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  1. #1
    Join Date
    Jul 2010
    Posts
    8

    Default TTD Not Paid After Claim Was Accepted

    My workers compensation claim was made in the State of: California my claim was accepted in Oct 09 been on SDI since july 09 just ended after 52 weeks max. Had a AME on june 10 got AME REPORT back july 10 states that im still not at MMI/P&S and in need of more medical and possible back surgery(ttd) now do i get retropay for all the time i was on SDI which is less than my ttd from my AWW? My CA said since i was getting SDI then I didnt need ttd in Oct 09 when claim was accepted. I was MMI/P&S BY my PTP IN Feb 2010 which was a Co. Doc. by the way, the CA paid PD for 5% impairment thats why i got a AA and got a AME EXAM. PLEASE HELP

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: TTD Not Paid After Claim Was Accepted

    yes but they will repay SDI for the overlap period.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: TTD Not Paid After Claim Was Accepted

    You'll be paid retro TTD if the AME provided specific dates TTD is due. Just because the claim was accepted doesn't mean TTD is paid retroactive to the DOI. Of first date your PTP said TTD/couldn't work.
    CA said since i was getting SDI then I didnt need ttd in Oct 09 when claim was accepted.
    CA is/was just making an assumption, with out basis. TTD is due when the PTP/AME provides dates and certifies the benefits. TTD isn't based on ''need'', or whether or not other benefits/SDI is paid.

    Go to the AME report and see if the AME provided dates TTD is due. If there isn't anything, get your AA to request a supplemental report specifically addressing TTD.

    There has been some discussion on whether or not the weeks you are paid SDI in lieu of TTD goes against the 104 week cap. The last I read, the SDI weeks do NOT count...you'd still be eligible for additional 104 weeks TTD. (within 5 years of your org DOI)

  4. #4
    Join Date
    Jul 2010
    Posts
    8

    Angry Re: TTD Not Paid After Claim Was Accepted

    Quote Quoting BvIA View Post
    You'll be paid retro TTD if the AME provided specific dates TTD is due. Just because the claim was accepted doesn't mean TTD is paid retroactive to the DOI. Of first date your PTP said TTD/couldn't work.
    CA is/was just making an assumption, with out basis. TTD is due when the PTP/AME provides dates and certifies the benefits. TTD isn't based on ''need'', or whether or not other benefits/SDI is paid.

    Go to the AME report and see if the AME provided dates TTD is due. If there isn't anything, get your AA to request a supplemental report specifically addressing TTD.

    There has been some discussion on whether or not the weeks you are paid SDI in lieu of TTD goes against the 104 week cap. The last I read, the SDI weeks do NOT count...you'd still be eligible for additional 104 weeks TTD. (within 5 years of your org DOI)
    THANKS .SH and BvIA OK 1st, my final report from my PTP stated that period of ttd, current symptoms and level of PD are directly work related from DOI. 2nd the AME report stated im limited to semi-sedentary work position and if no modified work available (NO JOB TERMINATED AFTER INJURY) then im entitled to TTD-NO DATE indicated- My AA said im entitled to back pay for under payment i received while on SDI. WHATS NEXT ON THIS RIDE FROM HELL.
    Last edited by Semaj bad back; 07-27-2010 at 05:30 PM. Reason: forgot something

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