Author Archives: Barbara Tilker

The SMART Act and Workers’ Compensation

Today’s post comes from guest author Leila A. Early from The Jernigan Law Firm.

            Medicare should not pay medical bills that are the primary responsibility of a third party.  When they do, they want to be reimbursed, and all parties understand that concept, but the problem is the lengthy delays and lack of due process. The SMART Act, which was signed into law by President Obama on January 10, 2013, amends and reforms the Medicare Secondary Payer Act to improve the reimbursement process. It is located in Title II of H.R. 1845 and entitled “Strengthening Medicare Secondary Payer Rules.”

            Section 201 requires CMS to maintain a secure web portal with access to claims and reimbursement information. Payments for care made by CMS must be loaded onto the portal within 15 days of the payment being made. The portal must also provide supplier or provider names, diagnosis codes, dates or service, and conditional payment amounts. Moreover, the portal must accurately identify that a claim or payment is related to a potential settlement, judgment or award. After several steps, the parties may download a final conditional payment amount from the website. If there is a dispute over the conditional payment amount, CMS must respond/resolve the dispute within 11 days or the proposed resolution by the claimant/applicable plan will be deemed accepted. In terms of appeals, CMS must draft regulations that give applicable insurance plans limited appeal rights to challenge final conditional payment amounts. This process will go into effect around April of 2013. 

            Section 202 states that by November 15th of each year (beginning in 2014), CMS is required to calculate and publish a threshold for liability claims. If an amount owed is under that threshold amount, CMS is barred from seeking repayment.  Section 205 states the statute of limitations for conditional payment recovery by CMS is three years after the receipt of notice of a settlement, judgment, award, or other payment made.

            The SMART Act applies to workers’ compensation cases, so it is important to understand the law and how it will be applied in the future. Read it and follow its implementation closely.

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Denied Or Partially Denied For Social Security Disability? A Special Ruling Means You May Be Entitled To A Re-Hearing

If you filed for Social Security disability and appeared at a hearing in the Queens Office of Disability Adjudication and Review before any of the following Administrative Law Judges – Michael D. Cofresi, Seymour Fier, Marilyn P. Hoppenfeld, David Z. Nisnewitz, and Hazel C. Strauss, you may soon be entitled to a new hearing before a different Administrative Law Judge. You may soon receive, or have already received, a “Notice of Proposed Class Action Settlement and Fairness Hearing” from Social Security. 

This notice concerns a lawsuit, Padro, et al. v. Astrue, brought against the Social Security Administration by the law firm of Gibson, Dunn, & Crutcher and the Empire Justice Center. The lawsuit was filed to address allegations of “general bias” against disability claimants by the five judges named above. In settling the lawsuit, the Social Security Administration is not admitting any wrongdoing by any of the judges. 

Under the terms of the proposed settlement, any individual who received an unfavorable or partially favorable decision from one of these judges dated after January 1, 2008, is eligible to have a new hearing. The hearing will be conducted by a different judge than the judge who issued their first decision. However, if an individual filed a lawsuit in District Court and the judge’s decision was upheld by the court, that individual will not be entitled to a new hearing in front of a different judge.

The proposed settlement has not been finalized and the terms are subject to change. There is a hearing scheduled to finalize the settlement on July 24, 2013. Once the settlement is finalized, all affected individuals will receive another notice from Social Security advising them of their right to a new hearing. If you receive such a notice, you will have sixty (60) days to notify Social Security that you wish to have a new hearing.  If you believe that you might be entitled to a new hearing, but have not received a notice, you should contact your local Social Security office as soon as possible.

If you are interested in having our office represent you at your hearing, please contact our office as soon as possible so that you can schedule a free initial consultation with our staff.

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What Does The Supreme Court’s Striking Down Of The Defense Of Marriage Act Mean For Your Social Security Disability Benefits?

The United States Supreme Court struck down the Defense of Marriage Act

On June 26, 2013, the Supreme Court ruled that Section 3 of the Defense of Marriage Act (DOMA) violated the Fifth Amendment and is therefore unconstitutional. While DOMA was in effect, the federal government did not recognize same-sex marriages that were performed in states where they are legal, such as New York.  This meant that the Social Security Administration was unable to pay certain benefits to individuals who would have otherwise been entitled to them if they were married to someone of the opposite sex. As this part of the law has been struck down, validly married same-sex couples should be treated identically to opposite-sex couples by the Social Security Administration. 

