How Workers’ Compensation Settlements Affect Social Security Benefits

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

It is fairly common for an injured worker to receive Social Security disability benefits and also receive a settlement for workers’ compensation. According to Social Security, “If you receive workers’ compensation or other public disability benefits and Social Security disability benefits, the total amount of these benefits cannot exceed 80 percent of your average current earnings before you became disabled.” Here’s how I handle this situation: in any settlement where an injured worker is receiving Social Security Disability Insurance (SSDI) benefits, an attorney representing that person and/or the injured worker must think about how a lump-sum settlement affects the SSDI benefits for the person. There will probably be a decrease in benefits because “workers’ compensation and other public disability benefits may reduce your Social Security benefits,” according to the Social Security Administration. Some items can be kept out of the workers’ compensation settlement total for Social Security benefits purposes. This list includes, but is not limited to, such things as: attorney fees; litigation expenses; past medical bills that need to be paid; future medications expenses; future medical care expenses; and vocational services expenses. Taking away these parts of the settlement can and should increase the value of the net settlement to the injured worker. The remaining net settlement should then be distributed proportionally over the injured worker’s life expectancy. The overall result of your attorney preparing for your settlement by making these calculations means that a workers’ compensation settlement will decrease your Social Security disability benefits less.

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Employee Rights Hurt by Supreme Court Decisions

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

Employee rights in the workplace took a step backward with the Vance and Nassar decisions made by the U.S. Supreme Court. So what does this mean in concrete terms for employees?

Vance: The main takeaway from Vance is that employees must tell upper management and human resources about workplace harassment. This has been federal law in the Court of Appeals for the 1st Circuit (Maine, Massachusetts, New Hampshire, Puerto Rico and Rhode Island) and the 8th Circuit (Nebraska, Iowa, North Dakota, South Dakota, Minnesota, Missouri and Arkansas). In order to sustain a workplace harassment claim under federal law, employees must now be able to show that management knew about harassment and that management failed to take effective action against the harassment.

Nassar: Nassar made it more difficult to prove retaliation under federal law. In the 5-4 majority decision written by Justice Samuel Alito, the court wrote that it was concerned about the increase in retaliation claims filed in the EEOC and the potential for “frivolous litigation.” The effect of this case is that even more retaliation cases will be decided by judges under summary judgment instead of being decided by juries.

However, just because it is harder to bring a discrimination or retaliation case under federal law doesn’t mean that an employee can’t bring a case under state law that could be more favorable to the employee. But employees pursuing wrongful termination cases in state court should be aware that state court judges oftentimes follow federal court judges in interpreting state fair-employment laws.  State court judges might find the Supreme Court’s concerns about “frivolous” retaliation suits to be well founded.

I think Justice Alito was off base in his concerns about “frivolous” retaliation where employees who are about to get fired file complaints in order to preserve their job or set themselves up for a wrongful termination lawsuit. Any competent employee-rights attorney knows that retaliation suits are difficult to win. I turn down about 9 out of 10 people who call my office who claim they were wrongfully terminated. Wrongful termination suits are costly and time consuming. I am not going to invest time and money in a suit where I will likely get dismissed and possibly face financial sanctions under court rules and also possibly be opened up to paying costs to the prevailing employer under federal fair-employment law. I am doubly suspicious of employees who are fired shortly after they file discrimination or other claims. Employers know that if they fire someone after filing some sort of complaint that it appears to look bad. But courts will uphold that reason if they had a legitimate reason to fire the employee. In other words, the employee who knows they are skating on thin ice and then files a complaint is going to lose a wrongful termination case. The decision in Nassar won’t stop disgruntled employees from filing claims with fair-employment agencies, it will just make it more difficult for employees with legitimate wrongful termination claims to obtain justice.

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Bangladesh Building Collapse Highlights Need for Safety Inspections

Today’s post comes from guest author Kit Case from The Causey Law Firm.

