The "Rock"

[Hot Topic]

What is the name of your state (only U.S. law)? California

On June 13, I suffered appendicitis like pain in my right lower abdomen. I went to the hospital the next day. They took a number of tests, and the doctor told me my kidneys were in bad shape. They discovered three kidney stones, the largest of which was 7mm. There was talk of admitting me, but they ended up letting me go.

I was admitted to the hospital Saturday, June 18, and part of the 19th. I was put on an IV, and they took all kinds of tests.

EDD questioned the time I was out, indicating in their letter that I might be required to supply a sign-off from the doctor. When they called today, they didn't mentioned needing a doctor's confirmation of time in the hospital. They told me I'd hear in ten days if I was still eligible for unemployment benefits.

I need to talk to another hospital which handles people without insurance and get a reference for a suitable doctor to remove the kidney stones, then the operation will have to take place.

How is this going to effect my benefits with EDD? Are they likely to postpone them while they question the time that I won't be available to job hunt during the operation? I'm now worried about being sick because reporting it may cause delays and investigations. I have plenty of proof that I was at the hospital.

 

[justalayman]

If you are not able to work, you are not eligible for benefits. That means if you are not able to walk out the door now and go to work, you are not eligible for benefits.

If you were in the hospital for a period of time, you were not able to work so you would not be eligible for benefits during the time you were in that hospital.

 

[Hot Topic]

A check of the handbook reveals that a seventh of a day will be subtracted from the benefits for each day a person is unable to work.

Thanks. Just a bit cranky from the experience.

 

[justalayman]

did you mean a seventh of a week?


here is a bit more into this:

FAQ - Eligibility
what if I am sick or injured and cannot work?

FAQ - Eligibility

and then the explanation of able and available:

Able and Available - Table of Contents

statutory provisions section #2::

Able and Available AA 235 - Health or Physical Condition Provisions

and you somewhere in there is speaks to California state disability insurance.

 

[commentator]

My greatest of sympathies to you. Kidney stones rule,the pain is like no other, including childbirth and heart surgery!

Let me be sure to point out that the weeks or partial weeks that you do not get your weekly benefits due to not being able and available, those benefits are not lost, but will be stay in your claim, dded on at the end of the claim. A tiny bright spot in the darkness.

Try very hard to be in contact with a live human who is working with you through this, there are a few of them still left in the EDD system, "EDD Tech support division" is a good number to call, a good place to find advice support. But let them guide you through this. Assume nothing through your reading the material, get it from a real person. The regulations about availability contain a few twists and turns and may sometimes come out more in your favor than the surface information would indicate.

 

[Zigner]

Have you checked in to disability benefits for that period of time? If you are unable to work due to medical reasons, you may be eligible for disability benefits.

 

[Hot Topic]

did you mean a seventh of a week?


here is a bit more into this:

FAQ - Eligibility
what if I am sick or injured and cannot work?

FAQ - Eligibility

and then the explanation of able and available:

Able and Available - Table of Contents

statutory provisions section #2::

Able and Available AA 235 - Health or Physical Condition Provisions

and you somewhere in there is speaks to California state disability insurance.

It's a seventh of a day, as confirmed by the EDD handbook, page 14.

 

[justalayman]

It's a seventh of a day, as confirmed by the EDD handbook, page 14.

well, the links I gave you say it is one seventh of a week, or one day.

here is the actual code section:

1253.5. Notwithstanding the provisions of subdivision (c) of
Section 1253, if an individual is, in all other respects, eligible
for benefits under this part, and such individual becomes unable to
work due to a physical or mental illness or injury for one or more
days during such week, he shall be paid unemployment compensation
benefits at the rate of one-seventh the weekly benefit amount payable
for that week for each day which he is available for work and able
to work. The amount of benefits payable, if not a multiple of one
dollar ($1), shall be computed to the next higher multiple of one
dollar ($1). The individual shall not be entitled to unemployment
compensation benefits for any day during such week which he is unable
to work due to such physical or mental illness or injury.

that simply says that if you are sick 3 days and able to work 4, you get paid 4/7ths of your regular weekly benefit.


and here is an excerpt from the handbook they put online http://www.edd.ca.gov/pdf_pub_ctr/de1275a.pdf :

page 15

1. Were you too sick or injured to work? - You must be well enough
to work every day of the week to receive full benefits. If you are
unable to work because of illness or injury, you must report the
number of days that you could not work. Unemployment benefits
are paid according to the number of days you are able to work.
Your benefits are reduced one-seventh for each day that you cannot
work.

 

[Betty]

I agree with Zigner that you might be eligible for disability benefits while you are disabled & unable to work/look for work. Ca. has a state disability income plan - EDD oversees.

 

[commentator]

I reiterate, talk to them, talk to them.

 

[Hot Topic]

Agreed, commentator, especially since the arbitrator in Orange County worded her response to the information that I supplied as letting me know in ten days if I'm "still eligible" for benefits. She could have asked for proof that I went to the hospital (I have a letter detailing the hospital's findings and one from the hospital thanking me for using their services. I'm also going to get a questionnaire about same).

 

[commentator]

Most of the information seeking vehicles done by ajudicators are very cut and dried. They've been pre-prepared so that the arbitrator/ajudicator doesn't have much personal input. Thus they can be done by less talented people

A doctor's statement releasing you to seek work might be what they ask for because it is the only thing the form says they will accept, not a letter from a hospital facility proving you were in the hospital. Was it signed by a doctor? Does it release you to return to work at full capability?

Or they may just from the doctor's statement you submit you may get a decision that now you are still fully eligible based on what you have told them. Or they may decide you are eligible for part of a week's pay for that particular week, and on-going from that point.

But whatever interpretation we put on what their handbook says here, they have a standard way of looking at these situations and thus will it be done, and they've looked at hundreds of similar situations in the last month or so. That's why I don't want to venture anything except that someone in their system would be able to answer questions if you can just find them, and I'm sure there are at least some nice people who do work there.

It's hard to tell from the outside. But in the meantime, do keep making weekly cerifications now for these weeks while you are not in the hospital or actually having surgery.

The arbitrators/ajudicators are not always the best people to talk to regarding what is and isn't, or what may be, as they are supposed to be on an unbiased "fact-finding" mission when they talk to you, all business, no generalities.

 

[Hot Topic]

If by certification, you mean a claim form, I won't get one until it's decided that I'm eligible for continued benefits. It's information I'll have to keep track of myself.

 

[commentator]

Are you fully released by the doctor, out of the hospital, ready to go back to work? Then call someone immediately, and ask, make very totally sure if you need to be doing certifications and submitting them as you are waiting for your decision on whether you were eligible for those few days while you were in the hospital...do you need to reopen your claim?

Anyhow, be on record as letting them know you need to be making these certifications for these these weeks that may pass, so that you can be paid for them. You are now out of the hospital, released to work again and fully eligible, even though you're having a decision made. That you're going to need surgery in the future does not mean you're ineligible right now.

They may in your state let you keep up with these weeks for yourself then turn it all in later for backpay, but that's not usually the way the system works. If you stop filing for weeks, even while you are in a pending decision status, it will stop your claim and you have to reopen it to get back into the swing of weekly certifications.