How Do Social Security Disability And Workers’ Compensation Benefits Work Together?

As a practitioner in the workers’ compensation field for almost 25 years, I have represented thousands of injured workers. A large percentage of those injured workers are also entitled to Social Security Disability (SSD) benefits which are benefits based upon disability and not age. My Partner, Barbara Tilker has practiced in the area of social security disability for over 35 years and she has provided me with important information regarding SSD. But what exactly are these benefits and who is entitled to them? In order to qualify you must have the requisite work credits. The number of work credits you need depends on your age. Generally speaking you need at least five years of work (20 credits). You will often hear people say you need to have worked five of the last ten years. You also must have substantial gainful employment – having minimum earnings of $1070 per month. The maximum SSD rates are based on individual income and FICA tax paid.  They are running around $2500 per person max and $4000+ if there is a dependent family

Filing for SSD can be a lengthy process. Every case is different, and some are processed faster than others. However, we’ve found that it takes the Social Security Administration (SSA) between four (4) to six (6) months to make an initial decision. If that decision is unfavorable (and about 70% of initial decisions are denials), it can take between eight (8) to twelve (12) months to have a hearing before an Administrative Law Judge (ALJ) scheduled. A year to a year-and-a-half wait is not uncommon.

Due to the lengthy process, you should file for SSD as soon as possible. You should file as soon as you know that you will be out of work for at least twelve (12) straight months OR if your condition is expected to result in death. You should talk to y our doctor to see how long he/she expects you to be unable to work. Your doctor’s support is incredibly important to your case so talk to him/her before making the decision to apply.

In order to make sure that you get the maximum amount of benefits you’re entitled to, your application must be filed within 17 full months from the time that you become disabled and unable to work. If you’ve already been out of work for a year or more, consider putting in an application right away to prevent any loss of benefits you would otherwise be entitled to. 

In New York, Social Security disability benefits are offset by workers’ compensation. There is an 80% ceiling on concurrent WC and SSD translates as follows:  A disabled individual (including dependent family benefits) cannot exceed 80% of highest gross income of the last five years worked, together with workers’ compensation benefit. This is computed on a monthly basis. If exceeded, social security is offset. Many of my clients have multiple concurrent medical issues – they may have a back injury as a result a work related accident but they may also have diabetes or a prior leg condition. Social Security takes all of these medical conditions into account to determine whether or not you are entitled to benefits. Your entitlement to SSD is based upon your overall medical condition and not just your workers’ compensation claim. While no one plans on getting injured or disabled, you should plan on knowing what you are entitled to before the unthinkable occurs.

Prior results do not guarantee outcomes.

Workers’ Compensation May Cover Weight Loss Treatment, Surgery

Gastric bypass is one type of weight loss surgery

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

Obesity is a disease that affects Americans in many ways.

Workers’ compensation is affected by obesity as well. A work injury or disease, coupled with chronic obesity, frequently becomes much more difficult to deal with. The usual methods of treatment may not be possible for an injured worker living with chronic obesity. 

Thomas A. Robinson, a noted expert on workers’ compensation, recently posted a great discussion on obesity treatment. The well-written article discusses how various state workers’ compensation systems deal with these problems. The short answer is some states award benefits for treating obesity as part of the work injury, and some don’t. Nebraska and Iowa have cases denying gastric bypass surgery based on factual findings that it was not necessary to treat the work injury, but leaving to door open with more proof of medical necessity. 

Our firm has had at least one case where gastric bypass surgery was paid voluntarily when it was apparent the surgery was necessary to enable proper treatment of a serious work injury. A workers’ compensation trial award was entered in early January awarding gastric bypass surgery as necessary to reduce weight so a back surgery could be performed safely. This award reinforces that with proof of medical necessity to treat a work injury, weight loss treatment and surgery may be covered by workers’ compensation in Nebraska.

Prior results do not guarantee outcomes.

FEMA Extends Deadline For Hurricane Sandy-Related Claims To April 28

I recently had the pleasure of attending the New Hamilton Beach Civic Association, where I was scheduled to discuss Workers’ Compensation benefits, Social Security Disability, and give updates on Superstorm Sandy. While waiting to speak, I was privileged to hear a number of public officials speak who attended this meeting, including Congressman Hakeem Jeffries, State Senator Joe Addabbo, State Assemblyman Phillip Goldfeder and New York City Councilman Eric Ulrich.  

The meeting, run by Civic Association President Roger Gendron, made it extremely clear that those living in the community and serving the community are the best resources when it comes to information regarding the aftermath of the Storm. Everyone involved is to be commended for not only their actions, but the dissemination of valuable information to those still trying to pick up the pieces. While it is clear that much remains to be done, it is also clear that there are many dedicated citizens and officials who want to offer assistance. 

