The Waiting Period: A 60-Second Seminar in Workers’ Compensation Claims Handling

Surprisingly, workers’ compensation claims professionals continue to encounter problems administering the three-day temporary disability waiting period. One misunderstanding concern whether the waiting period is applied or waived when an injured worker returns to work on light duty at half-days immediately following an injury. In our blog today we will tackle some of the basic questions asked about the waiting period, including the relationship between the waiting period and light duty.

First, the TD waiting period is 3 days. However, per LC § 4652 the claims administrator must go back and pick up the waiting period if:

1.  Temporary disability extends beyond 14 days.

2.  The injury results in the worker becoming a hospital inpatient.

3.  When the injured worker is an employee of the state civil service, an employee of the Regents of the University of California, or an employee of the Board of Trustees of the California State University and is injured because of a criminal act of violence (see Labor Code §4650.5)

When originally introduced into the workers’ compensation legal scheme, the waiting period was for 7 days, until 1974 when it was reduced to the current length of 3 days.  Also, when originally introduced, there were only two classifications for hospitalization, namely inpatient or outpatient, where the waiting period was waived if the injured worker was classified as an inpatient.  However, Medicare later introduced two additional classifications for hospital visits, called “short-stay” or “admitted for observation.”  Because we now had four classifications it became necessary for the DWC to issue a definition of an “inpatient” for the purpose of determining if the waiting period should be applied or waived.  Regulation 9789.21(n) was thereafter adopted where an injured worker is classified “as an inpatient when formally admitted as an inpatient with an expectation that they will remain at least overnight and occupy a bed, even if discharged or transferred to another facility and does not actually remain overnight.”

As for our initial question of whether the waiting period applies when a worker is immediately released to light duty at half-days, LC §4652 is the legal authority that addresses the 3-day waiting period for TD, and such statute references only TD, and does not distinguish between TTD and TPD.  Therefore, the waiting period applies to all forms of TD, including TTD and TPD benefits.  This is akin to how the 104-week rule under LC §4656(c)(2) is interpreted, which references the cut-off date of TD.  That law also does not distinguish between TTD and TPD benefits. With that said, the first three days of light duty are subject to the waiting period.  TPD benefits are not to be paid unless TPD lost time extends beyond 14 days, at which time the claims administrator must go back and pick up benefits for the first three days of partial wage-loss.

Should you have any questions about the waiting period please feel free to call upon the experts at F+B for guidance.