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  1. #1
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    Mar 2011
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    Default Permanent Disability Benefits and Their Relation to Unemployment Benefits

    My workers compensation claim was made in the State of: California

    Hello, I just received a letter reading "Commencement of Permanent Disability Benefits" from my insurance company.

    It stipulates my disability rating, amount the % translates to, and how many weeks the benefits will be paid.

    My question is this:
    1. Are these permanent partial disability benefits? The letter does not contain the word "partial", so I am confused. My rating is 12%, so I assume partial?

    2. How will these payments effect unemployment? I was laid off about a week ago, and plan to file for unemployment on March 29th when my severance pay ends. Will these permanent disability payments reduce my unemployment payments? Based on my salary I am eligible for the $450 max in California.

    Another note in the letter states the the insurance company has not requested a rating of the report from the State Disability Evaluation Unit. What is the significance of this? Is it something I should request.

    Until this point, I have handled this case myself without the assistance of an attorney as I feel my physician and the insurance company have both been fair in their assessments and payments. I do not want to an ugly battle.

    One final note: my doctor awarded me quite a bit of future medial. It includes possible surgery, pt, chiropractor, etc, etc. The insurance company wants to settle the claim outright. Would I need to hire a lawyer to determine the value of this future medical, or can I draft an excel spreadsheet with my estimates and simply tell them this is how much it will cost to get the problems I have healed.

    Thanks, guys.
    Last edited by maxhammer; 03-19-2011 at 03:20 PM.

  2. #2
    Join Date
    Feb 2007
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    Calif
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    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    1) yes. PDA's, Permenant Disablity Advances. PPD. You are not 100% PTD, so it has to be "partial".
    2) Yup... EDD will offset the UI by the amout of PPD you are receiving. You cannot be paid both for the same time/injury.

    3) Only a DEU is a 'final rating', used by a judge. A claim can be resolved on a PTP rating, or any other person rating. If you are not happy with the rating you have...you request a evaluation by PQME.

    Future medical... do what you like. You are not going to be paid the full amount of the potential cost of what the PTP indicated may be necessary down the line. Doesn't matter what is there...all treatment is subject to prior authorization and UR process.
    There is no guarantee you would ever seek or need a surgery. Or, that you'd live long enough to seek it. They= just don't pay cash for treatment you may or may not use.
    WC is all about paying the benefits as due. The only benefit to a C&R is the ER/IC gets off the hook, and the IW starts to pay.
    Take the PD indemnity= benefits, wait a few years, see just what treatment you may need, and, you have ability to reopen the claim for "new and further disability", within 5 years of your DOI.

    BTW... If you take money for FMC... you pay usual and customary fees,...not the contracted, or official medical fees the ER/IC enjoys. The cash you get will never, ever cover the potential costs you would face. If you require medical care now...do not close the medical in your claim.

  3. #3
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    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    Quote Quoting BvIA View Post
    2) Yup... EDD will offset the UI by the amout of PPD you are receiving. You cannot be paid both for the same time/injury.
    Really??

    This is the one I am most concerned about. I thought PPD benefits pay you for your handicap in finding jobs in the workforce and lose of body functionality, and therefore did not count as income in relation to Unemployment Benefits. I read that only Temporary Disability Benefits count as income. I read this multiple places, but nobody seems sure and there isn't a definitive answer I can find on the state website.

    That seems unfair if true.

  4. #4
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    Calif
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    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    The old rule was...
    Under Section 1255.5, a claimant’s UI benefits are reduced by the amount of temporary total disability benefits (including vocational rehabilitation maintenance allowance) received for that week. Receipt of other WC benefits, such as permanent disability or medical benefits, are not disqualifying. (Refer to TPU BDG for a complete discussion of WC as deductible income.)

    Note: If a claimant is unable to work for part of a week, and received WC for the same period, the UI benefit for that week is reduced by both Section 1253.5 (BR) and WC (the amount of either temporary total disability benefits or vocational rehabilitation maintenance allowance, but not permanent disability benefits).http://www.edd.ca.gov/UIBDG/Able_and_Av ... AA_235.htm
    The rule changed a few years ago...
    <<
    Employment Development Department, Lien of, Contd.
    . . . . . . . . . . . .
    ▫ PD, lien against: Lien allowed against PD where EDD paid for same days as PD was
    owed, “resulting solely from the same injury or illness,” L.C. 4904, Unempl
    Insurance Code 2629(b)(3); TD provision, (b)(2)
    >>
    The relevant section of L.C. 4904 is (b)(1)-(2).

