Temporary & Total Disability Benefits

Table of Contents

  1. Definition of “temporary & total disability benefits.”
  2. How does an injured worker qualify for TTD benefits?
  3. How much of TTD benefits do I get if I am injured on the job?
  4. When will my TTD benefits start after I am injured and the doctor finds me temporarily disabled?
  5. Frequency (How often or frequent will my TTD checks come?)
  6. Duration (How long will my TTD benefits last?)
  7. What are the maximum and minimum weekly amounts?
  8. What is “temporary and partial disability” (TPD) benefits?

Definition of “temporary & total disability benefits.”

If your on-the-job injury is preventing you from completely returning to your usual and customary work for the time being (i.e., temporarily for at least 3 days), the California Labor Code states you are entitled to be paid by the employer or workers’ compensation insurance carrier a benefit called “temporary & total disability” (TTD) benefits, and they are NON-TAXABLE! No federal, state, or county taxes may be charged on TTD benefits.

How does an injured worker qualify for TTD benefits?

In order to qualify for TTD benefits, the injured worker must be certified by a licensed medical professional doctor periodically:

That he or she is not able to perform his or her usual and customary work and is
under active medical treatment. The doctor must make this certification
periodically ——-typically every 30 or 45 days in a written report or note; or

That the doctor has ascribed some work restrictions (e.g. no heavy lifting and/or
no repetitive bending/stooping) on a temporary trial basis and the employer
cannot accommodate these restrictions.

Example # 1:

disabilitybenefits2Mr. John Smith is a construction worker and while on the job, a heavy cement block fell on his head and back. He is now in the hospital. The orthopedic doctor issued a note stating that Mr. Smith cannot work at any job for 2 months due to extreme pain and frequent dizzy spells. Mr. Smith will qualify for TTD benefits because the doctor stated that he (John Smith) cannot return to his customary job or any job.

Example # 2:

Miss Jane Doe is a receptionist at a dental office and lifted a heavy box of supplies. She filed a claim and went to see the doctor who stated that she strained her back and that she can work but should avoid “heavy lifting and no repetitive bending/stooping.” The employer (Mr. Dentist) said that the job as reception does not involve heavy lifting and/or bending and stooping because a receptionist sits most of the day and does typing along with answering of phones. Miss Doe will not be entitled to TTD benefits because the employer can accommodate her work restrictions.

How much of TTD benefits do I get if I am injured on the job?

In general, TTD benefits are two-thirds of your average weekly gross earnings when you are off work and recovering from the injury. The product of your average weekly gross earnings and two-thirds shall be your “TTD rate.”

TTD rate = (2/3) x (average weekly gross earnings)

If you have more than one job (i.e., 2 part-time jobs) and you injured yourself from one job while not injuring yourself from the second job, you can aggregate the average weekly earnings from both part time jobs to form the basis of your “average weekly gross earnings.” Your average weekly gross earnings can be from wages, bonuses, car allowance, clothing allowances, overtime, tips, etc.

Example # 3:

Mr. Johnny Brother has two part time jobs: 1) McDons where he earns $400.00 per week gross; and 2) Burger Link where he earns $200.00 per week gross including tips, overtime, etc. Now he was injured in a slip-and-fall accident at McDons but not at Burger Link, and the doctor stated that he should be off work for 2 months. What is his TTD rate?

TTD Rate= (2/3) x (weekly earnings at McDons + weekly
earnings at Burger Link)
= (2/3) x ($400.00 + $200.00)
= (2/3) x ($600.00)
= $400.00

Thus, Mr. Johnny Brother receives $400.00 per week as his TTD benefits because he can aggregate all earnings from all his jobs to form the basis of his TTD rate.

When will my TTD benefits start after I am injured and the doctor finds me temporarily disabled?

After you have seen a doctor who has placed you on “temporarily and totally disabled,” you should start receiving your TTD benefit payments within 14 days after you have filed your claim or have notified your employer. Please note that the carrier may have an additional 5 days (for a total of 19 days) to issue payment if it is apprised of your TTD status by mail. Thus, it is always better to notify the carrier by fax or email in addition to regular mail.

Frequency (How often or frequent will my TTD checks come?)

disabilitybenefits3Once the first payment is issued to you, the second, third, fourth, fifth, etc. payment should come every two (2) weeks following the previously issued payment. The carrier is obligated to send written notice of payment of TTD benefits, the amounts, duration and especially termination of benefits along with the reasons. Its failure to do so will expose it to penalties.

Duration (How long will my TTD benefits last?)

In general, the maximum duration is two (2) years. However, if any of the following conditions is met, your TTD benefits will stop:

The Panel Qualified Medical Examiner (PQME) states that you are able to return to your usual and customary job or even a modified job (regardless of whether you have such a job to return to or not);

The Agreed Medical Examiner (AME) states that you are able to return to your usual and customary job or even a modified job (regardless of whether you have such a job to return to or not);

Your primary treating doctor (or treating doctor) states that you are able to return to your usual and customary job or even a modified job (regardless of whether you have such a job to return to or not);

Either the PQME, AME or your treating doctor states that your condition has reached “maximum medical improvement” (MMI) or “permanent and stationary” (P&S) status;

Your payments have reached the maximum duration of 104 weeks (or two years). Even if you are still declared to be TTD after 2 years, TTD benefits will stop UNLESS your case meets the exception (see “exception” below);

Upon agreement of the parties;

Upon consent of the injured worker; or

Upon order of the court.

