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PTO - SDI - Workers Compensation California

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  • PTO - SDI - Workers Compensation California

    I have been forced to use over 200 consecutive hours of accrued PTO time after filing a Workers Comp Claim (currently in Delay status and pending SDI claim as well.) The length of time is primarily due to delays of the WC process such as waiting for Authorization, scheduling DR appointments, etc. In the meantime my PTO has slipped away and I believe my employer may have misapplied the guidelines forcing me to use my PTO in this situation as described below.

    A WC claim was initiated on Jan 21, 09 and I immediately attempted to schedule a Dr. appointment (non emergency). On Jan 23, I found that the Dr must be within a Medical Providers Network (MPN) and must gain authorization from WC claim manager...and then the delays began to unfold. First the authorization, then the Dr had to accept me as a patient, then an appointment could be scheduled...which finally occurred on Feb 6 (13 days after my claim started.) Then an MRI, then a follow up appt, as of last week a Return to Modified Work certification from Dr. but still waiting for the mean time PTO is still ticking away.

    At some point in the midst of all of this, I received a Delay letter from WC for my claim. So, during my Dr. visit I also filed a claim for State Disability to cover any loss of wages that may occur. I tried to clarify the PTO policy with my HR manager and I indicated I was concerned about utilizing my PTO when this injury should be compensated via WC (which reimburses SD when a claim is finally approved). I was lead to believe that a preservation and recovery of my PTO would be resolved.

    I then received notification from SD that I was not eligible for benefits because my employer has continued my full pay--yet this was with my earned PTO that I would have desperately chosen to preserve beyond the standard WC waiting period, which I believe is 7 days. Now this requires an appeal and I still don't know what is going to happen to my Workers Comp claim and any conflict it may have with PTO use...although I have attempted to contact claims manager (she is slow to respond and currently out of office today)

    So, as it stands...I have been given no option and my employer continues to force utilization of PTO (over 200 hours now).

    I would have preferred to receive the SD or WC reduced payments to preserve my PTO beyond standard waiting periods. It is only March and I will have nothing left when this passes.

    Please help with any guidance or comments that you can offer.

  • #2
    Have you been working since your date of injury? You mention that you have used PTO but I am unsure if that is for dr visits vs. being off work completely. Please clarify.

    The waiting period in CA is 3 days.

    Your employer may legally have a policy that requires you to use PTO to supplement w/c as long as they do it for all similary situated employees who are off work for non industrial reasons.


    • #3
      Re: Work Status

      My last day of work was Jan 21st, 09. Because of WC delays I was not able to see a Dr until Feb 6th, then came an MRI, then came follow up visit that resulted in a Return to Modified Work Status. I will be attending PT but have not scheduled yet because I am waiting for Authorization from WC.

      In the meantime, I am still waiting for a response from Employer regarding responsibilities for Return to Modified work.

      Our Employee Handbook only has the following statements as taken from various sections of our handbook that appear to be related to the use of PTO and WC.

      Paid Time Off

      Paid Time Off may be taken at any time during the year, subject to supervisory approval, and may only be taken up to –40 hours, not to exceed the annual maximum accrual.

      Unpaid Time Off

      With the exception of Military Leave, employees are required to use available PTO for absences and leaves. Once all available PTO has been exhausted (up to –40 hours), an employee may request unpaid time off.

      Leaves of Absence

      With the exception of Military Leave, or as otherwise required by law, employees must use available PTO prior to taking unpaid leave.

      Workers Compensation

      XXX reserves the right, when applicable, to designate workers compensation time off as FMLA leave.

      All Paid Time Off must be taken prior to taking unpaid FMLA.

      Please help....I think my employer has administered this policy incorrectly and has now created an ineligibility mess for me on top of the problems I may have trying to recover and replenish my PTO.
      Last edited by PTOBlues; 03-02-2009, 11:37 AM.


      • #4
        Well, your employer is stating that with the exception of a military leave (and USERRA has its' own rules) that any leave of absence must exhaust all PTO before being placed on an unpaid leave.

        If your employer mandates that you use PTO before w/c or SDI kicks in, they can do so. If you were still TD and ran out of PTO, the carrier would have to pick up benefits--unless the claim was denied and then SDI would pick up benefits. Sounds like that is what happened.

        I would doubt that you were able to get your PTO balance replenished.

        You say that you would have chosen to save your PTO balance, and I understand that. However, if your employer applies this policy to all, I don't see a cause of action.

        I do agree with you though that it sucks. We don't do this. However, if this keeps w/c claims from turning into Indemnity claims, it could be saving the employer money on time loss checks. Interesting approach.


        • #5
          RE PTO Policy

          It appears to me that PTO policy is limited by the following two statements in the policy below:

          "may only be taken up to –40 hours, not to exceed the annual maximum accrual."

          "Once all available PTO has been exhausted (up to –40 hours)"

          Please comment and give me some direction if you feel this is being improperly applied.

          P.S. My comp claim is currently in delay status.


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