My Employee is at a medical appointment: To Pay or Not to Pay?

“My doctor’s office can only schedule appointments during my work hours.”  How many times have you heard this or one of the many other issues your injured workers have declared regarding lost time and their medical appointments? 

You may have also heard:

• I need to leave work 2 to 3 hours early to make it to my appointment.

• My physical therapy can only be scheduled during my work schedule.

• Who is going to pay me when I miss work for my doctor’s appointments?

• Shouldn’t my Workers’ Compensation pay me for ALL my lost time?

• My appointments are because of my work injury, so who is going to pay me when I miss work because of them?

• I am out of sick time, so someone needs to pay me for missing work.

Then, you are stuck in a situation where you are questioning yourself and don’t seem to know the correct answer and if you do, you don’t know why.  You’re wondering if you should have been paying the employee this whole time or why your carrier has not already addressed this issue two months into your employee’s claim.

This issue was recently disputed in the case of Skelton v. Workers’ Compensation Appeals Board  The September 5, 2019 6th District Court of Appeal’s decision covers many cases related to this issue.

Here are the important citations taken from this case and reasons why you do NOT need to compensate your employee for his or her lost time during a medical appointment:

• “In general, temporary disability indemnity is payable during the injured worker’s healing period from the injury until the worker has recovered sufficiently to return to work, or until his/her condition reaches a permanent and stationary status.” (Huston, supra, 95 Cal.App.3d at p.868)

  • HH: Recognize that in your case, your employee has already recovered sufficiently to return to work so temporary disability does not apply to him/her.

• “The purpose of temporary disability indemnity is to provide interim wage replacement assistance to an injured worker during the period of time he or she is healing and incapable of working.” (Meeks Building Center v. Workers’ Comp. Appeals Bd. (2012) 207 Cal.App.4th 219, 224, italics added (Meeks); see Department of Rehabilitation, supra, 30 Cal. 4th at p. 1291.)

  • HH: Again, note that temporary total disability applies to someone incapable of working, in your case, your employee CAN work.

• “The purpose of the award is to rehabilitate, not to indemnify…” (Department of Rehabilitation, supra, 30 Cal.4th at p. 1300.)

  • HH: This means that temporary total disability is not meant to be an alternative to employment, but rather to allow the employee time to heal from his/her work-related injury.

• “Employees with nonindustrial injuries must follow the same rule and use their sick leave when away from the office attending medical treatment.” (Id. At p. 1301.)

  • HH: Your employee’s visit to his/her primary treating physician is included under this citation and he/she is eligible to use their accrued sick time for appointments

  • Note: employees are reimbursed mileage at $.58/mi for their medical appointments. Remind your employee to submit this request to the claim’s handler.

In summary, you are not required to compensate your employee during his or her medical appointments related to his or work-related injury.  Like most things Workers’ Compensation there are a few caveats and with that also tips. 

The Caveats:

• Your employee should be compensated by your carrier if he or she is attending a Medical Legal Evaluation- AME or QME exam (Labor Code §4600 (e) (1)). This is not on you, but this is one medical appointment in which compensation should occur.

• You should follow your own company’s handbook / guidelines on sick time.  Do not stray from your normal policies just because your employee has a Workers’ Compensation claim.

• Just because you are not required to pay your employee during his or her medical appointments does not mean you can’t.  Sometimes good faith gestures (like paying your employee during appointments) can be encouraging for your employee and good for rapport during his / her Workers’ Compensation claim. Establish you own company policy and then apply it consistently to all injured employees.

  • Example: XYZ Co will pay for 1 hr./per week / month/ etc. for the first 30/ 90 / etc. days following an injury

Tips:

• Contact the adjuster and explore your options and your employee’s options.  Yes, you both have them!

• Coordinate with the claim’s adjuster to help find a physician and/or therapist with better hours.

• Check with your employee’s supervisor to see if shift changes are available to better accommodate appointment times.

Contact ESM, your carrier or in-house counsel if you want to run it by someone to ensure you are doing the right thing.