Opinion ID: 2639498
Heading Depth: 2
Heading Rank: 2

Heading: Entitlement to TDI to Replace Wages Lost Attending Medical Appointments for Treatment of a Permanent and Stationary Injury

Text: Lauher contends that as a necessary means to the end of ensuring prompt medical treatment [pursuant to section 4600], [an] employee is entitled to temporary total disability indemnity for the time lost from work while attending necessary medical treatment. As we explain, because his industrial injury had become permanent and stationary, he was no longer entitled to receive TDI. Two of the types of benefits available to the worker injured on the job are temporary disability indemnity, or TDI, and permanent disability indemnity, or PDI. Although both take the form of financial benefits, [i]t must be remembered that temporary disability indemnity and permanent disability indemnity were intended by the Legislature to serve entirely different functions. Temporary disability indemnity serves as wage replacement during the injured worker's healing period for the industrial injury. [Citation.] In contrast, permanent disability indemnity compensates for the residual handicap and/or impairment of function after maximum recovery from the effects of the industrial injury have been attained. [Citation.] Permanent disability serves to assist the injured worker in his adjustment in returning to the labor market. [Citation.] ( Maples v. Workers' Comp. Appeals Bd. (1980) 111 Cal.App.3d 827, 836, 168 Cal.Rptr. 884; see also Nickelsberg v. Workers' Comp. Appeals Bd. (1991) 54 Cal.3d 288, 294, 285 Cal.Rptr. 86, 814 P.2d 1328.) That TDI is intended as wage replacement is inferable from section 4653, which requires temporary total disability be calculated as two-thirds of the average weekly earnings during the period of such disability, consideration being given to the ability of the injured employee to compete in an open labor market. Because [temporary disability indemnity is intended primarily to substitute for the worker's lost wages, in order to maintain a steady stream of income ( J. T. Thorp, Inc. v. Workers' Comp. Appeals Bd. (1984) 153 Cal.App.3d 327, 333, 200 Cal.Rptr. 219; Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd., supra, 34 Cal.3d at p. 168, 193 Cal.Rptr. 157, 666 P.2d 14), an employer's obligation to pay TDI to an injured worker ceases when such replacement income is no longer needed. Thus, the obligation to pay TDI ends when the injured employee either returns to work ( Huston v. Workers' Comp. Appeals Bd. (1979) 95 Cal.App.3d 856, 868, 157 Cal.Rptr. 355; see also § 4651.1) or is deemed able to return to work ( Bethlehem Steel Co. v. Ind. Acc. Com. (1942) 54 Cal. App.2d 585, 586-587, 129 P.2d 737), or when the employee's medical condition achieves permanent and stationary status ( Industrial Indem. Exch. v. Ind. Acc. Com. (1949) 90 Cal.App.2d 99, 202 P.2d 850; see generally Kopitske v. Workers' Comp. Appeals Bd. (1999) 74 Cal.App.4th 623, 631, 88 Cal.Rptr.2d 216; Ritchie v. Workers' Comp. Appeals Bd. (1994) 24 Cal. App.4th 1174, 1179; 29 Cal.Rptr.2d 722 1 Hanna, Cal. Law of Employee Injuries and Workers' Compensation (rev.2d ed., Peterson et al. edits., 2002) § 7.02[1], p. 7-7 (Hanna)). By contrast, section 4650 provides that the first permanent disability payment must be made by the employer within 14 days after the date of the last payment of temporary disability indemnity. From this, we may infer the Legislature anticipates an employer has no legal obligation to pay PDI until the obligation to pay TDI has ceased. Accordingly, we held in LeBoeuf v. Workers' Comp. Appeals Bd. (1983) 34 Cal.3d 234, 193 Cal. Rptr. 547, 666 P.2d 989 that [t]he right to permanent disability compensation does not arise until the injured worker's condition becomes `permanent and stationary.' ( Id. at p. 238, fn. 2, 193 Cal.Rptr. 547, 666 P.2d 989.) A disability is considered permanent after the employee has reached maximum medical improvement or his or her condition has been stationary for a reasonable period of time. (Cal.Code Regs., tit. 8, § 10152; see Gee v. Workers' Comp. Appeals Bd. (2002) 96 Cal.App.4th 1418, 1422, fn. 3, 118 Cal.Rptr.2d 105; 1 Hanna, supra, § 8.03, pp. 8-16 to 8-17.) That Lauher's industrial injury was permanent and stationary is undisputed. Lauher's physician, Dr. Houts, so reported, and Lauher entered into a stipulation with SCIF to that effect. That Lauher had returned to work is also undisputed. Under these circumstances, we conclude he was not entitled to any further TDI payments to compensate him for wages lost due to his attending medical appointments during the workday. An injured employee cannot be temporarily and permanently disabled at the same time; thus, permanent disability payments do not