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What about California TTD? - Babybadback - 02-26-2017

Good afternoon friends. I pray you all are doing well, and i want to thank you in advance for reading my post and giving me feed back. Today I would like to ask you all about wc ttd payments. I was injured April 6th 2015, and i am now... as of February 2, 2017 set up with a PTP. The PTP has sent in a work status report taking me off of work completely (as did the doctor who saw me for a few months in 2016). The thing is i did not recieve TTD in 2016. Im in fear that the same thing will happen. I immediately called my attorney (new one) and let them know i was faxing over the Work status report directly from the doctors office to them and the opposing side, i then advised them to demand TTD payments on my behalf. I was told the request was sent in same day. Here is my question, Can they deny TTD payments even though they accepted my claim? How long would it take to get a payment? I have a QME in one month, can or will they try to stall payments due to that appointment? Also i have proof that the erratic care of two other doctors that treated me on a lien bases in the past two years also had me under a (no work) work status. will they be required to pay me for those months? If so will the judge have to demand it, or will they pay on their own? Let me know if you need any more information. Again thanks for the help!



RE: What about California TTD? - 1171 - 02-26-2017

Yes comp can delay/deny td. Each type of benefit has it's own eligibility requirements.
Not everyone that has an accepted claim is off work because of it or needs treatment.
For example: with An accepted injury employer / carrier could deny TTD to workers still receiving wages.
Once Disability eligibility is determined they have 2 weeks to make payment.
They don't have to pay if/ when there is an issue with your eligibility. For example: differing medical opinions/evidence.
If/ when the eligibility issue for the prior period is negotiated or resolved in your favor, they are liable for payments.
If you were paid by SDI, comp would reimburse them for any duplicate periods.
If a resolution is negotiated, comp will pay voluntarily. If the issue is given to the court to decide, comp will wait for a written award. Either party can appeal a court decision.


RE: What about California TTD? - California_Help - 02-26-2017

(02-26-2017, 01:37 PM)Babybadback Wrote:
Good afternoon friends. I pray you all are doing well, and i want to thank you in advance for reading my post and giving me feed back. Today I would like to ask you all about wc ttd payments. I was injured April 6th 2015, and i am now... as of February 2, 2017 set up with a PTP. The PTP has sent in a work status report taking me off of work completely (as did the doctor who saw me for a few months in 2016). The thing is i did not recieve TTD in 2016. Im in fear that the same thing will happen. I immediately called my attorney (new one) and let them know i was faxing over the Work status report directly from the doctors office to them and the opposing side, i then advised them to demand TTD payments on my behalf. I was told the request was sent in same day. Here is my question, Can they deny TTD payments even though they accepted my claim? How long would it take to get a payment? I have a QME in one month, can or will they try to stall payments due to that appointment? Also i have proof that the erratic care of two other doctors that treated me on a lien bases in the past two years also had me under a (no work) work status. will they be required to pay me for those months? If so will the judge have to demand it, or will they pay on their own? Let me know if you need any more information. Again thanks for the help!

There is  1O4 weeks max on ttd. It sounds like you have not received any. Also, if your employer has a MPN (medical provider network) you have to be seen by one of those doctors to be taken off of work on TTD. Also, your claim has be accepted. If any of your doctors or a QME wrote you are permanent and stationary that is also a reason why they can stop/deny TTD. Some psych claims after 1/1/2013 may not be eligible for TTD.

If you were paid state disability you are also not eligible for TTD during same time period.

It sounds like you have a new attorney. You need to ask him to request all back payment of TTD owed to you and they should include a 10% self imposed penalty. He mat have to file for a hearing over this. If you have not done so already asking your doctors for copies of their reports may be helpful to you, so you know what they have been writing as far as your work status. To continue to receive TTD you need to send in a off work note at least every 4- 6 weeks to maintain TTD payments. Once a doctor writes you are permanent and stationary TTD stops. One of the questions the insurance company may ask in the letter to your QME is if you are permanent and stationary and at what date you were. This is to stop TTD. It is important you discuss all of your TTD payment questions with your attorney.