    The total number of workers killed or injured in the collapse of a building in Savar, Bangladesh on April 24, 2013 is not yet known, as rescuers continue to search for survivors.  As of Sunday, April 28th, the count was at least 377 dead.  Many of those killed were workers at clothing factories housed in the building, known as Rana Plaza, where fire broke out in the wreckage of the building, temporarily suspending rescue efforts as of April 24.  Efforts will restart with the aide of heavy equipment, which had previously been avoided in an effort to not injure those still buried in the rubble.  There no longer are assumed to be any victims remaining alive, although hundreds remain unaccounted for. The death toll surpassed a fire five months ago that killed 112 people and brought widespread pledges to improve worker-safety standards. But since then, very little has changed in Bangladesh.

Human Rights Watch reported on the building collapse, noting that it knows of no cases in which the Bangladeshi government has ever prosecuted a factory owner over the deaths of workers.

    USA Today reported on the tragedy with the news that Mohammed Sohel Rana, the fugitive owner of the illegally-constructed building, was apprehended by a commando force while trying to flee to India.  Rana was returned to Dhaka to face charges of negligence. Rana had been on the run since the building collapsed Wednesday. He last appeared in public Tuesday in front of the Rana Plaza after huge cracks appeared in the building. Witnesses said he assured tenants, including five garment factories, that the building was safe. Hours later, the Rana Plaza was reduced to rubble, crushing most victims under massive blocks of concrete.

    Human Rights Watch reported on the building collapse, noting that it knows of no cases in which the Bangladeshi government has ever prosecuted a factory owner over the deaths of workers. Many factory owners in Bangladesh are parliamentarians or members of the main political parties. In an interview with a government minister in 2011, the minister told Human Rights Watch that it would be “impossible” to improve workers rights so long as factory owners were senior members of political parties. 

    According to the Human Rights Watch report, Bangladesh has notoriously poor workplace safety inspection mechanisms. The Ministry of Labour’s Inspection Department, responsible for monitoring employers’ adherence to Bangladesh’s Labour Act, is chronically under-resourced. In June 2012, the Inspection Department had just 18 inspectors and assistant inspectors to monitor an estimated 100,000 factories in Dhaka district, where the Rana building is located. The garment sector alone employs an estimated 3 million workers. 

    According to the US Department of Labor Bureau of International Labor Affairs, workers in the Bangladeshi garment factories are primarily women – 75 to 90 percent – and children ranging in age from eight to fourteen years.  Most of the children are girls with an average age of just over 13 years.  Working conditions are described in the USDOLreport as follows:

        Garment factories are located in multi-storied buildings throughout Dhaka including Mirpur, Malibagh and Rampura districts (allegedly one of the worst areas), and the Free School District area. Working conditions in general in Bangladesh are far below western standards. On a par with other factory settings, garment factories are often dimly lit, with poor ventilation, and open for very long hours. However, some factories operate with good lighting and are not overly hot or crowded. The workers, mostly female, work without a break during their shift. Too often the factory doors are locked. Sometimes guards with keys stand by the locked gate; other times no one able to unlock the iron grating is near. Many times the locked gate is the only entrance or exit to a factory. The workers, including children, are frequently locked into their work place at the beginning of the morning shift and not let out until the end of the workday, and in some cases not until the next day. Overtime hours occur during peak periods in the production cycle when manufacturers are rushing to fulfill their export quotas. AAFLI’s 1994 survey of garment factories found that, like adult workers, children typically work 10 to 14 hours a day, with a half-day off on Friday.

    The similarities  are chilling to the working conditions of American garment workers at the Triangle Shirtwaist Factory prior to the tragic fire on March 26, 1911 that forever bears the same name. The horrific deaths from the Triangle fire, witnessed through photographs printed in the news media around the world, spurred a swift and aggressive response by workers and labor activists. Their response led to the establishment of many of the protective organizations American workers now rely on, including the workers’ compensation system, the American Society of Safety Engineers, and the U.S. Department of Labor.

    As with the Triangle fire, this should be a call to action as well as a time for reflection.  We, as consumers, are tied to the businesses in Bangladesh that supply garments to American companies.  That connection gives us the power to effect change in the working conditions of the Bangladeshi factories by insisting that American corporations purchase garments for sale in the US from safety-inspected factories that meet minimal international standards for basic worker protection.

