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Showing posts with label Social Security Disability Insurance. Show all posts
Showing posts with label Social Security Disability Insurance. Show all posts

Wednesday, September 5, 2018

Totally Injured Workers Maybe Getting an Increase in Benefits

The proposed Trump Administration 2019 Budget (p. 115) may allow NJ workers’ compensation beneficiaries to receive an increase in benefits. By eliminating the Social Security “reverse offset,” totally and permanently injured NJ workers will receive a triennial annual COLA increase.

“The Budget includes a re-proposal to eliminate reverse offsets in fifteen states where Workers' Compensation (WC) benefits and temporary disability insurance benefits (TDI) are offset instead of DI benefits."

Friday, October 7, 2016

US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System

As The Path to Federalization of the US workers' compensation system broadens, the US Department of Labor has published a report urging expansion of the Federal role in reforming the entire patchwork of state systems. As the Presidential Election Cycle moves ahead, the ultimate outcome will impact the the nation's struggling workers' compensation scheme. Based on historical statements both "Hillarycare" or "Trump Medical," (lead by his advisor, Former Speaker Newt Gingrich,  will focus on this issue. See  my prior blog posts below.

Saturday, December 28, 2013

Social Security - Administrative Law Judge Rulings

ALJ Disposition Data
FY 2014 (For Reporting Purposes: 09/28/2013 Through 11/29/2013)
A listing of hearings completion data by name of individual administrative law judges (ALJ) for all ALJs in ODAR. The data includes hearing office name, total dispositions, decisions, allowances, denials and fully favorable or partially favorable decisions.
Click here to down oad the data in PDF format.
Found on
Tembow….

Sunday, November 24, 2013

Social Security’s Job

The Social Security system is an "unfair" benefit distribution plan according to some authorities. Compounding this issue is the patchwork of workers' compensation system that all seem to apply different rules for setoff f benefits from lifetime benefits as well as COLA modifications. Choosing the "right" jurisdiction to file a workers' compensation total disability claim can make all the difference in the world for the amount of benefits an injured worker receives during his or her lifetime. Today's post was shared by Steven Greenhouse and comes from economix.blogs.nytimes.com

Ratio of Social Security benefits to Social Security taxes paid, by race or ethnicity and year.
Ratio of Social Security benefits to Social Security taxes paid, by race or ethnicity and year.
Source: The Urban InstituteRatio of Social Security benefits to Social Security taxes paid, by race or ethnicity and year.
Does Social Security need to be fixed?
As Democrats and Republicans grapple over how to reduce the government’s budget deficit in the face of rising costs for pensions and health care, whether Social Security should be touched remains one of the most controversial topics in American budgetary politics.
But something big is missing to the debate over the finances of what is still the largest component of the social safety net: an understanding of how well it does its job.
When you peek under the hood, it doesn’t always look so great. Indeed, this supposedly great redistributive program — which uses a broad tax on all workers to protect the elderly from poverty — exhibits some fairly stark regressive features.
One well-known regressive feature comes from the rule that benefits must be annuitized, paid out over time in monthly installments rather than as a lump sum. This means that richer people who tend to live longer will get a bigger benefit than poorer people with shorter life spans. Survivor benefits redistribute money from the singles — who don’t get the benefit — to the married, who do.
Eugene Steuerle, Karen Smith and Caleb Quakenbush of the Urban Institute in Washington just discovered another unsuspected regressive...
[Click here to see the rest of this post]

Thursday, October 24, 2013

“Lamestream Media” Enables Right-Wing Talking Points About Social Security Disability

