Denied Temporary Disability Benefits in California? What Injured Workers Must Know

Denied Temporary Disability Benefits in California? What Injured Workers Must Know

  • Apr 25, 2022
  • Blog
  • Michael Burgis & Associates, P.C

Suppose you are an injured worker or a workers’ comp attorney litigating disputed temporary disability benefits in the state of California. In that case, there is some recent litigation that may be of interest to you. The case, Parody Versus Central Concrete Supply Company, centers on an employee who was hurt on the job, hurt again, and the insurance company tried to deny the claim by saying the injury was a temporary exacerbation of the earlier injury.

Therefore, they were asserting that they were under no obligation to pay for a second workers’ compensation claim.

Fundamentals of Temporary Disability in California Workers’ Compensation Law

What Are Temporary Disability (TD) Benefits?

Temporary Disability benefits are wage replacement payments issued when an injured employee is unable to work due to a work-related injury or illness. In California, these benefits fall under two categories:

  • Total Temporary Disability (TTD): Paid when you are unable to work at all.
  • Partial Temporary Disability (PTD): Paid when you can return to work with restrictions but earn less than before.

As per California Labor Code §4650, payment of TTD must begin within 14 days after knowledge of a work-related injury if eligibility is confirmed.

How Much Does an Injured Worker Receive?

Typically, TTD benefits are calculated at two-thirds of the employee’s average weekly earnings, subject to minimum and maximum state thresholds updated annually. For example, in 2024:

  • Minimum Weekly Rate: $242.86
  • Maximum Weekly Rate: $1,619.15

Payment continues until:

  • You return to work,
  • You reach Maximum Medical Improvement (MMI), or
  • You’ve received benefits for 104 weeks within 5 years.

Eligibility for Temporary Disability Benefits in California

To receive TTD, you must meet at least one of the following criteria:

  1. Your treating physician provides written certification that you cannot work at all due to a workplace injury.
  2. You are placed on medical restrictions, and your employer cannot or does not accommodate those restrictions with modified duties.

Parody vs. Central Concrete Supply Company

This case involves an individual who had already been awarded disability for a prior work-related injury. The same worker suffered another incident at work that aggravated the original injury.

Here’s where things get complicated: The insurance carrier argued the second incident was merely a temporary flare-up of the old condition and therefore not compensable as a new injury.

This argument hinges on the causation of disability, a legal nuance that is often misunderstood.

Understanding Causation: Legal Nuance Between Injury and Disability

A central point of contention in this case was the distinction between:

  • Causation of the injury: What physically harmed the worker?
  • Causation of the disability: What prevents the worker from performing their job?

The insurance company argued that since the original injury caused the underlying condition, any new disability was not independently compensable. However, California workers’ compensation law maintains that if a new workplace incident causes a material change, it may constitute a new injury regardless of whether it arises from the same anatomical location.

Legally, even a temporary aggravation that leads to medical treatment, work restrictions, or wage loss can trigger new eligibility for TTD.

This interpretation is vital in ensuring injured workers are not denied due compensation under incorrect assumptions about causality.

Legal Implications and Practical Outcomes

This case highlights the importance of accurately distinguishing between new compensable injuries and exacerbations of pre-existing conditions.

Key Questions Explored:

  • Was medical improvement attained after the first injury?
  • Did a new event materially alter the condition?
  • Was there a gap in medical treatment that reset eligibility?

The court eventually determined the worker was entitled to a new round of temporary disability benefits, as the new incident altered his medical and functional condition significantly enough to be recognized independently.

Understanding Temporary Disability Denials

Insurance companies frequently deny claims using a range of tactics:

  1. Misclassification of the injury as non-work-related or as a flare-up.
  2. Use of Independent Medical Reviews (IMR) that challenge your primary physician’s opinion.
  3. Failure to receive proper documentation or medical reporting from the treating doctor.
  4. Disputes over MMI, whether the worker has reached the point of maximum recovery.

Knowing the legal and procedural requirements and how to present medical evidence effectively can mean the difference between denial and approval.

Legal Framework: Key Documents and Forms to Know

To protect yourself, familiarize yourself with these critical WCAB and DWC forms:

Understanding and submitting the right forms at the right time can greatly increase the responsiveness of your claim to query pathways used by the system.

Real-World Tips for Injured Workers

  1. Keep a diary of symptoms and work limitations, document every flare-up, restriction, and change.
  2. Ensure your doctor understands legal terms, and ask them to explicitly state in reports whether this is a “new injury” or “exacerbation.”
  3. Get a second medical opinion (QME or AME) if you feel your condition is being misrepresented.
  4. Don’t assume insurance company decisions are final; most denials can be overturned with proper evidence.

Connecting This Case to Larger Trends

This is not an isolated incident. Many injured workers in California face the same arguments and misuse of medical semantics by insurance providers.

Workers with:

  • Cumulative trauma injuries,
  • Stress-related injuries,
  • Pre-existing musculoskeletal disorders,

They are especially vulnerable to having legitimate claims denied based on ambiguity in diagnosis or disability status.

FAQs: Navigating Disability Claims Confidently

Is a second injury considered new if it affects the same body part?

Yes. If the second incident worsens your condition or results in new treatment, it qualifies as a separate compensable injury.

What’s the time limit for TTD in California?

Generally, you can receive TTD for up to 104 weeks within five years of the original date of injury.

Can I still get TTD if my employer offers modified work I can’t perform?

Yes. If the work violates your doctor’s restrictions or causes further harm, you remain eligible.

Can stress or mental conditions qualify me for temporary disability?

Yes. California recognizes psychiatric injuries and work-induced mental conditions under Labor Code §3208.3, though more documentation is required.

Conclusion: Strategic Legal Advice Makes the Difference

Sometimes you have to look deeper into a claim because things aren’t always what they seem.

If you have a California workers’ compensation claim, don’t try to handle it yourself. This case could have turned out a completely different way, with the individual receiving no compensation for his second injury.

Protect Your Rights with Expert Legal Guidance

If your temporary disability benefits have been denied, especially in complex scenarios involving prior injuries, don’t delay. You may still be eligible for full compensation under California law.

Contact Michael Burgis & Associates today to schedule your free consultation. Our team will fight to ensure that your case is evaluated properly, your medical rights are preserved, and you get every dollar you deserve.

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