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Official Disabilities Guidelines Now Covers Diabetes

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

While diabetes is not a work injury or illness, it can have a serious impact on the rate at which an injured worker recovers. For instance, people with diabetes may have a much harder time healing from a foot or leg injury. The latest edition of the annual Official Disabilities Guidelines (ODG) has been released, including the latest ODG volume on treating patients. ODG Treatment is the nationally recognized standard for medicine in determining the scope and duration of medical treatment in workers’ compensation.

For the first time this year, ODG Treatment includes a chapter on diabetes. According to the American Diabetes Association, there are nearly 26 million people in the United States who have been diagnosed with diabetes, and an estimated 7 million more people suffering who have not yet been diagnosed. Clearly, the implications of diabetes on workers’ compensation are significant.

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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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Slow Recovery Affects Workers’ Compensation Benefits and Costs

Today’s post comes from guest author Kit Case from Causey Law Firm.

A Press Release by the National Academy of Social Insurance

 

WASHINGTON, DC – Workers’ compensation benefits declined to $57.5 billion in 2010 according to a report released today by the National Academy of Social Insurance (NASI). The drop in workers’ compensation benefits was largely due to a 2.1 percent drop in medical benefits for injured workers. Employers’ costs for workers’ compensation also fell by 2.7 percent in 2010. As a share of covered wages, employers’ costs in 2010 were the lowest in the last three decades.

 

“As a share of covered wages, employers’ costs in 2010 were the lowest in the last three decades.”

 

“Employers’ costs as a percent of payroll declined in 43 jurisdictions,” said John F. Burton, Jr., chair of the study panel that oversees the report. “This decline is probably due to the slow pace of the recovery, with many jurisdictions still experiencing relatively high unemployment rates.”

 

Workers’ Compensation Benefits, Coverage, and Costs, 2010
Total

2010

Change   Since 2009 (%)
Covered workers (in thousands)

124,454

-0.3%
Covered wages (in billions)

$5,820

2.6%
Benefits paid (in billions)

$57.5

-0.7%
Medical benefits

$28.1

-2.1%
Cash benefits

$29.5

0.7%
Employer costs (in billions)

$71.3

-2.7%
Per $100 of Covered Wages

2010

Change   Since 2009 ($)
Benefits paid

$0.99

-$0.03
Medical benefits

$0.48

-$0.03
Cash benefits

$0.51

-$0.01
Employers’ costs

$1.23

-$0.06
Source: National Academy of Social Insurance, 2012.

 

The new report, Workers’ Compensation: Benefits, Coverage and Costs, 2010, is the fifteenth in the series that provides the only comprehensive data on workers’ compensation benefits for the nation, the states, the District of Columbia, and federal programs. 

 

“This report represents the first time the Academy has released employers’ costs by state.”

 

This report represents the first time the Academy has released employers’ costs by state. For a table showing employers’ costs for all fifty states and the District of Columbia, refer to Table 12 (page 34).

Most states reported a decrease in the number of workers covered but an increase in covered wages between 2009 and 2010. During the same period, the total amount of benefits paid to injured workers declined in 26 jurisdictions and increased in 25. As a share of payroll, benefits paid to injured workers fell by three cents to $0.99 per $100 of payroll in the nation.

The share of medical benefits for workers’ compensation has increased substantially over the last 40 years. During the 1970s medical benefits nationally accounted for 30 percent of total benefits, whereas in 2010 the share of benefits paid for medical care was almost 50 percent. Experts attribute this trend to the rising cost of health care.

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What Does That Stand For? Commonly Used Acronyms in Workers’ Compensation Cases

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

Every profession has certain turns of phrase or acronyms they use on a daily basis that, to the layperson, mean very little and may only serve to add confusion to an already difficult issue. The legal profession and the representation of injured workers is no different. Injured workers often find themselves traveling down a confusing road armed only with directions written in an unfamiliar or foreign-sounding language. The experienced attorneys at our firm navigate clients down this road on a daily basis.

Below is a list of commonly used acronyms to assist in understanding what is happening with your workers’ compensation case when everyone around you is suddenly speaking another language. Please keep in mind that the accompanying definitions are very general, and you should seek the advice of an experienced workers’ compensation attorney for more information or assistance with your case. Please also see the links for other blog posts for more information on some of these issues.

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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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