney/client relationship.


  5. If represented you should see y our attorney to determine whether another report should be requested clarifying your status. If unrepresented contact the doctor directly to get a clarifying report. See the information and assistance officer at your local wcab. Or get an attorney.

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