Today's post comes from guest author Jay Causey, from Causey Law Firm.
By Jay Causey from Causey Law Firm
- - Screen Shot from Fair.org
     Just in time for a scheduled meeting of the Senate Committee on Governmental Affairs to discuss the status of the Social Security Disability program (SSDI) on October 7th, on Sunday, October 6, CBS’ popular “news” show, 60 Minutes, aired "Disability USA" - a sensationalized program full of misleading and largely anecdotal information designed to convince viewers the program is riddled with fraud and on the brink of collapse.  If you watched this program, and it is your sole source of information about Social Security Disability, you know essentially nothing about the actual operation of the program.  You heard not a single word from disability recipients, their advocates, or from officials who administer the program, none of whom were invited to participate in the 60 Minutes piece.
...the 60 Minutes segment focused on some fraud in the program in one impoverished area of the country in order to paint disability recipients generally as the undeserving poor, slackers and frauds.
     First, listening to the program you might not have understood that the average monthly benefit of about $1100 is not tax-payer money but earned credits for money paid into the system by the disabled worker.  Then, in terms of the “shocking” growth of the disability rolls you heard CBS’s Steve Kroft and Senator Tom Coburn, R-Oklahoma natter on about, you didn’t hear that the statistical growth of the program is a direct function of the increase in population over the past 30 years, the aging of the baby-boomer population into their higher disability years, the entry of women into the work force in greater numbers, and similar demographic factors.  Finally, you likely came away from the program thinking that qualifying for SSDI is a cakewalk, when the actual standards for disability result in denial of two-thirds of all applications, only 10% of those denials being reversed on appeal, and an overall figure of about 41% of applicants ultimately qualifying.
     Completely ignored in this puff-piece for the right wing (Coburn is the lead Republican on the Senate Subcommittee for Investigations and has a long-standing, well-documented hostility to Social Security) is the shifting of responsibility for disability from workers’ compensation systems, where it properly belongs, to the Social Security Disability program because of the rollbacks in coverage and benefits in states’ workers’ comp programs across the country, all driven by right-wing and corporate interests.  So, while SSDI faces potential exhaustion of its funds in the next few years (although this can be – and in the past has been – remedied by shifting funds from the Social Security old-age program), the liability insurance industry, which includes workers’ compensation carriers, is enjoying record profits over the last two years.
     Similarly unmentioned was the impact of the worst economy in decades, shrinking the ability of disabled workers to find less physically challenging work.
     As is typically the case with these types of “news” pieces, the 60 Minutes segment focused on some fraud in the program in one impoverished area of the country in order to paint disability recipients generally as the undeserving poor, slackers and frauds. CBS could have moderated the potential negative impact of its program by including interviews of SSA program officials or of spokespersons from some two dozen national disability advocacy organizations who asked to be heard on this show.  It shamefully chose to ignore all such requests, and has diminished itself accordingly as a news organization.

Thursday, October 3, 2013

THE TRUTH ABOUT CHEATIN’ AND LYIN’

Today's post comes from guest author Susan C. Andrews, from Causey Law Firm.

     You hear it all over the place these days: there are lots of people out there who lied and cheated to get Social Security Disability (SSD) benefits. I’m here to tell you that is a myth. You don’t have to drill down very far to find out differently. I should know, from where I sit, as an attorney who handles SSD cases. Where I sit most days is in front of a big pile of medical records—I mean HUNDREDS of pages of medical records, all belonging to the same person. You see, some of my clients have just one great big medical issue—like cancer, or Multiple Sclerosis, or Parkinson’s, and many of my clients have multiple medical problems. Either way, they have spent more time in doctors' offices and hospitals than any of us would ever choose to do.
 There is a mistaken notion floating around out there that a person can just waltz into Social Security, claim to be disabled, and voila—he’s granted benefits!
     There is a mistaken notion floating around out there that a person can just waltz into Social Security, claim to be disabled, and voila—he’s granted benefits! Nothing could be further from the truth. The burden of proof is on the claimant (the person claiming benefits) to show that he or she is disabled from engaging in substantial gainful activity (SGA) for a period of at least 12 continuous months. More about SGA in a bit. That proof starts with medical records, and diagnoses made by doctors. Self-diagnosing just doesn’t cut it, even if you’ve read up on your condition all over the internet, and you’re absolutely positive you know what’s wrong with you! Sometimes we get calls from people who do not have health insurance, and even though they have a serious medical condition, they have been unable to access much in the way of health care. Sadly, some of those folks who should be able to qualify for benefits do not, because they simply do not have the necessary treatment records to document the seriousness of their conditions.
     As mentioned above, Social Security’s definition of disability is the inability, due to one or more medical impairments, to engage in substantial gainful activity for a period of at least 12 continuous months. Social Security defines SGA in part by a dollar figure that usually goes up a little every year. In 2013 it is $1,040. Social Security looks at a person’s GROSS earnings, not net earnings or take-home pay. So if I’m able to gross $1,040 or more per month, I can engage in substantial gainful activity and I do not qualify for SSD. This concept is important especially for individuals with progressive conditions.
     Take, for example, a person diagnosed with Parkinson’s. One famous example is the actor Michael J. Fox. His Parkinson’s affects his functioning, but he is still working. Many people with progressive conditions continue to work for some time after receiving their diagnosis. At some point, progression of the disease may force some of them to go to part-time work. When the hours worked decrease, their earnings may no longer qualify as SGA. Or—and I see this a great deal in my practice—some people begin to have more bad days than good days, and work performance is impacted. There are days so bad that they really have no choice but to call in sick. Then this begins to happen more frequently than a couple of days a month. In my experience, at that point most employers become very unhappy campers. Not only are the employees taking sick leave faster than they are accruing it, they can’t tell their employers ahead of time which days they will wake up with an exacerbation of symptoms that keep them in bed, or at least in their bathrobe, all day.
     Which brings me to my final point: Many of my clients look okay to the casual passer-by. Take the guy with a serious heart problem. Well sure, if I followed him around for half a day, I’d see that he can barely exert himself without getting out of breath. But if I just passed by, he might look fine. And the day he spends at home in his bathrobe because he can hardly catch his breath—I’m not going to see him at all when he’s having one of those really lousy days. His condition may be largely invisible.
     To sum it up, I’d say there’s a bit of wisdom in being slow to judge. Thank goodness we take our good health for granted—it’d be a miserable existence if I spent too much time worrying about getting sick before it actually happened. But, of course, serious illness can strike any of us when we least expect it. And on the other side of that defining moment, the world can look a whole lot different.
 Photo credit: Gemma Grace / Foter / CC BY-NC

