What a Government Default Will Do To Workers' Compensation

With only hours left, and the politicians in Washington DC still unsettled about how to resolve a US credit default, the focus turns to the impact on workers' compensation programs throughout the country.

Expanding on the problems besieging compensation programs following the US Government Shutdown, things are going to get much worse and very quickly. Social Security will stop paying benefits, its contractors and medical providers. Closing down those contributions will literally suffocate transactional information concerning integration of Medicare Secondary Payer Act benefits and reimbursement. Calculating offsets and reverse offsets will become an impossibility. Insurance companies in reverse offset states will be required to fund more dollars into the system as application flow into the state systems to modify prior awards still being paid.

Employers dependent upon government payments, including funding and contracts, will be unable to pay workers and insurance company premiums. Cascading financial distress will implode the economy and unemployment will become rampant.

Additional burdens will be placed upon injured workers who even already are struggling to make ends meet and obtain medical treatment with absolutely no Federal safety net in place to catch them. Injured workers with pending claims will be unable to seek medical and pharmaceutical benefits from collaterally funded programs.

Federal dollars actually fund over 70% on state rehabilitation programs. These programs will quickly dry up, and the those injured workers who are seeking placement in a new job through rehabilitation will be locked out of the states.

Workplaces will continue to be unregulated as OSHA (The Occupational Health Administration) will be unable to financially fund enforcement programs, new safety programs and even review comments for pending regulations, ie. The Smart Act.

Investigations requirement Federal records, including prior military records, will become increasingly difficult to secure. Stalling this process will delay completed workers' compensation medical records, expert evaluation opinions and the adjudication of workers' compensation claims.

Quite a mess! Not a pleasant prospect to look forward to, as the clock keeps clicking down

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Social Security raise to be among lowest in years

Social Security payments are tightly kinked to workers' compensation disability payments. When there are increases in benefits, some "reverse offset" states are liberal in passing along the adjustments to injured workers'. The State of New Jersey does NOT pass along the benefit increase and the workers' compensation insurance company does NOT increase the disability award payment to the injured workers. Today's post is shared from the dallasnews.org.

For the second straight year, millions of Social Security recipients, disabled veterans and federal retirees can expect historically small increases in their benefits come January. Preliminary figures suggest a benefit increase of roughly 1.5 percent, which would be among the smallest since automatic increases were adopted in 1975, according to an analysis by The Associated Press. Next year's raise will be small because consumer prices, as measured by the government, haven't gone up much in the past year. The exact size of the cost-of-living adjustment, or COLA, won't be known until the Labor Department releases the inflation report for September. That was supposed to happen Wednesday, but the report was delayed indefinitely because of the partial government shutdown. The COLA is usually announced in October to give Social Security and other benefit programs time to adjust January payments. The Social Security Administration has given no indication that raises would be delayed because of the shutdown, but advocates for...

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Listen to the GAO Podcast: Social Security Administration Improper Disability Insurance Payments

Social Security Administration Improper Disability Insurance Payments

Click here to listen

SSA's DI program is the nation's largest cash assistance program for workers with disabilities. Though program rules allow limited work activity, some work activity indicates beneficiaries are not disabled and therefore not entitled to DI benefits. Consequently, SSA might overpay beneficiaries if the agency does not detect disqualifying work activity and suspend benefits appropriately.

GAO was asked to study potential DI overpayments. GAO examined the extent to which

 (1) the NDNH indicates that individuals received potential DI overpayments; and 

(2) SSA's enforcement operation detects potentially disqualifying work activity during the waiting period. 

GAO drew random, generalizable samples of individuals from those whose earnings on the NDNH were beyond program limits and compared wages from their employers to DI program data to identify potential overpayments. To illustrate the circumstances in which SSA made potential DI overpayments, GAO reviewed case files for a nongeneralizable selection of six individuals--three who worked during their waiting period, and three who received potential overpayments for at least 3 years.

Recommendation: To improve SSA's ability to detect and prevent potential DI cash benefit overpayments due to work activity during the 5-month waiting period, the Commissioner of Social Security should assess the costs and feasibility of establishing a mechanism to detect potentially disqualifying earnings during all months of the waiting period, including those months of earnings that the agency's enforcement operation does not currently detect and implement this mechanism, to the extent that an analysis determines it is cost-effective and feasible.

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Christie Vetoes Bill That Would Have Prevented Some Truck Drivers From Being Treated As Independent Contractors

Today's post was shared by WCBlog and comes from njtoday.net

Gov. Chris Christie vetoed a bill that would have protected some truck drivers from being inappropriately classified as “independent contractors,” drawing criticism from one of the bill’s sponsors. “Because of the Governor’s veto, unethical companies will continue to skirt the law by gaming the system to avoid paying their fair share of taxes,” said Assembly Deputy Speaker John S. Wisniewski.  “In doing so, they will also continue to deprive their drivers of Social Security, Medicare, Workers’ Compensation and Unemployment benefits.” This “is just the latest example of the Governor siding against hard working New Jerseyans. His veto keeps in place a system that is unfair to workers and unfair to those companies that play by the rules,” Wisniewski said. The bill passed by a 43-30-5 vote in the Assembly and a 21-17 vote in the state Senate, so lawmakers are unlikely to override the governor’s veto. Under the bill, “drayage,” or short-distance truckers, and parcel delivery drivers could not be classified as “independent contractors” unless the employers can show that the workers are truly independent. The businesses would have to demonstrate to the New Jersey Department of Labor and Workforce Development that the workers are free from their day-to-day control, that the service is outside the usual course or place of business and that the employee is customarily...

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Media Portrays Social Security as an Avenue to Benefits for the Unemployed - WRONG! It's Not That Simple...

