California Code of Regulations › Title 22 - Social Security › Division 1 - Employment Development Department › Subdivision 1 - Director of Employment Development › Division 1 - Unemployment and Disability Compensation › Part 2 - Disability Compensation › Chapter 2 - Disability Benefits › Article 4 - Filing, Determination and Payment of Disability Benefit Claims › Section 2706-5 - Payment of Disability Benefits Pending Appeal by Claimant

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Scope. This section interprets whether
						  disability benefit payments continue in situations where the department
						  determines a claimant is initially eligible for benefits, but subsequently
						  determines the claimant is ineligible or disqualified for benefits for further
						  days, and the claimant files an appeal from the subsequent
						  determination.
(b) General. If the
						  department finally determines that a claimant is initially eligible for
						  disability benefits, subsequently determines that the claimant is ineligible,
						  disqualified or subject to a reduction of further benefits, and the claimant
						  files a timely appeal from the subsequent determination, within 30 days
						  pursuant to Unemployment Insurance Code Section
						  2707.2,
						  and a written election with the department on a prescribed form ("Notice of
						  Right to Receive Benefits Pending Appeal" DE Form 63155CC Rev.3: 6/86) to have
						  benefits continued and files continued claims pending disposition of the
						  appeal, the department shall continue to pay benefits until the appeal has been
						  resolved by the decision of an administrative law judge, except that benefit
						  payments shall cease if the appeal is dismissed or if a criminal complaint for
						  fraud is filed against the claimant under Section
						  2101 of the code (see subdivision
						  (c) of Section
						  1263 of the code and Section
						  2602 of the code).
(c) Claimant Finally Determined Initially
						  Eligible. The department has finally determined that a claimant is initially
						  eligible for disability benefits, if, after the filing of a first claim, the
						  department determines that all of the following conditions exist:
(1) The claimant is disabled.
(2) The claimant has received one or more
						  disability benefits payments.
(3)
						  The claimant has filed a claim in accordance with authorized regulations, which
						  appear in Title 22, California Code of Regulations, Division 1, Part 2, Chapter
						  2, Article 4.
(4) The claimant has
						  a monetarily valid claim.
(5) The
						  claimant has not exhausted the maximum benefit amount for the disability
						  benefit period of the claim.
(6)
						  The claimant is otherwise eligible.
(7) The initial determination is not subject
						  to reconsideration under subdivision (a) of Section
						  2707.5 of the code.
(8) The initial benefit amount has not been
						  recomputed under subdivision (b) of Section
						  2707.5 and determined to be
						  monetarily invalid.
(9) The
						  department has not determined that the claimant is ineligible for benefits
						  based on a new set of facts or conditions unless the new determination of
						  ineligibility meets all the other conditions of this subdivision.
EXAMPLE 1. Claim Filing. Claimant A files a first
							 claim for disability benefits with a postmark date of September 20. A claims
							 disability beginning June 30. The department determines A does not have good
							 cause for late filing, and under code Section
							 2706.1 gives the claim an
							 effective date of August 3. A is paid benefits based on that date. A appeals
							 the department's denial of benefits for the days from June 30 through August 2.
							 The department has not determined that A was initially eligible for those days.
							 Therefore, pending decision on the appeal, A is not entitled to receive payment
							 for any day prior to August 3. The days after August 2 are not affected by the
							 back dating issue raised by A's appeal, and A is entitled to continued payment
							 of benefits for days after August 2.
EXAMPLE 2. Claim Filing. The department receives a
							 first claim in which Claimant B states that the disability began August 10, on
							 which date B was examined by a doctor. The doctor's certificate does not
							 support a disability. B appeals the department's determination of ineligibility
							 under Section
							 2708 of the code. B does not have
							 the right to receive benefits pending decision on the appeal because B was not
							 finally determined initially eligible for benefits.
EXAMPLE 3. Claim Filing. The department determines
							 Claimant C is initially eligible for disability benefits. C receives benefits
							 for 28 days, but does not return the continued claim for the next period of
							 payment until after the 20-day filing period. The department determines that C
							 does not have good cause for late filing and holds C ineligible because C's
							 claim was not filed timely in accordance with Section
							 2706-3 of these regulations. C
							 appeals. Since the department has finally determined that C was initially
							 eligible, C is entitled to receive benefits for the disallowed period pending
							 decision on the appeal.
EXAMPLE 4. Reconsideration of Determination. Claimant
							 D claims disability for 56 days because of hernia surgery. There is no
							 indication on the claim that the hernia was caused by D's work. The department
							 pays D benefits for 35 days and then discovers that D is being paid temporary
							 workers' compensation indemnity for the same days of disability at the same
							 weekly rate. The department reconsiders the determination and determines that D
							 is ineligible under Section
							 2629
							 of the code for the period of the disability because of duplication of
							 benefits. D appeals. Since under subdivision (a) of Section
							 2707.5 of the code the department
							 may reconsider any disability benefit determination prior to the filing of an
							 appeal, the initial determination was not final, and D is not entitled to
							 receive disability benefits pending decision on the appeal.
EXAMPLE 5. Reconsideration of Computation. Claimant E
							 files for and is paid disability benefits. While E is in continued claim
							 status, the department recomputes E's claim and determines under Section
							 2652 of the code that E does not
							 have sufficient qualifying wages in the disability base period to have a valid
							 claim. E appeals. Since under subdivision (b) of Section
							 2707.5 the department may
							 recompute a claim within one year from the beginning date of a disability
							 benefit period, the initial computation was not final, and E is not entitled to
							 receive disability benefits pending decision on the
							 appeal.