Temporary Total Disability (TTD) Benefits in the California Workers' Compensation Syste-2021 Update
Temporary Total Disability (TTD) benefits serve as a primary benefit for California employees who sustain an on-the-job injury and are certified by their primary treating physician (PTP) as unable to work due to the work injury. California has minimum and maximum rates for TTD payments.
Temporary Total Disability (TTD) Benefits are a primary benefits available to injured employees.If an employee sustains an on-the-job injury covered by the California Workers' Compensation Act, temporary total disability benefits are available if the primary treating physician determines that the employee cannot return to work due to the effects of the work injury. Certification by a physician is a critical first step in determining eligibility for TTD benefits. In the current system, employees must select a primary treating physician from the employer's Medical Provider Network (MPN). Also, since 2004, there is a two-year limit on receipt of temporary total disability benefits. Additionally, those benefits must accrue within five years of the date of the work injury. Before 2004, when a major reduction of workers' compensation benefits was passed by the California legislature, there was no time limit on receipt of medical temporary total disability (TTD) benefits.
If your workers' compensation claim is denied by the insurance carrier, then EDD provides help.If the claim of an on-the-job injury is denied by the employer or its workers' compensation insurance carrier, the State of California provides an alternative benefits through the Employment Development Department (EDD). The rate of EDD benefits is often similar to the rate of TTD benefits had the claim been accepted. A treating physician must certify an injured employee for EDD benefits and the form must be transmitted to EDD for processing. EDD benefits can last for up to a full year. If EDD pays benefits in lieu of medical TTD benefits, EDD places a lien on the injured employee's workers' compensation case and seeks reimbursement from the workers' compensation carrier if the claim is ultimately accepted or determined by a Workers' Compensation Administrative Law Judge as work-related. In essence, if the court finds a period of medical TTD found during the period in which EDD paid benefits to the employee, then EDD will be reimbursed by the workers' compensation insurance carrier.
Reimbursement to EDD by the defendant insurance administrator benefits the injured employee as his or her account (usually under one's Social Security number) is "recharged" meaning that if the employee needs to go off work in the future due to a disability, EDD benefits will again remain available.
TTD payments are subject to minimum and maximum rates.Generally, an employee's TTD rate is two-thirds of her average weekly wages at the time of the injury. If an employee earns $300 per week at the time of injury, then, all else being equal, her TTD rate will be $200 per week. The maximum rate for TTD payments for injuries occurring in 2020 is $1,299.43, and the new maximum for injuries in 2021 is $1,356.31.
The minimum rate for TTD for injuries occurring in 2021 is $203.44. For example, if an employee makes only $125 per week at the time of injury, he will still qualify for the minimum rate of $203.44.
TTD benefits are tax-free and not subject to payroll deductions.Unlike regular earned wages, medical TTD benefits are generally tax-free and are not subject to payroll deductions for FICA, unemployment tax, etc. In general, all workers' compensation benefits received by an injured employee are tax -free. An exception occurs for fortunate employees who receive salary continuation from their employers in lieu of workers' compensation TTD payments.
TTD benefits do not last forever and are considered the Rolls Royce of workers' compensation benefitOnce a doctor certifies an injured worker as having reached Maximum Medical Improvement (MMI) status, formerly called "permanent and stationary" status, medical TTD benefits generally stop and an employee is placed on permanent partial disability benefits, usually at a much lower weekly rate. While medical TTD benefits are not deducted from a final settlement, permanent partial disability advances are deducted. As such, injured employees receiving TTD benefits enjoy the best of both worlds: benefits at a higher weekly rate than permanent disability benefits, and benefits that are not deducted from a final award or settlement.
However, again, it is noted that a two-year (104 week) limit remains in place for most injuries under the California Workers' Compensation Act.
Do not blindly accept the employer's or insurance carrier's calculation of Average Weekly WagesAn employer or insurance carrier has an economic incentive to conveniently ignore types of income that should be included in calculating average weekly wages. If an employee receives a housing allowance, a car allowance, a per diem benefit to work away from home for weeks at a time (a visiting nurse, for example, who receives a housing and per diem allowance when assigned to locations far from her usual place of work) those additional payments or payment-in-kind can be used to increase one's average weekly wages. It helps keep and scan wage statements, W-2 forms, etc., that your attorney can use as evidence to increase the injured employee's average weekly wages.
Overtime pay paid within the 52 weeks prior to the injury date is included in calculating one's Average Weekly Wage (AWW). Many Human Resources managers are in a rush to fill out workers' compensation forms and quickly calculate an injured employee's Average Weekly Wages by mutiliplying the set work schedule (e.g. 40 hours) times the hourly rate, and then provide that information to the workers' compensaiton administrator. An alert employee should keep all payroll slips and W-2 tax forms as those documents include overtime pay, which will result in a higher Average Weekly Wage, meaning a higher TTD rate.
Public Safety Officers are entitled to receive one-year of salary continuationPublic safety officers, such as police officers, deputy sheriffs, and firefighters, are covered under a special set of laws designed to recognize the hazardous duties involved in their employment. Instead of receiving two- thirds of their Average Weekly Wage as their TTD rate for the first year off work due to an injury, a safety office received up to one year of full salary continuation. California Labor Code 4810 and related statutes cover public safety officers.
Once a full year of full salary continuation is paid, the public safety officer's TTD rate defaults to the same TTD rate calculation as any other injured employee.
The 104-week limit on TTD payments is extended for certain types of injuriesWhile the vast majority of work-related injuries in California are subject to the 104-week limit on TTD payments, certain types of severe injuries quality an injured employee to receive up to 240 weeks of TTD payments within five years of the date of injury.
To quality for more than 104 weeks of TTD, the injured employee must have sustained one of the following injuries or work-caused conditions:
-acute and chronic hepatitis B
-acute and chronic hepatitis C
-Human immunodeficiency virus (HIV)
-high-velocity eye injuries
-chemical burns to the eyes
-pulmonary fibrosis, or
-chronic lung disease
For example, if a hospital employee contracts hepatitis A, B, or C from the work environment, or if a construction worker loses a limb due to a severe accident, up to 240 weeks (almost five years) of TTD can be paid if the injured worker is certified by the primary treating physician as medically TTD.