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  1. #1
    Join Date
    Apr 2010
    Posts
    58

    Question How do Benefit Caps Work

    I understand we injured workers are capped at 104 weeks and that the insurance company can not include SDI as TTD but did in my case. They paid off lien to SDI and included the 52 weeks in my benefit payment history. So then I was able to claim once again 52 weeks of SDI. I have a question. Has anyone else gone thru this? I find it very hard to believe they are just gonna pay off SDI again and those 52 weeks can not be included in TTD

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

    Default Re: Confused

    I'n not sure what you mean.

    comp does include payments to SDI as reimbursement as part of your TTD benefits.
    the second 52 weeks will again be reimbursed to SDI by the comp carrier and will once again be added as TTD benefits to your claim with a new total of 104 weeks paid as TTD.
    after that they will no longer reimburse SDI or pay any more TTD on that Date of Injury per the statute.
    Last edited by .SH; 04-03-2012 at 11:10 AM.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Confused

    I understand we injured workers are capped at 104 weeks and that the insurance company can not include SDI as TTD but did in my case.
    Apparently you have been misinformed...depends on your DOI whether SDI is included in the calculation of 104 weeks... that changed with the new statutes. Doesn't matter what others may have experienced, won't change your situation or eligibility for TTD, or SDI.

  4. #4
    Join Date
    Apr 2010
    Posts
    58

    Default Re: Confused

    My DOI is 8-2008. Insurance company paid me 76 weeks then disputed claim. I had to claim Sdi and have been paid out twice now. So according to my DOI will those weeks be included in my TTD ? Thank you for replies.

  5. #5
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Confused

    yes.
    all your temporay disability amounts will be used to compute the 104 week cap--including those that the carrier reimbursed to SDI.

  6. #6
    Join Date
    Jul 2012
    Posts
    4

    Default Re: Confused

    You might want to check out Yousef v. Millenium rugs. According to that case, unless and until the IC actually pays the lien, they can't count the SDI. I'm in a similar situation-- the IC stopped paying me TD after they'd paid about 48 weeks, and they are claiming that they don't have to pay me the other 56 weeks because they will have to pay the lien. The problem is, they're refusing to pay the lien until the case-in-chief settles, so I'm not receiving TD, and the SDI isn't back in my account, so I can't receive that either.

    If anyone has a definitive answer on how this situation is being resolved, or any relevant case law, I would love to know! Also, Chata, you were apparently told it couldn't be counted also, do you remember where you heard that and what, exactly was said? Thanks!

    - - - Updated - - -

    Per which statute, .SH? Thanks!

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