Workers’ compensation helps cover any medical costs employees might face following a work-related injury or illness. But workers’ compensation does more than pay for hospitalization fees. It can also help pay for any wages an employee has lost if their injury or illness led to temporary disability.
When do temporary disability benefits trigger?
Workers who can’t return to work within three days of their work-related illness or injury can claim temporary disability benefits. These benefits are meant to replace the equivalent of two-thirds of the worker’s lost wages, up to a maximum weekly amount set by California law.
To claim temporary disability benefits, a physician must confirm that the worker can’t perform their usual work for more than three days or has the worker remain in the hospital overnight for treatment.
Benefits are paid every two weeks once approved, and they’ll stop once the doctor declares the worker fit to return to work. It should also be noted that the employee won’t receive benefits for their first three days off work unless they were hospitalized overnight or their temporary disability prevents them from working for 14 or more days.
Benefits must be approved
But just like workers’ compensation claims, temporary disability benefits must be approved by a claims administrator. A claims administrator can dispute and refuse to cover an employee’s temporary disability benefits. To prove whether they need the benefits, the administrator might even require the employee to undergo evaluation by a qualified medical evaluator.
Employees whose temporary disability benefits are in dispute could consult an experienced attorney. An attorney can help employees appeal the denial before a California Division of Workers’ Compensation court and help pick an agreed medical evaluator with the claims administrator to ensure an impartial evaluation.