For those still suffering from the after effects of Superstorm Sandy, I will provide a little background information on FEMA’s flood program. Since standard homeowners’ insurance does not cover flooding, in 1968 Congress created the National Flood Insurance Program (NFIP), overseen by the Federal Emergency Management Agency (FEMA), to help homeowners. The NFIP offers flood insurance to homeowners, renters, and business owners if their community participates in the program. Participating communities agree to adopt and enforce ordinances that meet or exceed FEMA requirements to reduce the risk of flooding. Many of you who reside in South Queens were severely affected. If you have sustained damage, you need to file a claim with FEMA, as they have extended their filing deadline again, this time to April 28, 2014. Therefore, make sure you file a proof of loss before that time.     

Many homeowners who filed were not satisfied with their FEMA experience. Part of the problem was the sheer volume of claims. If you do not believe you were paid fairly and timely, or were unreasonably denied, you need to act now by filing a claim against your insurance carrier. There is a one-year statute of limitations to file against the insurance carrier when it denied payment or disbursed a final check.  The time to act is now. 

It is almost a year and a half since this monster storm caused unprecedented destruction and death.  There are residents still displaced and those still waiting for much-needed relief. Contact your public officials and your local boards and associations for assistance. Get proper legal advice. Speak to those who have been through similar disasters. Know what to do in a future emergency. While we all pray that Superstorm Sandy was a once-in-a-lifetime storm, we also need to be ready in case of a repeat scenario. While no amount of preparation can protect us against certain catastrophes, it is a comfort when we know what to do in the face of these obstacles.   

As we enter one of the holiest seasons for both Christians and Jews, I would like to quote Rabbi Mark Geller who said “we note that it is the season of renewal. Like babies, springtime is God’s inescapable message that life should go on.”  

Catherine M. Stanton is a senior partner in the law firm of Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP. She focuses on the area of Workers’ Compensation, having helped thousands of injured workers navigate a highly complex system and obtain all the benefits to which they were entitled. Ms. Stanton has been honored as a New York Super Lawyer, is the past president of the New York Workers’ Compensation Bar Association, the immediate past president of the Workers’ Injury Law and Advocacy Group, and is an officer in several organizations dedicated to injured workers and their families. She can be reached at 800.692.3717.

Prior results do not guarantee outcomes.

Not Expanding Medicaid: Deadly Consequences

Today’s post comes from guest author Charlie Domer, from The Domer Law Firm.

Please take a moment to ready this story out of Pennsylvania: Study: Many Will Die if Medicaid is Not Expanded.   As part of the Affordable Care Act (“Obamacare”), an expansion of Medicaid was intended.  Medicaid essentially is the joint federal-state program to provide health insurance to low income individuals and families.   The federal government strongly encouraged this expansion by the states, by offering to pay for that expansion for many years.   Unfortunately, the US Supreme Court–in upholding the constitutionality of the bulk of Obamacare–did strike down this Medicaid expansion.  The Supreme Court decision left it up to the state’s themselves to decide whether to expand Medicaid for their residents or not.

In many Republican-led states, the decision was made to not expand Medicaid.  As seen in this article, Pennsylvania was a state that declined to expand.  Wisconsin, with Republican Governor Scott Walker, also decided not to provide this expanded Medicaid coverage to the the state’s low income individiduals.  (Check out the story here and here.) 

Now comes news that failure to expand Medicaid may actually result in increased deaths among the affected population.  The failure to have this expanded coverage, according to the study examining Pennsylvanis, will result in thousands of deaths due to individuals foregoing necessary medication, medical treatment, and preventative screening. Additionally, the expansion failure will result in “catastrophic medical expenses and tens of thousands of cases of untreated depression, diabetes and missed screening tests.”   This is a truly scary scenario–and an avoidable one.

In Wisconsin, Gov. Walker is suggesting that these individuals can now obtain health insurance throught the federal-run exchanges.  The real issue is whether these low-income individuals can truly afford the premiums and whether they actually qualify for the federal subsidies.  These lower-income individuals were the one supposed to be covered by Medicaid expansion–not by the exchanges.    Based on the Pennsylvania study, if these individuals are ineligible for Medicaid and cannot secure health insurance elsewhere, dire health consequences (or even death) loom as possibilities.

Prior results do not guarantee outcomes.

Testosterone Drug Use: Watch Out for Dangerous Side Effects

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

Beware of testosterone drugs. 

Drugs to raise testosterone levels have very dangerous side effects. The drugs come in the form of prescription drugs, patches, creams, gels, deodorant or spray. These heavily promoted drugs have been linked to increased heart attacks, strokes, pulmonary embolism, blood clots, and death. For instance, men older than 65 taking such drugs are two times more likely to have a heart attack during the first 90 days of use than those who don’t take the drug. That is a sobering, if not outright scary, situation. Men younger than 65 with histories of heart disease are also twice as likely to have heart attacks during the first 90 days of use. 

Human nature and the desire to be healthy, strong and youthful appearing will draw many men to these drugs, particularly with the heavy advertising on TV, radio, online and in traditional print that the public is exposed to currently. The lure of a Fountain of Youth is hard to resist but also very dangerous. 

