A Temporary-Disability Overpayment Claim: Show Why the Proposed Credit Matters

A letter saying you received too much temporary disability can leave you wondering how much of your next benefit payment will disappear. Start by separating the alleged overpayment from the credit the insurer wants against another benefit. Evans v. San Mateo County Transit District shows why the cause of the excess payments and the effect of the proposed reduction can both matter when a judge decides whether to allow that credit.

Ask for the payment calculation and the proposed offset schedule. Then compare them with the medical-report timeline and the award the insurer wants to reduce. This gives you a way to identify an incorrect amount, a disputed date or a substantial interruption in benefits—and to explain the consequences with records.

Establish the disputed dates and the cause

Start with the payment ledger and the medical report said to have ended entitlement to temporary disability. Distinguish the doctor’s examination date, the stated permanent-and-stationary date (when the doctor considers the condition medically stable), the report date and when the relevant people received it. Those dates may differ. An insurer’s later receipt of a report can explain why payments continued without establishing that the worker caused the problem.

Identify whether the claimed excess arose from report delay, a rate calculation, overlapping benefits or some other reason. Do not use an example about delayed reporting as a universal rule for every kind of overpayment. Preserve messages showing what the worker and claims administrator knew while payments were being issued.

Find the proposed destination of the credit

A claimed dollar amount is only half the issue. Is the carrier asking to reduce permanent-disability payments? Does its calculation allocate the same payment twice? Is the requested offset a large proportion of the award? Compare the proposal against the actual benefit schedule and any prior payment allocations.

The disputed-credit petition rule, 8 California Code of Regulations section 10555, calls for identification of payments, the benefits against which credit is sought and the amount claimed. Use those categories to evaluate whether the proposal is understandable. A missing explanation should prompt a specific request for clarification; it is not a basis to invent the carrier’s theory.

Explain consequences with records

In Evans v. San Mateo County Transit District, No. ADJ13182924 (WCAB Jan. 3, 2025), a report delay led to about five and a half weeks of claimed temporary-disability overpayment. The employer sought a $5,720.14 credit, close to one third of the permanent-disability award. The parties agreed that report delay was the sole cause, and the record contained no evidence that the worker caused or contributed to the overpayment. The judge compared the loss to the employer with the burden on the worker; the Board upheld the denial of credit.

The worker also went without timely information that the doctor considered him able to return to work. That helped explain why the delay affected him as well as the employer. In your own records, connect the payment history to the proposed consequence: Which scheduled benefit would be reduced, by how much and for how long? Evans.

For example, withholding several upcoming installments may affect a household differently from a small adjustment spread over remaining payments. Keep the actual proposed schedule, necessary expenses and evidence showing what you knew when the payments arrived. These facts help explain the effect of the credit; the judge must still evaluate the applicable law and the whole record.

In applying Maples v. Workers’ Comp. Appeals Bd., 111 Cal.App.3d 827, 836–838 (1980), the Board considered the size of a credit, significant interruption of the second benefit and good-faith receipt of the payments. Use the proposed schedule to show the amount and interruption, and the contemporaneous communications to explain what you knew. Evans.

Keep the dispute focused

Separate the amount allegedly overpaid from the request for credit and from any separate medical or permanent-disability dispute. In Evans, apportionment was also contested, but the credit analysis depended on its own record and equities. Winning or losing one issue did not supply proof for the other.

Bring the award, payment ledger, medical-report timeline, proposed offset and relevant correspondence together for review. Keep the original records and explain any discrepancies. Our case analysis of Evans explains the judge’s reasoning and the separate medical-apportionment dispute.

Read the primary decision: Evans v. San Mateo County Transit District—WCAB panel decision (PDF).