Workers’ Compensation: Temporary Disability BenefitsThere are two categories of temporary disability benefits: temporary total disability (TTD) and temporary partial disability (TPD, also known as “wage-loss TD”). Both are payments to compensate for lost wages while you are recovering from your injury or illness. TTD payments are made if you cannot work at all during your recovery. TPD payments are also made if you can return to your work, but only for limited hours or limited duties at a lower wage. You may also be eligible if your doctor restricts the type of work you can do, and your employer does not provide full-time work (she only has part-time work) that fits into your restrictions. NOTE: You do not pay income taxes on temporary disability benefits.
- a. you have a job-related injury and
- b. your doctor has stated that you are temporarily disabled.
- return to work;
- your doctor says you can return to work (whether or not you actually go back);
- your doctor deems you permanent and stationary (i.e., you have reached “maximum improvement”)
- have received more than 104 compensable weeks of payments for a single disability within a period of two years from the date TD payments began (with exceptions for certain injuries), or
- you or the insurance company disputes the treating doctor’s evaluation and a QME (or AME if you are represented by an attorney) evaluates you and finds any of the above.
How can I calculate my temporary total disability (TTD) benefits?
Usually TTD benefits are equal to two-thirds of your prior gross (before tax) income. Your gross income includes overtime and the market value of board, lodging, and fuel. You may also receive more than two-thirds of your wages at the time of your injury if you were scheduled for a pay raise. In that case, you may receive two-thirds of the higher wage.
These benefits are subject to minimum and maximum rates, depending on the date of your injury. See Current Temporary Total Disability rates.
How can I calculate my temporary partial disability (TPD, or wage loss TD) benefits?
Usually TPD benefits are equal to two-thirds of your lost wages, subject to your maximum TD rate. Your lost wages are the difference between your average weekly wages and the amount you are earning by working part-time.
What happens if I was working more than one job at the time of injury?
Calculate your average weekly wage by adding your wages from all jobs. The rate will be equal to two-thirds of the wages from all jobs combined. Keep in mind that your gross income includes all jobs that are affected by your inability to work based on the advice of your treating doctor.
Who decides if I can receive TD?
Usually your treating doctor. If you disagree with your doctor’s evaluation, you may request a change of treating doctor or get a second opinion from a Qualified Medical Examiner (QME) or an Agreed Medical Examiner (AME). Your claims administrator may also disagree with your treating doctor and request a second opinion from a QME or AME.
(For information about changing doctors or getting a medical-legal opinion from a QME or AME, please see our Fact Sheet titled Workers’ Compensation: Medical Care.)
When will TD payments begin?
The first payment must be made within 14 days after your employer learns that:
Your claims administrator should send your TD payment together with an explanation of the payment calculation.
NOTE: No benefits will be paid for the first three days off work unless the injury lasts more than fourteen days or requires hospitalization.
What happens if I don’t receive payment within 14 days?
If there is a delay, your claims administrator must send you a delay letter within fourteen days of your request for benefits explaining the reason for the delay, further information she needs to process your claim, and when you can expect a decision. A decision is usually required within 90 days from the date you reported your claim.
If there is a delay and you do not receive a delay letter within fourteen days of your request, your claims administrator is required to pay an additional 10% even if there was a reasonable excuse for the delay.
Call the insurance company and follow up with a written letter requesting your TD benefits.
What if my employer provides a different job with lower pay?
You may be eligible for temporary partial disability benefits of two-thirds of the wages lost due to your work restrictions (subject to the maximum rates in the chart above).
When do TD payments end?
You may continue receiving TD until you:
Your claims administrator is required to send you a letter stating the reasons for ending your TD payment.