begin until temporary disability payments cease. ( City of Martinez v. Workers' Comp. Appeals Bd. (2000) 85 Cal.App.4th 601, 609, 102 Cal.Rptr.2d 588; see also Ritchie v. Workers' Comp. Appeals Bd., supra, 24 Cal.App.4th at p. 1180, 29 Cal. Rptr.2d 722 [same]; New Amsterdam Cas. Co. v. Ind. Acc. Com. (1951) 108 Cal. App.2d 502, 507, 238 P.2d 1046 [same]; 1 Hanna, supra, § 7.02[1], p. 7-8 [same].) Here, Lauher had passed out of the healing period (for which TDI serves as a wage replacement) and had agreed to a stipulation compensating him for his diminished ability in the workplace due to a permanent and stationary injury. Because Lauher had begun collecting PDI, he was no longer entitled to TDI. Lauher's counterarguments are not persuasive. As did the WCJ, he first relies on section 4600, which relates generally to medical and hospital treatment for an injured worker. That section provides in pertinent part that Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatus, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve from the effects of the injury shall be provided by the employer. He contends that section 4600 should be liberally construed to include replacement of lost wages occasioned by an employee's medical treatment. Although he is correct that [t]he Legislature intended that section 4600 shall be liberally interpreted in favor of the employee's right to obtain reimbursement ( McCoy v. Industrial Acc. Com. (1966) 64 Cal.2d 82, 86, 48 Cal.Rptr. 858, 410 P.2d 362; Rodriguez v. Workers' Comp. Appeals Bd. (1994) 21 Cal.App.4th 1747, 1758, 27 Cal.Rptr.2d 93), he is incorrect that even a liberal interpretation of section 4600 will extend so far as to authorize the payment of temporary disability indemnity to replace lost wages when an injury has become permanent and stationary. Lauher apparently would have us analogize the right to reimbursement for sick and vacation leave used for seeking continuing treatment for a permanent and stationary industrial injury to the right to reimbursement for transportation costs. Citing Avalon, supra, 18 Cal.4th 1165, 77 Cal.Rptr.2d 552, 959 P.2d 1228, Hutchinson v. Workers' Comp. Appeals Bd. (1989) 209 Cal.App.3d-372, 257 Cal.Rptr. 240, and Bundock v. Herndon and Finnigan (1923) 10 I.A.C. 32, Lauher contends that because section 4600 has been construed liberally to compensate an injured worker for transportation costs associated with obtaining medical treatment, we similarly should conclude he is entitled to TDI to compensate him for wages lost while seeking treatment with Dr. Houts. We disagree because the two situations are not comparable. In Avalon, we observed that although section 4600 does not expressly refer to medical treatment transportation expenses as an aspect of medical treatment benefits, they have consistently been so regarded under the workers' compensation laws. [Citations.] ( Avalon, supra, at p. 1173, 77 Cal.Rptr.2d 552, 959 P.2d 1228.) The board's practice ... of awarding medical treatment transportation expenses, we observed, is of long standing, noting that such benefits have been paid [a]s early as 1923. ( Id. at p. 1174, 77 Cal.Rptr.2d 552, 959 P.2d 1228.) No comparable precedent exists for compensating an injured employee for his wage loss once his injury becomes permanent and stationary. Nor is Lauher's claim for TDI to offset the associated wage loss he would incur should he fail to use his sick and vacation leave during his appointments with Dr. Houts supportable as a conceptual matter. Lauher argues that [i]t necessarily [follows] that if an injured worker loses wages from attending necessary and mandated ... medical treatment, there is a resultant chilling effect on the injured worker's ability to obtain medical treatment. (Italics added.) We disagree and reiterate that although TDI is intended as a wage replacement while the injured worker is healing from his injury, once the injury becomes permanent and stationary and/or the employee returns to work, any future benefits authorized by the workers' compensation scheme are not intended as wage replacement. The worker is provided medical benefits, including reimbursement for transportation costs ( Avalon, supra, 18 Cal.4th 1165, 77 Cal.Rptr.2d 552, 959 P.2d 1228), during the healing period in order to enable him to return to productive employment and to prevent him from becoming a public charge. Once he returns to work, in addition to the wages he earns, he is also compensated in the form of PDI for the permanent diminution of his abilities caused by his industrial injuries. The system of workers' compensation is not intended to provide full and total recompense for any and all consequences of a worker's injury, but instead represents a compromise between the interests of workers and