Friday, September 27, 2013

ARE YOU OVEREXPOSING YOURSELF IN SOCIAL MEDIA?

Today's post comes from guest author Laurel Anderson, from Causey Law Firm.
By Laurel Anderson from Causey Law Firm
     Facebook, Twitter, YouTube, LinkedIn, Pinterest, Instagram and other wildly popular social media websites have transformed how people both connect with each other and obtain information about other people. It has also created a change in the legal arena. For our clients who are currently applying for or receiving workers’ comp time loss benefits, or Social Security Disability Insurance (SSDI) benefits, our advice is to keep in mind the importance of privacy settings for both written information and photos on their individual accounts. While a Washington State law went into effect this weekend barring employers from requesting access to Facebook passwords, if your privacy settings are not tight, curious parties can randomly obtain information about you.
While a Washington State law went into effect this weekend barring employers from requesting access to Facebook passwords, if your privacy settings are not tight, curious parties can randomly obtain information about you.
     From our experience, you can now assume that claims managers, employers, and defense attorneys will search for information on the internet regarding your personal life that can impact your claim for benefits. Please make sure that any outdated information regarding your activities is removed from your personal page. Do not use social media to vent about your employer or state agencies that are the decision-makers in your claim. You may be under the impression that only your friends can see your personal page, and that you have some right to privacy. However, be aware that all of the content on your walls, including photos and instant messaging, could be potentially discoverable by your employer or opposing counsel in a litigated case if the content is relevant to your claim for benefits.
     The risk is somewhat less in the SSDI arena since there actually is an agency directive to ALJs and DDS adjudicators that they are not to use social media to research claimants. We nevertheless warn our SSDI clients concerning social media, as we are not convinced that agency people are always playing by the rules, or that those rules may not soon change.
Photo credit: lindes / Foter / CC BY-NC-SA

Monday, November 7, 2011

Social Security Disability: Get the Evidence You Need

Guest Blog by by Roger Moore a member of the Nebraska Bar

Take the right steps to make sure this doesn't happen to you!
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.
While your attorney may invite your doctor to schedule an appointment with you so that they can gather the correct information, doctors often do not do this, and may complete your report with incomplete knowledge of your physical condition.
SOLUTION: It is important for you to educate your doctor about your limitations every time you see them, so that when they have to fill out a disability report, they will have a basis of knowledge to complete the report with.
Whether your disability is physical, mental, or some combination of the two, make sure to give your doctor specific examples of your limitations each time you see them. Talk to your doctor about what you can and cannot do such as:
  • how much you can lift,
  • how long you can stand for,
  • how much you can do with your hands,
  • or how easily you can handle social interactions.
Take the right steps to make sure that you get the evidence you need to support your Social Security Disability claim!

Saturday, February 12, 2011

Published: 2011 Workers' Compensation Law Treatise

The 2011 Supplement to Gelman on Workers' Compensation Law has been published and is shipping. Now in its third edition, the 3 volume hard-bound series, provides a comprehensive analysis of workers' compensation law. Published by West Publishing, a business of Thomsom-Reuters, it is totally integrated into the West citation system and Westlaw® research system. The series and updates may be ordered in hardbound, CD-Rom and/or accessed thorough the Westlaw® research system.

What's New

The newly enacted statutory changes to the New Jersey Workers’ Compensation Act and promulgated Rules permitting Emergent Medical Care Motions, new registration requirements for insurers, and new judicial enforcement powers of Judges of Compensation, including sanctions and contempt powers, are contained in this supplemental material. The judicial decision imposing direct liability against an insurance carrier for delay and/or denial of medical treatment is discussed.

An analysis of the newly adopted procedures for the reimbursement of conditional payments established by Medicare and the protocols to co-ordinate workers’ compensation claims with the Centers for Medicare and Medicaid Services is contained in this supplement. The materials also provide the authorizations required to obtain conditional payment information from the Coordinator of Benefits. Debt collection referral to the Department of the Treasury is also reviewed.

