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: 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.
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