    If an EE is receiving PD payments and is eligible for EDD, the EDD payments are reduced by the amount of the PD. Again, this was not done until a few years ago.
    That seems unfair if true.
    Often what appears unfair is not illegal... The two are not related.

  5. #5
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    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    Quote Quoting BvIA View Post
    The old rule was...
    The rule changed a few years ago...
    Often what appears unfair is not illegal... The two are not related.

    In that case, should I wait as long as possible before filing for unemployment benefits? Is there any rule that says you must file for UI within a certain time frame of losing your job?

  6. #6
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    Calif
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    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    A UI claim is good for a year, plus any extensions you may be eligible for...
    But, that does not relieve from the offsets due...to TTD or PD for the same injury/time period
    The labor code is here http://www.leginfo.ca.gov/cgi-bin/di...le=4900-4909.1
    you can't circumvent the law for your own benefit.

  7. #7
    Join Date
    Mar 2011
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    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    Thanks, all.

    One final question. If I resolve my WC claim (i.e. via lump sum settlement) before filing for UI how does it effect unemployment insurance?

  8. #8
    Join Date
    Feb 2007
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    Calif
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    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    You cannot be paid PD indemnity and UI or SDI for the same time periods, for the same injury. Doesn't matter how you spin it... doesn't matter how you manipulate the system, or payment of benefits... the law defines what you may be eligible for.
    And, you cannot force a C&R/lump sum settlement...that is entirely at the discretion of the ER/IC.

  9. #9
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    Mar 2011
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    5

    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    I'm not sure why you're putting words in my mouth and making an assumption that I am scamming the system. My IC and I have come to an agreement for a lump sum settlement, and I want to know if that effects unemployment benefits that I will apply for in a few days when my severance runs out. It is a simple question without the implied intent other than how to answer the question on my UI form.

    Basically, we settled today, and I am unsure how to answer the question regarding whether I expect WC income, which is located on the unemployment form, when I file next week. In short, is the lump sum considered income?
    Last edited by maxhammer; 03-25-2011 at 06:16 AM.

  10. #10
    Join Date
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    Default Re: Permanent Disability Benefits and Their Relation to Unemployment Benefits

    Im not putting words in your mouth, youa re asking the same question again and again. You CANNOT be paid PD indemnity and UI or SDI for the same periods for the same injury. Asking the same question, even slightly different, is a differnt spin.

    The portion of the C&R allocated to PD indemnity is what you report to EDD, it's not "income" its PD indemnity benefits. the link to the labor code provides the answer...
    (f) The amount of unemployment compensation disability benefits
    that have been paid under or pursuant to the Unemployment Insurance
    Code in those cases where, pending a determination under this
    division there was uncertainty whether the benefits were payable
    under the Unemployment Insurance Code or payable hereunder; provided,
    however, that any lien under this subdivision shall be allowed and
    paid as provided in Section 4904.
    (g) The amount of unemployment compensation benefits and extended
    duration benefits paid to the injured employee for the same day or
    days for which he or she receives, or is entitled to receive,
    temporary total disability indemnity payments under this division;
    provided, however, that any lien under this subdivision shall be
    allowed and paid as provided in Section 4904.
    (h) The amount of family temporary disability insurance benefits
    that have been paid to the injured employee pursuant to the
    Unemployment Insurance Code for the same day or days for which that
    employee receives, or is entitled to receive, temporary total
    disability indemnity payments under this division, provided, however,
    that any lien under this subdivision shall be allowed and paid as
    provided in Section 4904.
    (i) The amount of indemnification granted by the California
    Victims of Crime Program pursuant to Article 1 (commencing with
    Section 13959) of Chapter 5 of Part 4 of Division 3 of Title 2 of the
    Government Code.
    (j) The amount of compensation, including expenses of medical
    treatment, and recoverable costs that have been paid by the Asbestos
    Workers' Account pursuant to the provisions of Chapter 11 (commencing
    with Section 4401) of Part 1.


    EDD changed the rule a few years ago...to include Permenant Disability Indemnity benefits.
    Talk to the rep at EDD... that's where you get the final answer to the question.

    Aren't you reading/assuming Im saying you are trying to scam the system...read what I typed...not what you read.

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