There are several Social Security benefits that married individuals are entitled to that unmarried individuals are not.  The two largest programs are survivor benefits and disabled widow(er)s benefits. A surviving spouse can now be entitled to benefits on a deceased spouse’s earnings record once they attain age 60 or are disabled and age 50. These benefits, once only available to opposite-sex couples, should now be extended to same-sex couples as well. Stepchildren may now also be entitled to benefits on a worker’s earnings record, if the worker is either deceased or receiving Social Security retirement or disability benefits. 

The Social Security Administration relies on state law to determine if a person was legally married. Social Security looks at the law of the state where a person was living at the time of their death to determine if their marriage was valid. It’s possible that a same-sex couple could be married in New York (or another state where same-sex marriage is legal) and then move to a state that does not recognize same-sex marriage.  According to Social Security’s current rules, the Administration would look to the rules of the state where the person lived at the time of their death to determine if the marriage was valid. 

At first glance, this seems to mean that validly married same-sex couples could be denied benefits they would have been entitled to if they didn’t move. However, Social Security also recognizes a “deemed marriage” provision. In simple terms, if both partners believed themselves to be married, and acted like a married couple, and the only reason they are not validly married is “a legal impediment not known to the applicant” at the time of the marriage ceremony, Social Security will consider the marriage to be valid for benefit purposes.

We don’t know yet how Social Security will enact these provisions or what the end result will be. However, it appears clear to us that many people who were being denied benefits because of who they love will now be entitled to them. 

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Why Is The Social Security Administration Trying To Take My Money Away?

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

I wrote the attached article, When Did I Get My Windfall and Why Is the Social Security Administration Trying to Take It Away? (link is to a PDF) for the January edition of Social Security Forum, a publication of the National Organization of Social Security Claimants’ Representatives. I thought this information would be valuable to a broader audience than just other Social Security Disability lawyers, so I am republishing it on our blog. The Social Security Administration has been reducing benefits to former National Guard members based on an obscure provision, and lately the courts have been overturning these benefit reductions. If you or someone you know has received a notice from the Social Security Administration indicating that the “Windfall Elimination Provision” applies to them, you should read the attached article immediately or contact us for more information. We want to make sure that you receive the maximum benefits that you are entitled to under the law. You can read the article by clicking here: When Did I Get My Windfall and Why Is the Social Security Administration Trying to Take It Away?

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Social Security Disability: Get the evidence you need

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

Social Security Disability applicants sometimes have trouble getting the evidence needed to demonstrate that they have a disability. PROBLEM 1: You haven’t had regular medical care because you don’t have health insurance. Without regular medical care, it’s difficult to develop a relationship with a doctor that is strong enough that the doctor can complete a report on your health. Even if your disability is very real, proving it in Court can still be a hard thing to do. However, without medical insurance, most doctors won’t see a patient. SOLUTION: In Nebraska there are some free clinics where you can be seen by a doctor even if you cannot afford to pay. To find a free clinic near you, contact your local health department. Anyone planning on applying for Social Security Disability should try to develop a relationship with a doctor by seeking regular medical care as often as possible. PROBLEM 2: Many applicants don’t have the right kinds of conversations with their doctors about their disabilities. Doctors are mainly concerned with your symptoms and how they can help you get well. They aren’t necessarily focused on the kinds of things they’ll need to know to help you with your Social Security Disability claim. To fill out a report for your claim, they’ll need to know exactly how much you can and cannot do. Continue reading →

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Temporary Employees Cannot Be Excluded From Workers’ Compensation

Today’s post comes from guest author Paul J. McAndrew, Jr. from Paul McAndrew Law Firm.

According to a recent decision by the Texas Supreme Court, a temporary employee cannot be excluded from an employers’ workers’ compensation policy.

In 2005, Rafael Casados was killed on his third day at work at a grain storage facility owned by Port Elevator-Brownsville L.L.C. Because Casados was a temporary employee of Port Elevator at the time of his death, he was initially awarded a liability ruling of $2.7 million directly from Port Elevator. However, according to the latest Supreme Court ruling, Casados’s family should receive remedy under Port Elevator’s workers’ compensation policy instead. Port Elevator’s insurance provider is liable for Casados’s death benefits, despite the fact that Port Elevator never paid workers’ compensation insurance for any of their temporary employees.