I do not understand why you were at two doctors who treated you on a lien. If your claim was accepted you should have been seen by a doctor within the insurance carriers MPN (if they had one) and not on a lien. To maintain TTD status you have to get off work documents regularly and turn them in to your claims adjuster. If you are owed back payment of TTD, ask your new attorney to file an expedited hearing if they refuse. I do not know the riles on if they have to pay you TTD for doctors that are not within their MPN (ask your attorney).


RE: What about California TTD? - Babybadback - 03-29-2017

(02-26-2017, 11:44 PM)California_Help Wrote: There is  1O4 weeks max on ttd. It sounds like you have not received any. Also, if your employer has a MPN (medical provider network) you have to be seen by one of those doctors to be taken off of work on TTD. Also, your claim has be accepted. If any of your doctors or a QME wrote you are permanent and stationary that is also a reason why they can stop/deny TTD. Some psych claims after 1/1/2013 may not be eligible for TTD.

If you were paid state disability you are also not eligible for TTD during same time period.

It sounds like you have a new attorney. You need to ask him to request all back payment of TTD owed to you and they should include a 10% self imposed penalty. He mat have to file for a hearing over this. If you have not done so already asking your doctors for copies of their reports may be helpful to you, so you know what they have been writing as far as your work status. To continue to receive TTD you need to send in a off work note at least every 4- 6 weeks to maintain TTD payments. Once a doctor writes you are permanent and stationary TTD stops. One of the questions the insurance company may ask in the letter to your QME is if you are permanent and stationary and at what date you were. This is to stop TTD. It is important you discuss all of your TTD payment questions with your attorney.

I do not understand why you were at two doctors who treated you on a lien. If your claim was accepted you should have been seen by a doctor within the insurance carriers MPN (if they had one) and not on a lien. To maintain TTD status you have to get off work documents regularly and turn them in to your claims adjuster. If you are owed back payment of TTD, ask your new attorney to file an expedited hearing if they refuse. I do not know the riles on if they have to pay you TTD for doctors that are not within their MPN (ask your attorney.


No I have not received any ttd payments, i did get state temp for about six months until it maxed out. Now the state is attempting to get sedgwick to court to pay it back with no avail. Two of my doctors that took me off work were in the mpn only one (chiro) was not in the mpn, but i recieved state ttd while the chiro had me off work for three months. Yes they accepted the claim as industrial, and the last QME labeled me both at MMI and permanent and stationary, with a 5% whole person impairment rating for three herniated discs! That was before Therapy or any treatment was rendered. When my Atty tried to subpoena the QME to do a deposition he had disappeared off the face of the earth. So the atty had the QME  struck from record and a new AME set up for this coming April 26th.
We filed for an expedited hearing regarding back pay today.
 Do i need to tell the atty i want a self imposed 10% penalty or do they know to do that? 
I have all my origional work status papers!
 My lawyer agreed that 20,000 was an acceptable settlement, I believe that is only the 2/3 of my last two years of missed work! That is not acceptable to me what about pain and suffering? what about the fact that i have a permanent disability?
 My atty said to me "the herniation's are so small, im not sure they will give you the 35k your counter offering" I wanted to reach through the phone and herniate three of his discs at that point! The pain i have been in out weighs the #'s on the MRIs! My MRI shows three disc herniation's, but the defense has said they believe only one disc was injured on the job. I have absolutely no prior medical history to support that statement though! Am i being too sensitive or is he being insensitive?


RE: What about California TTD? - 1171 - 03-29-2017

There is no pain and suffering in workers comp.
Both the worker and employer are liable-- that's why the benefits are limited.
Your alternative is to have the judge look at evidence from both sides and decide.
The judge will award the disability payment and leave the med open.
If you can live with that you don't have to accept their offer.
You'll need medical evidence from another doctor if you want to challenge the rating.
If the state can,t get reimbursed what makes you think you have a better chance?


RE: What about California TTD? - tbear6410 - 03-29-2017

NY here.... Good luck with getting anything from that Ins. Carrier... Yes, they are my Ins. Carrier too and they just discontinued my checks and told me to go back to work... even though I'm not released from my surgeon or doctor...