Q: Am I entitled to TTD benefits if the QME reported 3X I was TTD and could not return to work under no circumstances?
My employer filed my claim for industrial injury. The QME determined my injury was predominantly industrial on more than one occasion and that I was unable to return to work under no circumstances. This can also be supported by my treating doctors for treatment I recieve on a private basis.
It seems as though my employer who initially filed my claim for workplace injury and their insurance carrier encouraged me to apply for SDI through the EDD since I was not eligible for FMLA, but they did not inform me I was eligible for TTD benefits after being seen by the QME.
Upon further review, it seems as if SDI Provided by the State is to be used when my TTD benefits have exhausted through workers compensation . Am I correct?
Can I still make a claim for those past due wages/ benefits?
A: MORE INFO NEEDED.
YOU ARE ASKING THIS QUESTION IN A CRIMINAL LAW FORUM.
IT SOUNDS LIKE A WORKERS COMP MATTER AND MOST LAWYERS THAT HANDLE WC WILL GIVE YOU A FREE CONSULTATION.
A: Sadly, a finding by a QME that you are Temporarily Totally Disabled for particular dates may not be enough to require the Adjuster to pay TTD. IF the employer is saying the injury is not industrial and the employer wants a trial to try to prove the QME got it wrong, the adjuster won't pay. If the Adjuster has a report from a Treating Physician on the Medical Provider Network that disagrees with the QME and states this worker has reached Maximum Medical Improvement, the adjuster won't pay. There is no set time to use State Disability Insurance...Ideally, the injured worker would NEVER have to apply for SDI at all, the MPN Treating PHysician would write the injured worker was TTD and the adjuster would pay until the Treater wrote this worker is at Maximum Medical Improvement and then the worker would go back to work or get a new job and not apply for SDI. If what you say is accurate, you need a WCAB Judge to order the insurer to (1) pay you TTD and (2) reimburse the EDD for any SDI you have received...and it appears you will need an attorney to make this happen.
Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.
The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.
Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.