The 240-Week TD Rule: A Sixty-Second Seminar in Workers’ Compensation Claims Handling

Most claims professionals operate from the premise that temporary disability compensation benefits are limited to a maximum payout of 104-weeks within five-years of the date of injury; however, under Labor Code 4656(a)(3) there are 9 injuries which provide a disabled worker with temporary disability compensation for up to 240-weeks: 

Acute and chronic hepatitis B; acute and chronic hepatitis C; amputations; severe burns; human immunodeficiency virus; high-velocity eye injuries; chemical burns to the eyes; pulmonary fibrosis; and chronic lung disease.

Five major elements are to be considered when any of the above 9 injuries are in issue. First, look at the adjectives that describe the injury. For example, it is not just lung disease but “chronic” lung disease. It’s not just burns. It’s “severe” burns. Here, words matter! Second, once an injured worker qualifies for up to 240 weeks of TD, the cause of ongoing TD no longer becomes relevant. For example: if an employee qualifies for up to 240 weeks of TD due to a finger amputation, it does not matter if they become MMI for the finger. TD is still due up to 240 weeks even if disabled for other industrial reasons, such as a psych overlay from losing the finger. Third, we have the appellate case law definition of the word, “amputation.”  It is the full or partial severance or removal of limb or appendage. Therefore, although the removal of a disc or meniscus is a loss of a body part, it is not legally considered an amputation, as the loss does not involve either a limb or appendage.  Fourth, a serious back injury is not one of the nine exceptions to the 104-week TD rule, even if the injured worker is now restricted to use of a wheelchair. Fifth, payment of SDI benefits by EDD count toward the 240-week cap.

And as a further practice pointer, note that 240 weeks of T.D., does not equate to 4 years, it equates to approximately 4 years and 8 months!