What to Do If Your Employer Disputes Your TTD Benefits
Workers’ compensation law in California is supposed to protect employees when they’re injured on the job, but too often, employers or their insurers push back against rightful claims. If your employer disputes your temporary total disability (TTD) benefits, you need to take action right away. California law gives you rights, and you don’t have to accept delays, denials, or reductions without a fight.
I’m Cezar J. Torrez, and at my law office in Sacramento, California, I represent workers across California who find themselves caught in battles they never asked for—particularly when it comes to their TTD benefits.
What Are TTD Benefits?
TTD benefits are a type of wage replacement under workers’ compensation law. They’re meant to support you when a work-related injury or illness keeps you from doing your job. These benefits are paid when your injury is serious enough to take you off work entirely for a period of time, but not permanently.
In California, you’re generally eligible to receive two-thirds of your average weekly wages, up to a statutory maximum. These payments are usually made every two weeks and are supposed to continue until you return to work, your doctor says you’ve reached maximum medical improvement, or 104 weeks have passed—whichever comes first.
Why Do Employers Dispute TTD Benefits?
Employers or their insurance carriers may dispute TTD benefits for a variety of reasons. Some may argue that the injury wasn’t work-related. Others might claim that you’re able to return to work, even if your treating doctor disagrees.
Sometimes, they’ll claim your medical reports don’t support disability or that you’re exaggerating symptoms. In other cases, employers might try to avoid paying by saying you refused modified work, even if the modified position wasn’t suitable.
There are many excuses. But under workers’ compensation law in California, these arguments don’t always hold up in court, especially when your rights are properly asserted.
First Steps When Benefits Are Disputed
When your TTD benefits are delayed or denied, your first step should be to understand why. You’re entitled to receive a written notice from the claims administrator explaining the reason for the dispute. Read it carefully.
If the reason is medical, it’s likely based on a report from a Qualified Medical Evaluator (QME) or your treating physician. If you haven’t seen a QME yet, you may be entitled to request one. The QME’s opinion can be crucial in determining whether your benefits will continue or be cut off.
How to Request a QME
Under California workers’ compensation law, if there’s a dispute about your condition, you can request a QME within 10 days of receiving a letter that challenges your doctor’s opinion. If you don’t request one in time, the insurance company gets to pick the doctor instead.
You’ll receive a panel with three names and must choose one to evaluate your injury. The QME will conduct a physical exam and issue a report stating whether you’re temporarily totally disabled and for how long. These findings carry legal weight, and the judge will often rely heavily on the QME’s report when resolving disputes.
When Medical Reports Conflict
It’s common for your treating physician to say you’re disabled while the QME or the insurer’s doctor claims otherwise. When that happens, a judge will eventually need to decide which opinion to follow.
At this stage, the quality of your medical evidence matters a great deal. Under workers’ compensation law, you have the right to present testimony, bring in your medical records, and even cross-examine the QME in certain cases. A lawyer can prepare every client thoroughly before any hearing and make sure their documentation supports their claim.
Actions to Take if Your Employer Disputes Your TTD Benefits
Here’s what to do if your employer disputes your TTD benefits:
Review the denial or delay letter for specific reasons given by the insurer
Consult your treating physician and get updated medical documentation
Request a Qualified Medical Evaluator within 10 days if required
Keep records of all doctor visits, prescriptions, work restrictions, and missed workdays
Make sure you attend all scheduled appointments and follow treatment plans
File for a hearing with the Workers’ Compensation Appeals Board (WCAB) if necessary
Gather witness statements if there’s a dispute about job duties or injury circumstances
Monitor communications from the claims administrator and respond promptly
Consider requesting an expedited hearing if your benefits have stopped abruptly
Seek legal representation to prepare evidence and argue your case before a judge
The Importance of an Expedited Hearing
When your benefits are stopped or denied unfairly, you don’t have to wait months for relief. California allows you to request an expedited hearing through the WCAB. These hearings are designed for urgent situations, especially when your income is on the line. A lawyer can help clients get hearings scheduled.
At the hearing, I present evidence, question witnesses, and argue why your TTD benefits should be restored. A judge will usually make a ruling shortly after the hearing, and if successful, your benefits may be ordered retroactively, covering the time you went unpaid.
Avoiding Common Mistakes That Undermine Your Claim
Some workers lose out on benefits simply because they missed appointments, failed to keep records, or didn’t understand their obligations. One of the most common mistakes is not following your doctor’s restrictions. If your employer offers modified work and you turn it down without justification, your TTD benefits could be cut off.
Another pitfall is ignoring letters from the insurance company or missing deadlines for requesting a QME. Under workers’ compensation law, you’re expected to stay engaged in your own case.
When Modified Work Is Offered
Sometimes employers offer light duty or modified work and then try to cut off TTD benefits when you refuse. But the modified work must meet very specific criteria—it must be within your doctor’s restrictions and located within a reasonable commuting distance.
If it doesn’t meet those conditions, you aren’t required to accept it, and your benefits should continue. A lawyer will help clients evaluate these offers carefully. If it’s just a pretext to force you back before you’re ready, they can challenge it in court.
What If You’re Accused of Faking Your Injury?
Some employers or insurers accuse injured workers of exaggerating or faking their injuries. These accusations are insulting and stressful, but under California law, they must be backed by credible evidence. Surveillance, social media, and conflicting medical reports are often used to support these claims.
If you’ve been accused of fraud, don’t panic. A lawyer can dig into the records, challenge improper surveillance, and clarify any misunderstandings. Workers’ compensation law allows you to defend yourself vigorously and present your own version of events.
Reach Out to My Firm Today
As the attorney at The Law Office of Cezar J. Torrez, I’ve helped workers across this state stand up to denials and get the compensation they deserve. I’m proud to serve Sacramento, California, and the surrounding areas of Oak Park, South Natomas, North Natomas, Arden-Arcade, Rosemont, Lemon Hill, Pocket, and Riverview. Call my firm today to get started with my services.