Indemnity payment deadlines

Medical payment deadlines

How long does temporary disability run?

For injuries on or after January 1, 2008, aggregate TD is capped at 104 compensable weeks within five years of the date of injury.

A defined list of conditions gets 240 compensable weeks within five years instead: acute and chronic hepatitis B and C, amputations, severe burns, HIV, high-velocity eye injuries, chemical burns to the eyes, pulmonary fibrosis and chronic lung disease. Injuries meeting the §3212.1 definition occurring after January 1, 2023 also qualify for the 240-week limit.

What are the death benefit amounts?

For injuries on or after January 1, 2006:

Death benefits are paid in installments in the same manner and amount as temporary total disability, but no payment may be made at a weekly rate of less than $224.

When do I owe the SJDB voucher?

You avoid the voucher entirely by making a qualifying offer of regular, modified or alternative work no later than 60 days after the claims administrator receives the physician's report finding the injury permanent and stationary with permanent partial disability. The administrative director created the physician's return-to-work & voucher report (form DWC-AD 10133.36) for this purpose.

If you do not make that offer, the voucher must be furnished within 20 days after the offer window expires. It is worth up to $6,000 and expires two years after it is furnished, or five years after the date of injury, whichever is later.

Which penalty applies: 10 percent or 25 percent?

Both can. They are different mechanisms and adjusters conflate them constantly.

The 10 percent self-imposed increase under §4650(d) is automatic on a late indemnity payment and is paid to the employee without any application. You add it yourself; nobody has to ask.

The §5814 penalty applies only where the delay or refusal was unreasonable, is claimed by the applicant, and is capped at 25 percent of the delayed payment or $10,000, whichever is less. No action to recover it may be brought more than two years after the payment was due.

§4650(d) also carries exceptions worth knowing: no increase applies to a payment coming due within 14 days of the claim form being submitted, or where you could not determine entitlement within 14 days and gave proper written notice of the delay and what you needed. The written notice is what earns the exception.

What about liens on the back end?

A lien claim for expenses under §4903(b) must be filed within 18 months of the date the services were provided, for services on or after July 1, 2013. For services before that date, the period is three years.

Health care plans, group disability insurers, self-insured welfare benefit plans, Taft-Hartley funds and publicly funded medical benefit programs instead have 12 months from when they knew or should have known an industrial injury was claimed, and no later than five years from the date of service.

A lien claimant may not file a declaration of readiness to proceed until the case-in-chief has been resolved.

The one-line version

Fourteen days for the first indemnity payment either way, forty-five for a medical bill, fifteen working days for an electronic bill, and sixty to offer work before the voucher is owed.