those of employers. As the Court of Appeal reasoned below, quoting Mead v. Diamond International Corporation (1974) 39 Cal.Comp.Cases 1, 4: `[I]n compensation practice day in and day out employees are totally uncompensated for wages lost while attending to medical treatment during their work day. It has long been considered that in exchange for that blanket coverage of compensation without regard to fault, the employee bears some of the burden.' (Quoting the trial referee in Mead. ) We agree. [5] Although Lauher relies on specific language in section 4600 mentioning reimbursement for transportation expenses, such language applies to a specific and discrete situation not present in this case. Thus, the second paragraph of section 4600 provides in part:  Where at the request of the employer, the employer's insurer, the administrative director, the appeals board, or a workers' compensation judge, the employee submits to examination by a physician, he or she shall be entitled to receive in addition to all other benefits herein provided all reasonable expenses of transportation, meals, and lodging incident to reporting for the examination, together with one day of temporary disability indemnity for each day of wages lost in submitting to the examination. (Italics added.) Contrary to the views of both Lauher and the WCJ below, this specific statutory benefit is not a broad obligation to pay TDI to replace an employee's wages for time away from work while pursuing medical treatment for a permanent and stationary injury. Rather, this benefit is in the nature of a medical-legal benefit, reimbursing the employee for his time when requested to submit to a medical examination to resolve a compensation claim. Lauher cannot take advantage of this benefit, both because his semi-regular treatment with Dr. Houts is not undertaken at the request of one of the enumerated entities, such as his employer or SCIF, and because his appointments with Dr. Houts are for continuing treatment, not for an examination connected with resolving an application for benefits. Finally, Lauher argues the Schedule of Administrative Penalties, Administrative Director Rule 10111.1(a)(4), which is codified in California Code of Regulations, title 8, section 10111.1, subdivision (a)(4) (hereafter rule 10111.1), indicates the Legislature's intent that section 4600 be interpreted broadly enough to authorize payment of TDI to reimburse an employee for time away from work seeking medical treatment even though the employee's injury has become permanent and stationary. The Board accepted this argument as further support for awarding TDI to reimburse Lauher for time spent out of the office seeking treatment with Dr. Houts, but, with due respect to the Board, we do not. Section 129, subdivision (a) provides in part: To make certain that injured workers, and their dependents in the event of their death, receive promptly and accurately the full measure of compensation to which they are entitled, the administrative director shall audit insurers, self-insured employers, and third-party administrators to determine if they have met their obligations under this code. In connection with this auditing procedure, section 129.5, subdivision (a) provides in pertinent part: The administrative director may assess an administrative penalty against an insurer, self-insured employer, or third-party administrator for [enumerated failings]. Finally, section 129.5, subdivision (b) requires the administrative director to promulgate regulations establishing a schedule of violations and the amount of the administrative penalty to be imposed for each type of violation. Pursuant to this legislative delegation, the Labor Department's administrative director promulgated rule 10111.1(a)(4). That provision sets forth a schedule of graduated financial penalties for failures to pay enumerated benefits. In particular, rule 10111.1(a)(4) provides: The penalty for each failure to pay mileage fees and bridge tolls when notifying the employee of a medical evaluation scheduled by the claims administrator, in accordance with Labor Code Sections 4600 through 4621; or to pay mileage fees and bridge tolls within 14 days of receiving notice of a medical evaluation scheduled by the administrative director or the appeals board; or to object or pay the injured worker for any other transportation, temporary disability, meal or lodging expense incurred to obtain medical treatment or evaluation, within 60 days of receiving a request, is: [¶] $25 for $10 or less in expense; [¶] $50 for more than $10, to $50, in expense; [¶] $75 for more than $50, to $100, in expense; [¶] $100 for more than $100 in expense. (Italics added.) Lauher contends this administrative rule, with its specific mention of temporary