Employer Isn't Required to Pay Workers' Comp Claimant for Time Off to See Doctor

A workers' compensation claimant was not entitled to receive temporary disability indemnity (TDI) payments for time lost from work to attend medical appointments following her return to work, a California appeals court ruled, affirming a decision of the California Workers' Compensation Appeals Board (WCAB).

TDI only provides wage replacement to an injured worker when he or she is healing and incapable of working, the court said.

The claimant injured her ankle in July 2012 and her shoulder in July 2014 while working for the California Department of Motor Vehicles. She continued working after each injury and was placed on modified work in 2017. She had to miss work to attend doctor appointments because her work hours were not flexible and she could not visit her doctors on weekends. She initially used her sick and vacation leave, but eventually her pay was docked for missed work time.

The claimant sought TDI for all the work time she missed for doctor visits after she exhausted her sick and vacation leave. She contended that denying reimbursement for lost time could prevent her from receiving medical treatment, contrary to the intent of the workers' compensation system. A workers' compensation judge ruled that she was not entitled to the reimbursement, and the WCAB agreed. The claimant appealed.

General Principles Regarding TDI

A "temporary disability" is defined as an incapacity to work that is reasonably expected to be cured or materially improved with proper medical treatment. In general, TDI is payable during the injured worker's healing period from the time of the injury until the worker has recovered sufficiently to return to work or until the condition renders the claimant permanently disabled.

The appeals court noted that California's workers' compensation system isn't meant to cover all expenses and losses. Rather, it is "limited to assuring the injured worker subsistence while he or she is unable to work and to effectuate his or her speedy rehabilitation and reentry into the labor market," the court said.

[SHRM members-only HR Q&A: What penalties are imposed on a California employer who fails to provide workers' compensation coverage?]

The WCAB has reasoned that an employee, by returning to work full time, no longer suffers from a wage loss coupled with an incapacity to work. Rather, the employee has restored his or her earning capacity, which eliminates the income replacement rationale underlying TDI.

The claimant in this case admitted that she returned to work full time after her injuries, the court said. She subsequently took time off from work because she could not schedule medical treatment during nonwork hours.

Neither her time off from work nor her wage loss were due to an incapacity to work, the court said. Rather, these circumstances were due to scheduling issues and her employer's leave policy. Thus, the court held she was not entitled to TDI for that time off or wage loss and affirmed the WCAB decision.

Skelton v. Workers' Compensation Appeals Board, Calif. Ct. App., No. H046249 (Sept. 5, 2019).

Professional Pointer: This case is different from a situation where the employer or the employer's insurer requests that a worker submit to a medical examination to resolve a compensation claim. In that case, the employee is entitled to be reimbursed for any wages lost due to the doctor visit.

Joanne Deschenaux, J.D. is a freelance writer in Annapolis, Md.