Payment Benefits: Temporary disability and permanent disablitity Flashcards
What is the three-day waiting period?
Three consecutive calendar days beginning with the first day the worker loses time or wages from work as a result of the compensable injury.
How are those three days determined?
▪It begins with the first day the worker loses time or wages due to their injury.
▪It is three consecutive calendar days (not working days).
When is the three-day waiting period payable?
▪The worker is authorized and is totallydisabled for a period of 14 consecutive days, or
▪The worker is admitted as an inpatient to a hospital within 14 days of the onset of total disability.
How is the 3DW paid if it needs to be paid?
If the three-day waiting period is payable, pay one-half for the initial work day lost if worker leaves during first half of the shift and does not return. No compensation is due on the first day if the worker leaves during the second half of the shift.
What information is required before an adjuster pays time loss?
The attending physician or authorized nurse practitioner (or Type B provider if appropriate) must be able to verify the worker’s inability to return to work and then authorize time loss.
Generally, when is the first time-loss payment due by statute?
14 days from the employer’s date of knowledge and/or the worker’s disability.
When is the first time-loss payment due by SAIF’s best practice?
13 days from the employer’s date of knowledge.
After the first time-loss payment is issued, how often is the time-loss benefit paid?
Every 14 days.
When are time-loss benefits NOT payable?
▪A person has withdrawn from the workforce.
For example, an injured worker is not working and has made no reasonable effort to obtain employment or the injured worker is a full-time student.
▪The attending physician or authorized nurse practitioner (or Type B provider) is unable to verify the worker’s inability to work.
▪The worker is incarcerated for the commission of a crime.
▪The Type B Provider time frames have expired.
What are some situations when an adjuster may stop paying time-loss benefits?
▪The claim is denied.
▪The worker is released to regular work.
▪The worker returns to modified work and making their full AWW.
▪A bona fide job offer is made for modified work and the worker refuses the job(if the BJO was made for the full AWW).
▪The terminated worker process has been completed.
▪The claim is closed.
What are the basic rules for determining the injured worker’s rate of time loss?
▪Generally, the TD rate is 662/3 percent of the weekly wage.
▪It’s based on the worker’s wages at the time of injury.
▪Monthly wages are divided by 4.35 to determine the weekly wage.
▪For seasonal, on call, paid hourly, paid-by-piece work, or with varying hours, shifts or wages, request 52 weeks of payroll records to determine the average weekly wage.
▪For workers employed less than four weeks, use the intent at hire as confirmed by the employer and worker.
▪Overtime hours are only included in the calculation when worked on a regular basis.
▪Bonus pay is only included in the calculation when provided as part of the verbal or written employment contract.
When would an adjuster pay TPD?
When the worker has returned to modified work, but at reduced hours or reduced wages.
When would an adjuster pay Sup TD benefits?
When an injured worker has more than one job at the time of injury and because of the work injury is unable to work the other jobs.
Note: there is no three-day wait taken for Sup TD benefits.
Can Sup TD be paid on a nondisabling claim?
Yes. Sup TD may be due on a nondisabling claim even if time loss is not due on the primary job.
When would you pay the PPD award in a lump sum?
▪If award is less than $6,000, or
▪If award is more than $6,000 and the worker requests a lump sum payment.
