There are a few things injured workers should expect. Medical treatment and pay for time lost due to the injury among them. Often not expected, however, is the paperwork and regulations buried in a sea of acronyms. Here, we will discuss some of those acronyms along with some relevant notes.
Temporary Disability (TD) can be Temporary Total Disability (TTD) or Temporary Partial Disability (TPD). TD is the benefit paid when an injury causes missed time from work. It’s calculated as two-thirds (2/3) the injured worker’s Average Weekly Earnings (AWE) (often used interchangeably with Average Weekly Wage (AWW)). See Labor Code §4653. TD is subject to a legal cap and legal floor. How that two-thirds is arrived at can be calculated several different ways under Labor Code §4453.
TD will only be paid on an accepted claim. The work status establishing entitlement to TD needs to come from the injured worker’s Primary Treating Physician (PTP). For most injuries occurring after Jan 1, 2008, TD is only available for up to 104 weeks (Labor Code §4656(c)(2)) within 5 years of the date of injury and only while the injured worker is not medically stable for the injury (Labor Code §4656(c)(3)).
Permanent Disability (PD), like TD, can be Partial (Permanent Partial Disability or PPD) or Total (Permanent Total Disability or PTD) This is the benefit that is designed to compensate for the impact of lasting disability when a recovery is less than complete. Once an injury is deemed medically stable or “permanent and stationary” (P&S)—sometimes referred to as “maximum medical improvement” (MMI)—a determination should be made regarding how much medical impairment exists under California’s guidelines.
California, , under Labor Code §4660, adopts the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition) (often simply referred to as the AMA Guides). The AMA Guides are divided into Chapters and Tables a doctor is required to reference when determining how much impairment exists for a given body part or condition. The impairment (expressed as Whole Person Impairment or WPI) is adjusted to a percentage of permanent disability. Certain particularly severe injuries bypass rating and are presumed to cause Permanent Total Disability under Labor Code §4662.
An injured worker’s PD pay rate in cases of PPD is based on AWE like TD but subject to different caps and floors. An employer or insurance carrier might need to pay Permanent Disability Advances (PDAs) before doctor issues a P&S report or before a case settles.
This is the doctor charged with orchestrating an injured worker’s recovery following an injury. Among other things, the PTP should report on changes in the injured worker’s condition, changes to the treatment plan, needs for consultations, work restrictions, whether the injured worker should be released from care, and permanent impairment he or she believes the injury is stable. See 8 CCR §9785.
Generally, any treatment outside true emergency, care must be requested formally and authorized by the claims examiner before it can be provided. This is done with a Request For Authorization (RFA) specifying the services requested and establishing the medical need which goes through Utilization Review (UR). If UR denies or modifies the request, the UR decision should include a form to request Independent Medical Review (IMR).
The above is not meant to replace case specific advice and not all of the above will apply in every (or any given) case. Nor is the above an exhaustive list of acronyms that might come up nor an exhaustive discussion of all related laws or cases. It is often a good idea for an injured worker, particularly one missing time due to the injury, to consult with an attorney.
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