Sadly, there have been many other instances of new drugs that have been heavily promoted that have had dangerous side effects. The law has provided damages for the now millions of people who have been damaged by various dangerous drugs with serious side effects. I recommend looking into your legal rights if you or a loved one suffered a heart attack, stroke, pulmonary embolism, blood clots or death while taking testosterone replacement drugs or after taking such drugs. Feel free to contact me, and I can arrange for a consultation with lawyers with special knowledge, experience and good ethics to help you or your family member.

Prior results do not guarantee outcomes.

Confidentiality Agreements and Dennis Rodman

Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.

Many defendants, particularly celebrities, often try to keep settlement agreements private and they seek confidentiality as part of the bargain. Dennis Rodman, former Chicago Bulls basketball player and current friend of the North Korea dictator Kim Jong-un, kicked a photographer in 1997 during a basketball game and the photographer sued for personal injuries. Eventually a $200,000.00 settlement was reached and, as part of the deal, the photographer agreed to keep the settlement confidential.

In steps the Internal Revenue Service. The IRS asserted that since no specific dollar amount had been allocated for the confidentiality portion of the agreement, 60% of the amount should be taxed. The photographer appealed and argued that the tax value was de minimis, if any, but he lost his appeal.

So, dear friends, the next time a confidentiality clause is suggested by the defendant as a necessary part of the agreement, remember Dennis Rodman. Remember the photographer who had to pay taxes on $80,000.00. Remember that you should always try to avoid confidentiality agreements.  However, if you do agree, be sure to designate a specific dollar amount for that portion of the settlement and expect this amount to be taxable. For more information, see Amos v. Commissioner of IRS, T.C.M. of 2003–320. US Tax Court. 

Prior results do not guarantee outcomes.

Mileage Reimbursement Set at 56 Cents per Mile for 2014

Today’s post comes from guest author Brody Ockander, from Rehm, Bennett & Moore.

Getting reimbursed for mileage and travel expenses is often part of the medical process in a workers’ compensation claim. However, it’s essential to keep detailed receipts and have a plan for submitting those expenses in a timely manner.

The federal government has set the 2014 mileage reimbursement rate to 56 cents per mile. This rate was effective Jan. 1, 2014. This is a decrease from 56.5 cents per mile last year, but the price of gasoline is also slightly cheaper.

Generally speaking, the federal rate changes annually. However, when gas prices went soaring in 2008, a mid-year increase went into effect.

As a reminder from a blog post that firm partner Todd Bennett wrote in 2011, injured workers can be reimbursed for activities such as “travel to seek medical treatment, pick up medications, or while participating in a vocational rehabilitation plan.”

The best way to do this is to work with your attorney and legal assistant to keep track of all mileage. This can include appointments for Independent Medical Exams (IME), too. Then your attorney can help you get reimbursed. 

It is often essential to save receipts and keep a record for yourself of your doctor’s visits and other reimbursable trips, including physical therapy and trips to pick up medication. Providing that log to your attorney and saving receipts incurred from specific doctor visits and other reimbursable trips creates a “narrative” that makes it easier to justify those expenses.

Because money is always tight for injured workers, contact an experienced workers’ compensation attorney if you have questions about a specific situation.

Prior results do not guarantee outcomes.

College Athletes Unionized? They Must Be Employees First

Northwestern University Quarterback Kain Colter

Today’s post comes from guest author Charlie Domer, from The Domer Law Firm.

Northwestern University quarterback Kain Colter announced plans to form the first labor union for college athletes. The College Athletes Players Association, in concert with the Steel Workers (who have agreed to pay the legal bills for the effort) will try to unionize college athletes. The big question: whether college athletes can be considered employees.  If certified by the National Labor Relations Board, the union will be called the College Athletes Players Association. In order for the association to be recognized as a union, the players have to prove they are employees and that the NCAA or each school is its employer. Most experts indicate this is an uphill legal fight.

Worker’s compensation lawyers see everything through the prism of worker’s compensation law. Most State statutory schemes presume that a worker is an employee, except where the employee may be considered a volunteer or an independent contractor. Where the top five power conferences ACC, SEC, Pac-12, Big Ten, Big Twelve generate nearly $10 billion annually, it is hard to claim players are “volunteers” in this system.

Some college athletes who have been seriously injured have filed worker’s compensation claims. Those claims have all been dismissed on the notion that the injured player was not a “employee” and thus not entitled to benefits. (see our prior blog posts on this issue

Athletes who successfully use their college careers as a platform for a later career in professional sports are not the norm. In many situations, college players are injured, precluding any further athletic career for pay. There is no compensation awarded for this lost potential career. Furthermore, if an athlete is injured while on campus, once they leave school or graduate, the school generally does not covered future medical costs for that injury.  

Worker’s compensation lawyers will be monitoring the case with interest.

Prior results do not guarantee outcomes.