Exception to the two-year maximum duration of 104 weeks: If your condition is such that you have an amputation, acute and chronic hepatitis B, hepatitis C, immune deficiency, severe eye injury (e.g., loss of sight), chronic lung disease (i.e., pulmonary fibrosis), or severe chemical burns, then you can receive more than the 104 weeks of TTD and extend the payments up to 240 weeks.

What are the maximum and minimum weekly amounts?

disabilitybenefits4The California State Legislature has ascribed a maximum and minimum weekly TTD amount to an injured worker. The injured worker’s maximum and minimum TTD rate will depend on the date of injury. In general, the rate goes up every year to take into account inflation. For example, if the injury occurred in 2016, the maximum TTD rate is $1,128.43 per week while the minimum is $165.49.

Because the workers’ compensation system is a very limited form of compensation, the California State Legislature saw fit to put a cap on the amount of weekly benefits so as not to bankrupt the employer or carrier. For example, if the injured worker’s salary gross per week is $1 million dollars and he or she is injured on the job in 2016, he or she will NOT receive $666,666.66 per week as his or her TTD rate, but rather his or her TTD rate will be subject to the cap below and should receive at maximum $1,125.43 per week.

The converse is true where the State Legislature does not want the worker to receive less than a minimum amount because doing so could cause an injured worker to face serve financial and economic hardships such as homelessness. If the same worker were injured in 2016 and his/her salary was $100.00 per week gross, he or she will NOT receive $66.66 per week as his/her TTD benefit, but rather he/she will receive the statutory minimum TTD rate of $169.26.

Date of Injury Maximum/Week Minimum/Week
2010 $986.69 $148.00
2011 $986.69 $148.00
2012 $1,010.50 $151.57
2013 $1,066.72 $160.00
2014 $1,074.64 $161.19
2015 $1,103.29 $165.49
2016 $1,128.43 $169.26
2017 $1,172.57 $175.88
2018 $1,215.27 $182.99
2019 not determined yet not determined yet
2020 not determined yet not determined yet

What is “temporary and partial disability” (TPD) benefits?

When an injured worker is not totally and temporarily disabled, he or she may be considered “temporarily and partially disabled” (TPD) if the doctor states that he or she may return to work but not at his or her usual and customary duty (such as being able to do light work). When an injured worker per the doctor can work while still under active treatment and the employer has taken him/her back to work, then the worker is considered TPD. Typically, when a worker is under TPD status, he or she is working under some form of work restrictions (e.g. no heavy lifting and no prolonged standing). The question then becomes has he/she lost any wages by working with those work restrictions? If so, the worker is entitled to “wage loss”(i.e. difference between the salary pre-injury and the salary post-injury).

To qualify for TPD benefits (i.e. wage loss), the injured worker must meet either one of two scenarios:

Scenario # 1:

If the doctor states that the worker can return to work with some physical restrictions (e.g. light work only) but the employer either cannot or refuses to accept the said restrictions, then the injured worker is entitled to TTD benefits at the TTD rate (i.e., 2/3 x average weekly gross earnings) per above even though he/she is “temporarily and partially disabled” (i.e, can work with some physical restrictions);

OR
Scenario # 2:

If the doctor states that the worker can return to work with some physical restrictions (e.g. light work only) and the employer gives him/her lighter work but that the worker is earning less than the pre-injury salary, then the injured worker is entitled to TPD benefits which are calculated as two-thirds of the “wage loss.”

Example # 4:

Mr. Daring Danny was earning $600.00 gross per week as an auto mechanic for Bob’s Auto Shop as his usual and customary job until he hurt his legs on the job. The treating doctor states that Mr. Danny may return to work with the physical restrictions of “no carry heavy objects and no frequent standing.” The Auto Shop’s owner welcomed Mr. Danny back but because he cannot be a mechanic assigned him to be a receptionist answering phones and typing but at a lower wage of $420.00 gross per week. His “wage loss” per week is therefore $180.00 ($600.00 – $420.00). His TPD benefits is calculated as follows:

TPD benefits= (2/3) x (weekly earnings preinjury – weekly earnings postinjury)
= (2/3) x (wage loss)
= (2/3) x ($600.00/week – $420.00/week)
= (2/3) x ($180.00/week)
= $120.00/week

So, Mr. Danny’s TPD benefits are $120.00 per week. In essence, Mr. Danny shall receive $540.00 per week (i.e. $420.00/week as a receptionist + $120.00/week as TPD benefits).

Note: Mr. Danny will have to pay income taxes on the $420.00 salary but not on the $120.00 TPD benefits.

We know that the concept of TTD and TPD may be difficulty for you to understand, and you may have been denied these benefits. Therefore, we do NOT recommend that you handle the matter alone. Help is only a phone call away. Please call either one of the two Fong brothers and we shall answer your question for FREE!!!!!!

Law Offices of Fred L. Fong, APC

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Carson, CA, 90746
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