Total Temporary Disability is a major benefit paid out to Injured Workers as a result of their industrial injuries. At times, an Injured Worker’s Compensation claim is denied and delayed and they seek to collect State Disability Benefits. Also, there are times in which State Disability Benefits may supplement an Injured Worker’s workers’ compensation payments.
What is State Disability Insurance?
The California State Disability Insurance is a program that provides employees Short-Term Disability Insurance benefits to eligible workers who need time off of work due to an injury or illness.
How am I eligible for State Disability Insurance?
You may be eligible for State Disability Insurance if you are unable to work due to a non-work-related illness or injury. The California State Disability Insurance Program is part of the State of California’s Employment Development Department. If there is a dispute concerning eligibility for workers’ compensation total temporary disability benefits, State Disability Insurance benefits may be available.
In Workers’ Compensation, does State Disability Insurance go by any other names?
In the Workers’ Compensation Community, it is common to refer to someone who is receiving SDI benefits as being “on EDD” or collecting “EDD benefits.” Also, when benefits have been paid, SDI will file an “EDD” lien.
If I have filed a Workers’ Compensation Claim, Can I receive State Disability Insurance?
Yes. There are certain circumstances in which an Injured Worker who has filed a Workers’ Compensation claim can collect State Disability Insurance benefits. State Disability insurance benefits may be paid if the Workers’ Compensation Claims Administrator denies or delays workers’ compensation benefits. Any delay or denial letter concerning benefits from the Claims Administrator will be helpful to provide to State Disability insurance in order to assist in obtaining benefits. Also, in certain circumstances TTD can be supplemented by SDI.
Why are State Disability and Workers’ Compensation Claims Administrators concerned about paying benefits?
The State Disability Insurance Program and the Claims Administrators are very cautious to make sure that the Workers’ Compensation payments and the State Disability Insurance payments do not overlap. In the case of an overlap of benefits, either the Claims Administrator or the Injured Worker may be responsible for the repayment to State Disability insurance. An overlap of payments is also referred to as an “overpayment.”
Is it possible to get my Workers’ Compensation Total Temporary Disability Payments supplemented by State Disability Insurance?
There are also times when an Injured Worker’s State Disability Insurance rate is higher than their Workers’ Compensation total temporary disability rate. In those circumstances, SDI will pay the balance.
If State Disability Insurance pays out on a Worker’s Compensation Claim, what happens at the Workers’ Compensation Appeals Board?
If State Disability Insurance issues benefits while a workers’ compensation case is pending, SDI will file a lien at the WCAB to recover the benefits. SDI Liens are taken seriously at the WCAB. Workers’ Compensation Judges will make sure that there is resolution and/or payment of EDD Liens prior to approving settlements.
Is there a difference in State Disability insurance Rate and Workers’ Compensation Total Temporary Disability rate?
Yes. According to SDI, your weekly benefit amount is calculated based on your past earnings and equals approximately 55 percent of your earnings up to the maximum weekly benefit amount. Per the Labor Code Worker’s Compensation Temporary Total Disability is a payment of two-thirds of the average weekly earnings during the period of such disability, consideration being given to the ability of the injured employee to compete in an open labor market.
Besides, the percentage difference, the calculation of SDI benefits is made upon your highest quarter of earnings in the base period upon which they make calculations. Your base period covers 12 months and is divided into four consecutive quarters. The base period includes wages subject to SDI tax which were paid approximately 5 to 18 months before your disability claim began.
In contrast, the workers’ compensation rate is based upon average weekly wage and pays 2/3rds of it. It is subject to a cap.
Is there a difference in the length of State Disability Insurance benefits and Workers’ Compensation Benefits?
You may receive up to 52 weeks of Disability Insurance (DI) benefits. Workers’ Compensation TTD benefits may run either for 2 years and up to 5 years depending on the body parts injured.
If I work in the State of California, am I entitled to receive State Disability Insurance?
No. The mere fact that you work in the State of California does not make one eligible to receive SDI benefits. One must have been a contributor to the system, paid into State Disability Insurance, to be eligible. In contrast, the mere fact that an Injured Worker sustained an admitted injury and is totally temporarily disabled does entitle an Injured Worker to receive benefits.
How am I eligible to receive State Disability Insurance?
State Disability Insurance eligibility requires that (a)The individual must be unable to do their regular or customary work for at least eight consecutive days; (b) the individual must be employed or actively looking for work at the time they become disabled; (c) the individual must have lost wages because of their disability or, if unemployed, have been actively looking for work; (d) The individual must have earned at least $300 from which State Disability Insurance (SDI) deductions were withheld during a previous period. The individual must be under the care and treatment of a licensed physician/practitioner or accredited religious practitioner during the first eight days of their disability. (The beginning date of a claim can be adjusted to meet this requirement.) The individual must remain under care and treatment to continue receiving benefits; (e) he or she individual must complete and submit a claim form within 49 days of the date they became disabled or may lose benefits; (f) The individual’s physician/practitioner must complete the medical certification of their disability. A nurse practitioner may certify to a disability within his/her scope of practice however, he/she must perform a physical examination and collaborate with a physician or surgeon. A licensed midwife, nurse-midwife, or nurse practitioner may complete the medical certification for disabilities related to normal pregnancy or childbirth. (If the individual is under the care of a religious practitioner, request a “Practitioner’s Certificate,” DE 2502, from an SDI office. Certification by a religious practitioner is acceptable only if the practitioner has been accredited by Employment Development Department.
How am I ineligible for State Disability Insurance?
An employee may not be eligible for DI benefits if they (a) are claiming or receiving Unemployment Insurance (UI) or Paid Family Leave (PFL) benefits.; (b) became disabled while committing a crime resulting in a felony conviction (c) are in jail, prison, recovery home, or any other place because they were convicted of a crime (d) are receiving workers’ compensation benefits at a weekly rate equal to or greater than the DI rate or (d) fail to have an independent medical examination when requested to do so.
If you would like a “free” consultation with a workers compensation attorney, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 25 years. Contact us today for more information.