disability, supports his view that the Legislature intended section 4600 be interpreted to authorize the payment of TDI as a replacement for wages an employee loses while pursuing medical treatment for an industrial injury that has become permanent and stationary. No basis for such a conclusion exists. Read as a whole, rule 10111.1(a) addresses several distinct situations. For example, rule 10111.1(a)( 1 ) addresses the failure to pay the self-imposed penalty for a late indemnity payment pursuant to section 4650, subdivision (d). Rule 10111.1(a)( 2 ) addresses the failure to begin paying permanent disability indemnity in a timely fashion. Rule 10111.1(a)( 3 ) addresses the failure timely to reimburse a worker for self-procured medical treatment. At issue here is rule 10111.l(a)U). That subsection addresses the failure to pay transportation and associated costs in certain enumerated situations. Thus, it first prescribes an administrative penalty for failing to pay mileage and tolls when notifying the employee of a medical evaluation scheduled by the claims administrator. (Italics added.) Such an evaluation would typically occur during the healing period when a worker would claim entitlement to TDI, but it could also occur at other times, for example, when the employee's ability to return to work is undisputed but disagreement exists over the degree of the permanent injury, in which case further medical evaluations may be necessary. Nevertheless, although Labor Code section 4600 specifically provides for payment of transportation expenses and temporary disability when the evaluation is performed at the request of, for example, the employer or the employer's insurer, neither this clause of rule 10111.1(a)(4) nor Labor Code section 4600 authorizes TDI or wage replacement where, as here, an employee seeks medical treatment for a permanent injury. The second clause of rule 10111.1(a)(4), which sets forth the administrative penalty for failure to pay mileage and tolls within 14 days of receiving notice of a medical evaluation scheduled by the administrative director, similarly fails to mention wage replacement. Here, too, the medical evaluation referred to would typically occur during the healing period to determine the nature and extent of a worker's injury in connection with an application for benefits. In the less frequent situation of a medical evaluation conducted after an injury is permanent and stationary, the requirement that the evaluation be scheduled by the administrative director would bring the case within the specific language of Labor Code section 4600, which provides for payment of transportation expenses and TDI when submitting to an examination at the request of the administrative director. Again, there is no mention in this clause of TDI or wage replacement where the employee seeks medical treatment on his own. Finally, rule 10111.1(a)(4) prescribes a penalty for the failure ... to object or pay the injured worker for any other transportation, temporary disability, meal or lodging expense incurred to obtain medical treatment or evaluation, within 60 days of receiving a request. (Italics added.) This clause of rule 10111.1(a)(4) differs from the first two clauses in two respects. First, unlike the two previous clauses, this clause refers to both treatment and evaluation. Second, it specifically mentions temporary disability. Although the mention of treatment could refer to medical care after a worker's industrial injury becomes permanent and stationary, it seems unlikely the administrative director, exercising delegated legislative powers, intended to authorize payment of TDI to replace wages an employee loses while pursuing medical treatment for a permanent and stationary injury, absent any statutory authorization for such a benefit. Moreover, the mere mention of temporary disability in rule 10111.1(a)(4) is insufficient to create a benefit untethered to any statutory authorization. In short, rule 10111.1(a)(4) does not speak at all to the question whether an injured worker is entitled to TDI to compensate him for wages lost while seeking medical treatment once his injury has become permanent and stationary. In sum, we find no authority for the proposition that an injured worker is entitled to payment of TDI to reimburse him for wages lost while pursuing medical treatment for an industrial injury once that injury has become permanent and stationary. On the contrary, once the employee's injury is permanent and stationary and, as here, the employee returns to work, he is no longer entitled to TDI. Exercising independent review on this legal question ( Barnes v. Workers' Comp. Appeals Bd, supra, 23 Cal.4th at p. 685, 97 Cal.Rptr.2d 638, 2 P.3d 1180), we find the Board erred in ruling otherwise.