According to the decision: “If Port Elevator’s policy had set out certain premiums solely for temporary workers and Port Elevator had not paid those premiums, Casados would still have been covered under the policy and the failure to pay premiums would be an issue between Port Elevator (their insurance provider).”

 

 

Photo Credit:sixninepixels / FreeDigitalPhotos.net

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Can My Social Security Disability Benefits Be Taken to Pay Old Debts?

I am often asked by clients if their disability benefits can be taken to pay old debts. Filing for Social Security disability benefits is a lengthy process, and many people accrue significant debt during the application process. These people are worried that their benefits will be taken from them in order to satisfy these debts.  However, most people have nothing to fear, as Social Security disability benefits can only be garnished in certain circumstances.

If you owe money to the federal government (for example, unpaid taxes or past-due student loans from the Department of Education) the government has the power to take your Social Security disability benefits in order to satisfy the debt. Your benefits can also be garnished if you are in arrears in child support or alimony, or if you have been ordered by a court to pay restitution.

Generally, these are the only circumstances in which your Social Security disability benefits can be taken to pay old debts. If you have other debts, such as private loans or credit card debt, your Social Security disability benefits cannot be garnished as long as the benefits are not “intermingled” with other assets.  Therefore, you should keep your Social Security disability benefits in a separate bank account. If your disability benefits are combined with other money you may have, the benefits are subject to garnishment. Once you are awarded disability benefits, you should consider setting up a separate bank account just for your benefits to make sure that those benefits cannot be garnished.

However, some creditors and even banks aren’t aware of the fact that Social Security disability benefits cannot be garnished. If your disability benefits (which have not been intermingled with other assets) are garnished, inform the creditor and the bank immediately that the garnishment violates Section 207 of the Social Security Act. Section 207 protects your benefits even after they have been paid to you as long as the money can be identified as being Social Security benefits – that’s why you cannot intermingle the benefits with other money you may have.

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Social Security Disability Denied? Don’t Give Up Hope. (Part 2)

Last week we told you about the denial of John’s claim for Social Security Disability. This week we present the results of John’s appeal. 

Unfortunately, John’s run of bad luck with the Social Security Administration continued, and the Appeals Council affirmed the judge’s decision. The only good thing about this decision was that it came relatively quickly, allowing us to move on to the next step in the process. With the Appeals Council denial, there were two options.  John could file a new application and begin the process again, which would mean forfeiting all the retroactive benefits that he would otherwise have been entitled to, or we could file a lawsuit in Federal court. 

The only good thing about this decision was that it came relatively quickly, allowing us to move on to the next step in the process.

I selectively file these lawsuits because of the lengthy process and the standard of proof required. After discussing his options, John and I decided to move forward with the lawsuit. After a lawsuit is filed, the Assistant United States Attorney (AUSA) assigned to the case contacts me to work out a schedule for filing our briefs and for oral arguments in front of the judge.

When I heard from the AUSA this time, it wasn’t to set up a briefing schedule. She had reviewed the case file and realized that the judge’s decision was wrong and couldn’t be defended. She was the first person who I felt had really taken the time to review the case and realize that John was truly disabled. She prepared an order for the judge to sign sending the case back to Social Security for a new hearing and a new decision.

 The same judge who had issued John’s original unfavorable decision was again assigned to the case. I was concerned that John would be in for another denial, but the judge had clearly changed his mind about John. After a brief hearing, the judge stated on the record that he would be issuing a fully favorable decision. John received the decision granting him benefits two weeks later. John and his family were awarded all of the benefits that they were entitled to, because I believed in his case and didn’t give up.

Even if you get turned down the first time, or you get an unfavorable decision from a judge, don’t give up.

Even if you get turned down the first time, or you get an unfavorable decision from a judge, don’t give up. If John had decided to file a new application, he may have eventually been awarded some benefits, but he wouldn’t have received all the retroactive benefits to which he was entitled. Having an attorney who believes in you and will work hard to get you the benefits you deserve is very important to the success of your case.  If you would like our assistance with your claim, please contact us today.

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