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Help! The Insurance Company is Stopping my Temporary Disability.

So, you’ve gotten that letter from your adjuster telling you that your temporary disability payments are coming to an end in the near future and you want to know if there’s anything you can do about it.  Well, the answer is—it depends.  The biggest factor here is why did the payments stop.  First, let’s look a little closer at Temporary Disability payments.

What is Temporary Disability?

temporary disability benefits overviewTemporary Disability, or TD for short, is designed, as a temporary wage-loss replacement.  Essentially, it is two thirds of your average weekly wage, subject to a minimum earnings floor and a maximum earnings ceiling.  If you only suffer a partial wage loss as a result of your injury, then your temporary disability benefit is calculated at two thirds of your partial wage loss.

How do I qualify for Temporary Disability?

Qualifying for temporary disability benefits takes three things.

  1. First, you must suffer a work injury that results in a loss or reduction of your wages.
  2. Next, you must be made either temporarily totally disabled or temporarily partially disabled by the company doctor.
  3. Finally, your injury must cause you to miss work for more than three days before your temporary disability payments start.  But, if you miss more than 14 days, you will be paid TD for that three day waiting period.

Alternatively, if the company doctor makes you temporarily partially disabled, you have one additional hoop to jump through.  If you are temporarily partially disabled, the doctor will allow you to return to work with restrictions.  Your employer may then offer you alternate or modified duty.  If you are offered alternate or modified duty which accommodates your restrictions then you return to work and you don’t get TD unless your modified duties pay you less than you were earning pre-injury.  If your employer does not offer you alternate or modified duty, then you qualify for temporary disability benefits.

Are there any limits on Temporary Disability?

Per current law, you can only get TD for a maximum of 104 weeks and those 104 weeks must occur during the first five years after your date of injury.  There are a few types of more serious injuries where the 104 week cap is extended to 240 weeks but these are uncommon situations and don’t apply to most people.

What can I do if my Temporary Disability is shut off?

The first thing you need to do is find out why.  Then, depending on the reason, you may be able to see a judge for an expedited hearing.  However, the judge cannot make a decision in your favor without medical evidence.  If you’re still having a tough time wrapping your head around temporary disability, speak with an attorney.  One small distinction with your individual situation may mean the difference between getting your TD again or moving on towards the next step in the resolution of your claim.