Payment for lost wages doesn't trigger cap on temporary disability
Case name: Meeks Building Center, et al. v. Workers' Compensation Appeals Board, No. C065944 (Cal. Ct. App. 06/26/12).
Ruling: The California Court of Appeal held that the cap on temporary disability was not triggered by an insurer's payment to an associate for lost wages due to a qualified medical evaluation.
What it means: In California, a payment to an injured worker for lost wages while he attended a qualified medical examination does not trigger the cap on temporary disability benefits.
A paint sales associate sustained a cumulative injury to his low back, neck, and left shoulder in the course of his employment. Despite his injuries, he continued to work in his usual job. His employer's insurer sent him to a qualified medical evaluation and paid him temporary disability indemnity to reimburse him for wages lost due to attending the evaluation. Later, the associate was determined to be temporarily disabled and restricted from work. The insurer began making temporary disability payment. Then the insurer ceased payment, asserting that the associate reached the limitations period for benefits, which began on the date of his evaluation. The California Court of Appeal held that the cap on temporary disability benefits was not triggered by the payment for wages lost due to the evaluation.
The court explained that the purpose of temporary disability indemnity is to provide interim wage replacement assistance to an injured worker during the period of time he is healing and incapable of working. The insurer argued that the associate was unable to work on the day of the evaluation due to his injury because of his required attendance at the evaluation. The court found that on the day of the evaluation the associate's injuries had not restricted him from performing his usual work duties. He only lost time from work to attend the evaluation to resolve his claim.
The court found that the insurer's payment was not a temporary disability benefit but a medical-legal benefit intended to allow the worker to recover costs associated with resolving a claim.
The court said that under the insurer's argument an injured worker who continued to work after an injury and did not suffer an incapacity to work until later would be disadvantaged. Further, an employer or insurer would be able to "artificially trigger" the cap period on temporary disability benefits.
Read more at the WorkersComp Forum homepage.
August 23, 2012
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