My doctor still has me out of work as disabled, but workers’ compensation benefits have ended, am I entitled to any other benefits?
An injured worker must understand that workers’ compensation is a limited benefits system. For example, once all 104 weeks of temporary disability have been exhausted, there are no more weekly indemnity benefits available to cover lost wages. (240 weeks for limited injuries, see 4656(c)(e3))
In California, most employees pay into the state disability insurance system, or “SDI,” through the Employment Development Department (EDD). To make sure you contribute to state disability, simply look at your last pay stub and check to see if a deduction was made for SDI or EDD.
If you do pay into the SDI system, you should be able to obtain disability benefits if workers’ compensation is no longer paying you. Generally, SDI will cover up to 52 weeks of an ongoing disability if necessary. The rate is calculated at approximately 55% of earnings within the highest quarter of the 12 months before the accident occurred.
It is important to note that you cannot receive both state disability benefits and workers’ compensation benefits at the same time. Even if your workers’ compensation benefits are reduced, an injured worker must notify state disability of any additional monies received as SDI is entitled to a dollar-for-dollar reduction.
The timing of applying for state disability benefits is crucial too. In many cases, an injured worker won’t think to apply for SDI until 104 weeks of TD has elapsed. In this instance, EDD may have a difficult time calculating benefits as there is no longer an applicable base period because the individual has been out of work too long. SDI may deny the claim and an appeal has to be made. We have helped many injured workers successfully apply for and appeal state disability benefits and determinations.
Other benefits available may include a short term or long term disability plan provided by an employer or third party, federal social security and possibly CalWORKs. Because the workers’ compensation system provides inadequate benefits in many instances, we are familiar with other benefits available to injured workers and their interplay between each other. We will make sure you are obtaining any and all benefits available to you whether within the workers’ compensation system or outside of it.