Workers Comp Zone

104 OR 240?

A bill to loosen the cap on how long some disabled workers can draw temporary disability benefits advanced in a California Assembly committee today.

The bill, AB 947 (Solorio), would add injuries that require treatment that cannot be medically completed within 104 weeks to a list of specified conditions that can qualify for a longer period of disability payments.

Under current law, a worker injured after January 1, 2008 is potentially eligible for up to 104 weeks of temporary disability benefits over a 5 year period. There are exceptions which allow up to 240 weeks of temporary disability over a 5 year period in specified circumstances.

Those circumstances are for amputations, severe burns, acute and chronic Hepatitis B and C, HIV, high velocity eye injuries, chemical burns to the eyes, pulmonary fibrosis and “chronic lung disease”.

Sufferers of those conditions are no doubt worthy of careful consideration from the system. But the gap between their special dispensation and the limitations on TD for other severely disabled workers doesn’t pass the “smell test” of fairness.

Workers lost significant legitimate rights in the 2004 reforms. Aside from the loss of free choice of treating physican, nothing riles disabled workers and unionists as much as the arbitrary cap on TTD benefits.

Here’s the problem, laid out in a frequently occurring scenario….

The worker falls off a ladder at work. For a while the occupational health doctor resists doing anything but physical therapy. After 2 or 3 months an MRI is performed, revealing a large herniated disc. After several months of utilization review wrangling over treatment referrals, the worker gets to a spinal surgeon, who urges a go slow approach for another several months.

When the pain becomes intractable, the worker’s orthopaedic surgeon recommends surgery. The carrier disputes the spinal surgeon.

The parties go through the spinal second opinion process, and the spinal second opinion recommends a fusion. By the time it is scheduled the worker is about a year downstream.

Unfortunately, the fusion does not heal properly. After prolonged convalescence and therapy, it is determined that the fusion is not solid.

The worker needs a re-do of the fusion. But the problems are multiplying. He still has sciatic type leg weakness, and his leg gives out, causing him to fall and rupture many knee ligaments.

Now he’s facing 2 surgeries, a major knee reconstruction and a fusion.

He’s past the 104 weeks of TTD. Pretty soon he’s past the additional help that EDD provides through its state disability benefits program.

By that time his problems are legion. If he wasn’t depressed before, he is now. There are marital problems. Financial problems. It’s likely that his health insurance expired. There’s no money.

And no more TTD after those 104 weeks.

AB 947 (Solorio) would address this problem.

The vote the Assembly Insurance Commmitte today was 8-4, Voting yes were Democratic Assembly members Jose Solorio (D-Anaheim), Chuck Calderon (D-Montebello), Wilma Carter (D-Rialto), Mike Feuer (D-Los Angeles), Mary Hayashi (D-Castro Valley), Nancy Skinner (D-Berkeley), Norma Torres (D-Pomona), and Bob Wieckowski (D-Fremont).

From here the measure will go to the Assembly floor. It’s likely that the bill will wind up on the Governor’s desk later this summer.

Here’s a link to the current text of the bill: … sm_v97.pdf

And here’s the current Assembly analysis: … _comm.html

Stay tuned.

Julius Young

Category: Political developments