Temporary Partial Disability

[tomboni]

I've recently discovered this forum and have been reading every day looking for answers to questions about some issues about my case.
The basics are:
I got hurt about 1.5 years ago and was out for a few months. My boss kept asking when I would be back. I asked my doctor when I could go back to work and he said that I would tell him. My boss continued to pay my family's healthcare benefits and some other stuff which amounted to over $2,000.00 per month. After a few months he told me that if I didn't come back then he would cut the benefits off. So I told my doctor that I didn't feel like I was ready but that I had to get back to work. He released me to get back with some limitations. My boss had said that I could just do office stuff. After getting back to work and payday came around my boss tells me that my pay is now $6/hr less than before. I had been making $35/hr so now my pay was $29/hr. IC had been paying 2/3 of $35/hr so they now started paying me $4/hr which is 2/3 of the lost $6/hr. A couple of months later the boss raises my pay to $30/hr and IC stops checks. I am not P&S. Is this the correct thing for the IC to do? Thanks in advance for any comments.

[.SH]

You may have hit the maximum wage. Earnings above maximum are not compensated. The maximum varies with the date of injury
there is a website with some calculators. Free to use but you have to register.
http://www.pdrater.com/original-calculators/

[tomboni]

State: CA

DOI: June 2007

At time of injury I made $1,400 per week.

My TTD checks were $881.66 (max ?) per week. (2/3 would be $932.40)

I went back to work (alternate work) and made $1160.00 per week.

My TPD checks were then $160.00 per week. (2/3 of my lost wages)

My pay was raised to $1200.00 per week.

So I expected TPD to be $133.32 per week. (2/3 of my lost wages)

IC stopped my TPD checks.

Do they average a certain number of weeks pay prior to DOI come up with the TTD amount?

I thought they paid 2/3 of the wage I was at on my DOI.

The raise in pay did take me to within 15% of my pay at DOI but I am not P&S so I thought the within 15% thing didn't apply.

Am I wrong here?

I looked at the calculator and it says: $881.66 for TTD, $160.00 TPD and $133.20 TPD

[.SH]

I'm not sure what "15% thing" you are referring to??
there are provisions that increase the permanent disability rate depending on the existence of an offer of modified work but that does not apply to wage loss or temporary disability.

disability payments are not based on your hourly rate; they are based on an Average Weekly Wage. For your injury date earnings are compared to the maximum Average weekly wage of $1322.49/wk - which is where they get the total temporary rate of $881.66/wk.
For temporary partial calculation whatever weekly wage you receive from your employer is subtracted from the $1322.49 max and comp pays 2/3 of the difference. if you are getting more then $1322.49 now then no partial disability is due.
You still have to have partial disability authorization from your physician as well.
whenever the rate changes or stops the carrier/employer is required to send a benefit notice that gives the basis of the calculation and/or explains the action. Request a benefit notice for the ending of your partial payments.
If you are not represented you can contact the I&A officer for help correcting the payment.

[tomboni]

letter from IC says:
"payments are ending because you have returned to modified work on ..."

doesn't "modified work" mean the same position modified to accomodate restictions at the same pay?

i returned to a different, lower paying, position and i believe this should be called alternative work and so i think i should be compensated for 2/3 of the loss of wages between the two positions.

is this not correct?

thanks for your patience

tomboni

[kelly38]

If you returned to another full time position, that pays no less than 85% of your previous salary, I don't believe that the IC has to pay the difference between the two...at least that has been my understanding.

[.SH]

looks like the carrier is not aware that the employer reduced your pay.
again: make sure the carrier has medical approval that you are released to modified work.
they have to know your wages have been reduced and that it's medically authorized before any disability payments can be made. employers and doctors are not always great about providing timely information.

[.SH]

not true kelly.
there is no minimum loss of earnings required for payment of temporary partial disability.

[tomboni]

Thanks for your comments sh and kelly,

I've only just recently started digging through stacks of paperwork about my case as the last year and a half has been a bit of a blur.

I just figured out that I was declared P&S last February and that is why my TPD payments stopped.

I have permanent damage and will be getting rated, I guess.

I got an atty about a month ago as every Dr. that I have seen says I have Causalgia or RSD or CRPS (whatever the difference is) and the IC says I don't.

All I know is my hand hurts.

One good thing the atty did is he changed my ptp to a PM doctor so now I'm getting the PM that my doctors kept referring me to and the IC kept denying.

I never knew it could be that easy.

I just got a copy of a letter my atty sent requesting an AME panel.

Hopefully I will see some progress.

Again, thanks.

tomboni

[BvIA]

I just got a copy of a letter my atty sent requesting an AME panel.

Ask your AA why s/he requested a panel process for your AME...and is running the risk of getting an doctor/PQME he has no/little knowledge of...?

The better option here would be to negotiate the name/selection of a evaluator/AME with the CA/IC to at least be somewhat familiar with which side the doctor sways his reporting...(no doubt too late at this point..or they simply couldn't agree...but a valid question none the less...)

I just figured out that I was declared P&S last February and that is why my TPD payments stopped.

At the time you became P&S/MMI your condition should have been rated to PD/WPI and PDA's begun within 14 days of that report...
TPD/Temp Partial Disability is paid as follows...http://www.leginfo.ca.gov/cgi-bin/di...file=4650-4664

4654. If the injury causes temporary partial disability, the
disability payment is two-thirds of the weekly loss in wages during
the period of such disability. However, such disability payment
shall be reduced by the sum of unemployment compensation benefits and
extended duration benefits received by the employee during the
period of temporary partial disability.

4657. In case of temporary partial disability the weekly loss in
wages shall consist of the difference between the average weekly
earnings of the injured employee and the weekly amount which the
injured employee will probably be able to earn during the disability,
to be determined in view of the nature and extent of the injury. In
computing such probable earnings, due regard shall be given to the
ability of the injured employee to compete in an open labor market.
If evidence of exact loss of earnings is lacking, such weekly loss in
wages may be computed from the proportionate loss of physical
ability or earning power caused by the injury.

What benefits have you been receiving since you became P&S/MMI ?

Hopefully this AME will address the RSD/CRPS issue...it is important that this condition be accepted by the ER/IC as a 'compensable consequence' to your orginial injury. The IC will fight this...but treatment is very expensive and long term in nature.
If the AME doesn't talk to you about this... YOU bring it up at the evaluation.
It would be a good idea for you to take a family member, or friend with you to the AME exam.