The new Community and Worker Right to Know material has been incorporated into this supplement. The current hazardous substance lists and the substances that have been deemed extremely dangerous are provided.

The supplement reviews new case law concerning electronic cancellation of coverage as well as the standard for claims to be considered casually related to the employment.

The judicial interpretation of the Exclusivity Doctrine is discussion in light of the dual capacity status of a household contact / bystander and also former employee. The evidential requirements in latent occupational claims is reviewed.

The mandatory reporting requirements of the SCHIP Extension Act of 2007 are described as well as the appeal procedure under the reimbursement provision of the Medicare Secondary Payer Act.

These pocket parts provide information concerning the requirements for medical monitoring in workers’ compensation claims. It discusses. the Asbestos Fund, which has been established for those entities where workers’ compensation coverage cannot be established. The newly designed forms that need to be utilized in filing for benefits are included. Also, the recently modified Motion for Temporary and Medical Benefits, including a form Certification, is provided and discussed.

The newly revised Judgments for Total and Permanent Disability are provided in this pocket part. The Judgments include new refinements in offsets for pensions and Social Security disability benefits. Reviewed also is the “intentional wrong exception” to the Exclusivity Bar which has been the subject of new workers’ compensation insurance policy language and regulation.

The recently promulgated administrative rules governing the disposition of Temporary Disability Benefits are discussed. The non-duplication of benefits provisions are reviewed including the multiple agency adjudication process. An expansion of benefits available to Federal public safety officers is reviewed in this supplement.

Collateral medical benefit issues are discussed in light of the recent Supreme Court decision concerning this matter. The pocket parts include a Motion to Join the Collateral Health Carrier and provide sample Certifications to be used in support of the application. New pleadings issued by the Division of Workers’ Compensation in the area of medical payment and reimbursement claims are provided and commented upon in these materials.

Additionally, these pocket parts provide information concerning the new Rules of the Division of Workers’ Compensation embodying electronic filing requirements and new procedures involving both formal and informal proceedings, motion practice, post judgment process, and judicial performance. The expanded Medicare secondary reporting requirements and the mandatory coordination of benefits are reviewed in this supplement. The recovery aspects of Medicare conditional payments as well as future medical provisions are updated and discussed. The new Child Support Lien distribution forms, computation worksheets and judgments are provided and explained in depth. The NJ Supreme’ Court ruling and the legislative enactments are discussed concerning same sex couples and the availability of workers’ compensation benefits.

This supplement reviews the newly promulgated Rules concerning the Uninsured Employers’ Fund and audio and video coverage of workers’ compensation proceedings. The horrific tragedy of September 11th, 2001 and the impact it has upon the Workers’ Compensation system is discussed. This supplement reviews the newly enacted Smallpox Emergency Protection Act as well as recent court decisions concerning acts of terrorism. The subsequent legislative changes enacted in response to potential terrorist threats are reviewed, including the Public Safety Officers’ Benefit Act as well as the liberalized legislative enactments involving rescue workers and medical personnel.

The far-reaching ramifications of the newly enacted healthcare reform legislation are reviewed. The new prototype occupational medical care program, encompassing potential occupational exposure claims, is presented in this supplement.

The impact of the newly promulgated Federal rules and regulations concerning medical record privacy and compliance with the Health Insurance Portability and Accountability Act (HIPPA) medical authorization requirements are reviewed in this supplement and model forms are furnished. The recently enacted statutory workers' compensation coverage options available to proprietors and partners are discussed. The supplement reviews the recent court decisions expanding the responsibility of the Second Injury Fund for pre-existing medical conditions in cases in which latent diseases become manifest during retirement. The statutory enactments concerning State Temporary Disability Benefits are reviewed. The recently amended Energy Employees Occupational Illness Compensation Act is explained in detail and forms are furnished and discussed.

The new administration and management of claims arising from insolvent workers’ compensation insurance is covered in this pocket part.

The recent Supreme Court decisions concerning the high judicial threshold for evaluation of scientific evidence are analyzed. The requirements for proof of scientific evidence in complex workers’ compensation cases are discussed including the admissibility of testimony from non-physicians experts. Furthermore, the evolving and expanding issues concerning medical monitoring are reviewed.

This pocket part also discusses recent changes in the application for counsel fees. The supplement includes the newly promulgated administrative directive embodying those changes.

To Order
The series and updates may be ordered in hardbound, CD-Rom and/or accessed thorough the Westlaw® research system.

More Information
Table of Contents Supp. 2011
Index, Supp. 2011
Summary of Contents

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