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  1. #1
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    Default Refusing Modified Duty and SDI/EDD

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

    Can I get state disability if I refuse modified work from my employer?
    Last edited by 1radjojo; 11-11-2011 at 06:13 AM.

  2. #2
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    Default Re: Refusing Modified Duty and Sdi/EDD

    And......

    Tony
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
    http://www.workerscompensationinsura...inks/index.htm

  3. #3
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    Default Re: Refusing Modified Duty and Sdi/EDD

    sorry, first time posting... typed out this whole long thing, and then it didn't save! UGGGGH!

  4. #4
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    Default Re: Refusing Modified Duty and Sdi/EDD

    Quote Quoting 1radjojo View Post
    My workers compensation claim was made in the State of:CA

    Can I get state disability if I refuse modified work from my employer?
    If you are released to return to work, whether light duty of full time... you are not "disabled" for SDI purposes.
    If you are light duty, and there is wage loss...you would be paid wages by your ER, and TPD/Temporary Partial Disability benefits by the IC.

    So... what is your actual status?
    Your DR/PTP must certify disability...meaning you cannot work at all, to be eligible for SDI.

  5. #5
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    Oct 2011
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    Default Re: Refusing Modified Duty and Sdi/EDD

    I have been out for three months, FMLA is up on 11/15. My physician gave me EXTREME work modifications (no use of hands) I believe he did this because my employer was disputing my claim, figuring no one in their right mind would want that liability. I was receiving disability thru the state, because wc ins wasn't paying me. My employer now has "modified work available" (no, I am not a greeter at Wal-mart!!) and my job description and my restrictions are not in the slightest bit able to be accommodated. my employer says I just need to "sit there", I know my employer wants me to refuse the work. I could into more detail, but it would take a long time to post/read. Basically, my employer is offering me modified work to begin the day before my FMLA runs out, so if I don't return, they can fill my position. I do not want to ever work for this employer again. I want to get better, and get back to work for another employer who doesn't have a 100% injury rate. My physician says it may be 2 plus years before I can return to regular duty, if not modified duty with some permanent disability, which would still allow me to work in some capacity in my previous position. My work never paid disability benes, they disputed the second my physician took me out..... state now thinks I can return to work because my physician gave me these strict modifications, however, according the the SDI website, if I cannot perform my regular job I am eligible. My regular job is not "just sitting" and requires I use my hands ALL DAY. My atty has requested AME just this week.... I also have a psych claim, due to the mistreatment of my employer and additional things, am taking meds that make me groggy, work 50 miles away from where I live, and endure pain while driving.....Any thoughts....??

  6. #6
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    Default Re: Refusing Modified Duty and Sdi/EDD

    Again... if your Dr says you can perform even sedentary work, you are not "disabled"... therefore, you won't be paid SDI.
    And, if you have rec'd 52 weeks of SDI, there are no more SDI benefits available.

    Your ER doesn't determine whether or not your claim is compensable/benefits are due...the IC does that based on the medical evidence provided by your PTP...if the IC denies the claim, then as your atty has done, you go to AME to determine the issues, if they refuse benefits then, you go to court.

    You don't have a stress claim because your ER has mistreated you during the process... though you may have a claim under section 132(a) of the labor code due to harrassment or discrimination.

    Of course your ER would make light duty available...that's the goal in comp... return to work, the ER would rather pay wages than have the IC pay disability indemnit benefits.
    I know my employer wants me to refuse the work. I could into more detail, but it would take a long time to post/read. Basically, my employer is offering me modified work to begin the day before my FMLA runs out, so if I don't return, they can fill my position.
    You may have been misinformed regarding FMLA... even though you may be out on FMLA/WC, and they can run this concurrently, being on FMLA, or WC does not mean the ER cannot fill your position. FMLA provides up to 12 weeks/annum of job and ER paid benefits continuation... and allows you to return to your pre injury job. Or a suitable job if available.
    state now thinks I can return to work because my physician gave me these strict modifications, however, according the the SDI website, if I cannot perform my regular job I am eligible.
    Right.. IF your DR determines you cannot peform the job duties, due to your injury/illness. Sedenarty, or a job accommodation to light duty isn't the same. If you can peform some type of work, you are not "disabled".

    It's easy to read into the rules the way you'd like to apply them to your situation...that doesn't mean that's the way the rule reads.
    If the AME determines benefits/TTD is due, your ER/IC will reimburse EDD for any SDI paid, and those weeks will be available again in the event you need them, and your Dr certifies disability exists. If you refuse work if offered, you won't be paid TTD, or SDI.

  7. #7
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    Oct 2011
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    Default Re: Refusing Modified Duty and Sdi/EDD

    thanks for your response. my attorney says I have a good psych claim.... but that doesn't really matter.... my attorney says that I do not have a 132a even though the DFEH is doing an investigation as well as OSHA, for poor work conditions and failure to accommodate work restrictions, and follow two ergonomics evaluations, which resulted in additional injuries to myself and two other staff.

    I am going to ask my physician to state specific restrictions that I have on doing every day activities, such as driving. I cannot drive the 50 miles one way to work with my arms the way they are and expect to get better. If I can't drive that distance, even tho it sets my employer free of TTD and holding my position open for me, perhaps I can still get the state to pay me some disability benes while this thing gets settled. If not, my physical and emotional welfare, my family, and the impact this has had on all of us, is not worth it. I will refuse work. My TTD maxes out at state limits, the amount I receive is less than half of what I make, my employer is just concerned about what this will do to his premiums.... he has told me this before. Also, if I refuse work it affects my rating by 15%, like the point you were making, which is in interest of the IC. I have a soft tissue injury, and do not expect a big settlement anyway.... I just want to get better and move on with my life. I am even paying for treatments on my own, as HR changed my IC without informing me, my doctor hasn't been getting authorization for the treatments he is proposing, because he was sending claims to the wrong place!! The place I work for is getting a horrible reputation in the community for injuring then dismissing their employees, I don't want my name attached to them any further. Again, thanks for you time and info.

  8. #8
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    Calif
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    Default Re: Refusing Modified Duty and Sdi/EDD

    my attorney says that I do not have a 132a even though the DFEH is doing an investigation as well as OSHA, for poor work conditions and failure to accommodate work restrictions, and follow two ergonomics evaluations, which resulted in additional injuries to myself and two other staff.
    AA is probably right. 132(a) has nothing to do with OSHA... or FEHA... 132(a) has to do with harrassment/discrimination DUE to a work injury, or filing a comp claim.
    Besides, any action taken by OSHA would be to the ER, and any fines levied would go to the state/OSHA. Not the EE.

    There are too many variables with this issue for a message board.

    I am going to ask my physician to state specific restrictions that I have on doing every day activities, such as driving. I cannot drive the 50 miles one way to work with my arms the way they are and expect to get better. If I can't drive that distance, even tho it sets my employer free of TTD and holding my position open for me, perhaps I can still get the state to pay me some disability benes while this thing gets settled.
    You are overlapping "light duty" and a release to work at MMI... these are completely seperate issues. The ER is not required to offer light duty job or modified job.
    If your PTP has released you at MMI, with permenant restrictions... your ER must determine if a valid job offer can be made with in 60 days. That also determines the 15% +/- in PPD indemnity benefits. Light duty has nothing to do with this.

    If you have been released at MMI...and even though you cannot perform your pre injury job function...you won't be paid SDI, becuase you are no longer "disabled"... nor would you receive TTD. Nor would you receive TPD, if you do not return to work at your pre injury ER...
    You may be eligible for UI...all you can do is make the application for those benefits, EDD will make the determination based on the facts surrounding your situation.
    the amount I receive is less than half of what I make, my employer is just concerned about what this will do to his premiums.... he has told me this before.
    Well... WC premiums are a cost of doing business... of course there would be concern. I doubt your claim is affecting his premiums however.
    I have a soft tissue injury, and do not expect a big settlement anyway.... I just want to get better and move on with my life. I am even paying for treatments on my own, as HR changed my IC without informing me, my doctor hasn't been getting authorization for the treatments he is proposing, because he was sending claims to the wrong place!!
    Don't know what you mean by "HR changed my IC....". Your own health coverage has nothing to do with your ER comp coverage. Even IF the ER changed comp carriers, your claim would remain with the same one in effect at your DOI.
    If your PTP was sending to the wrong place, that would become apparent from the first submission of a PR-2....(???)
    You are paying out of pocket for treatment to your injury because you have opted to...there is no reason for this... there is a process fro getting authorization .... something is missing here.

    I have to be curious too... why you would cap TTD of 104 weeks for a 'soft tissue' injury.... that would be outside the norm.

  9. #9
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    Oct 2011
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    147

    Default Re: Refusing Modified Duty and Sdi/EDD

    Perhaps I am using the incorrect terminology and therefore you are not understanding what I mean. This is all new to me, and I am learning the hard way, so to speak. During my deposition, when I made comment about the fact that my proposed treatments have not been authorized since June, and that it has held up my tests and treatment, the atty for the WC ins asked to go "off record" and told me and my atty that the insurance company had changed and ALL claims, even those from before the effective date of change, were being handled by the new one. This was effective 10/1. Apparently, there was some sort of ugliness that occurred, and I was never notified. Yeah, you would think that my PTP would have received some sort of notice from the old insurance, but they didn't have the courtesy to contact him and let him know they were no longer involved with the claim. It certainly is a mess, especially since my employer or their outsourced HR never informed me of the change either. I think it's very interesting that they can send me notification of my FMLA expiration and even FEDEX me a modified work offer, but cannot give me this critical information needed for my treatment and recovery. Very upsetting, my atty says that this happens, frequently. Wow. All I can say is Wow, what a jacked up system! I guess I got desperate to feel better, have friends in the PT and CMT fields, and have taken my own healing process into my own hands when nothing was being authorized. The physicians I have seen for WC have all been extremely crazy busy, and seem to be completely unaware of what is going on with me, their patient, until I am sitting in their office. Managed care, my butt....

    When I say I max out, I meant TTD payments for the state of CA.

    My injury is a repetitive strain injury which is now developed into Chronic Myofascial Pain and Trigger Points. I have a great husband who makes enough to support our family, am young, and hope to eventually get back into the field, I have come to an impasse. Someone once told me that life happens when you have other plans. I s'pose this is what they meant.

    I never anticipated to get rich on WC, laugh!!! I just want my treatment and the time I need to get better. If that means I have to go it on my own, then so be it. There are probably scores of folks in these forums who wish they hadn't waited on the system, that their outcome would have been different if they had been more proactive. .

    There definitely is much more to the story, and I could go all day, not that this would be healthy or productive anyway.

    How is it you know so much about the system? Are you a veteran injured or an atty of some sort?? Thanks for your insight.

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