The Social Security Administration turns down many worthy applicants when they first apply.

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

     There is a lot in the news these days about the Social Security Disability Program, with some pundits suggesting people are getting on benefits simply because they are unemployed, or because they claim to be injured or ill when in fact they are able-bodied and fully capable of working. Every day, all day, I work with people filing for Social Security Disability benefits. So I work with the program’s rules - yes, there are rules for deciding these cases – it is not enough just to claim to be disabled. And I come face to face with individuals who are struggling, sometimes with a major health issue such as cancer, or rheumatoid arthritis, or Multiple Sclerosis. Other folks have multiple health problems that have combined to force them from the labor market. All of them have medical records, often reams of them, documenting diagnoses, chronicling surgeries and other treatment regimens. This is one big thing I think the general public does not know: a person must have one or more diagnoses from a qualified physician that could account for the symptoms and limitations he or she is reporting to Social Security. There must be convincing medical documentation. Much of my day is spent obtaining and reviewing the medical records of my clients, and ensuring that the decision-makers at Social Security also see them.

...the medical condition must be not only serious, but also prolonged.

     Many people are not familiar with Social Security’s definition of disability or the program’s rules, so they do not realize that the disabling medical condition or conditions must be serious enough to have prevented the person from working for AT LEAST 12 continuous months. If the individual has not yet been out of the labor market for a period of at least one year, it must be very clear that this will be the case. In situations where there is doubt about this, Social Security typically turns down the claim. I have had callers who have been unable to work for a few months while going through chemotherapy treatment for cancer, but have been able to get back to work in less than one year. They do not qualify for Social Security Disability benefits. So the medical condition must be not only serious, but also prolonged.
     One broadly held belief about Social Security Disability is, in fact, true: The Social Security Administration turns down many worthy applicants when they first apply. It is necessary to appeal (the first appeal is called a Request for Reconsideration). Often, a second denial follows. Then it is necessary to request a hearing in front of a judge. For a person who is too sick to work, not feeling well, and home alone trying to navigate this system, it can be daunting. One of the joys of my practice is our capacity to lend support to such individuals, to take the reins of the case and drive it forward, so my client can concentrate on taking care of herself or himself while I and my staff handle the legal stuff.
     We are able to offer representation to people at any stage in the process, including initial application. We are happy to talk with callers who are weighing their options, and simply need information in order to know whether to apply for benefits in the first place. There is no charge for such calls, so do not hesitate to contact us if you have questions about Social Security Disability.
Photo credit: Thomas Hawk / Foter.com / CC BY-NC

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WHEN IS THE RIGHT TIME TO APPLY FOR SOCIAL SECURITY DISABILITY?

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

     We get many calls from folks who have been off work for a while, and are wondering if the time is right to place an application for Social Security Disability benefits. There are several program rules that should be kept in mind in making this decision.

Applications for Social Security Disability
now can be filed online.

      The first thing to know about Social Security Disability is that it is a program for people who have one or more health issues that prevent the person from working for a period of at least 12 continuous months. If you have not yet been off work for that length of time, but anticipate that may be the case, you may want to go ahead and apply, since the entire process can take months and, in some cases, a year or more, before a final decision is made. On the other hand, if you are fairly confident you will be able to get back to work before 12 months has passed, then holding off makes more sense.

  ...benefits can go back no more than one year from the date of the application. This is a matter of concern for those who hold off too long and, as a result, lose out on benefits to which they are entitled.

      To collect any benefits at all, one must satisfy the above-described 12-month duration requirement. That said, once a person has satisfied the 12-month rule, it also is helpful to know that benefits cannot begin until five full months after the date of the onset of disability. So, for example, if I am diagnosed with a cancer and, because of my treatment, I must stop working on June 7, 2013, (and I know, because of the course of proposed treatment, that I am likely to be off work for more than 12 continuous months), then I could apply right away, but benefits would not begin until December of 2013. The five full months that I must wait for benefits to begin (in this example, July through November) is called the waiting period. The month of June cannot be counted because it is not a full month.  Thus, if there is some possibility I might be able to return to work before 12 months has passed, depending on how my treatment goes, then I might want to hold off initially, to see how it goes.

Do I Need To File A Tax Return On My Workers Compensation?

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

If you received workers’ compensation benefits, you may be wondering if you will need to report this money to the IRS and pay taxes on it. Under the Iowa Workers’ Compensation Act, money that you receive as workers’ compensation benefits is not taxable, with a few exceptions. You will have to pay taxes on your work comp benefits if:

• if the benefits are retirement plan benefits (this is true even if you retired due to disability)
• if part of your workers’ compensation benefit money lowers the amount you receive from your Social Security or Railroad Retirement Benefits. In that case, that the part of your workers compensation benefits is considered part of your Social Security (or RRB) and may be taxable.

If you return to work, your salary will be taxable again, as is it was before you received workers’ compensation benefits.

When Should A Disabled Worker Take Social Security Benefits

Disabled workers are faced with complex decisions on when they should take Social Security benefits. The senario is complicated with the addition of  workers' compensation benefits and pensions, especially if they are married and/or have dependent children.

Answers to maximizing Social Security benefits are now available on-line as reported by the PBS Newshour. Several versions, including a free basic version, of software is available from Laurence Kotlikoff, Professor of Economics at Boston University. A version called, Maximize My Social Security is available for a licensing fee of $40.00 per year.

Lack of Medical Evaluators Delays Social Security Claims Processing

Guest blog by Rodger D. Moore
of the Nebraska Bar


Recently, the Waal Street Journal reported that the Social Security Administration (SSA), frustrated by the backlog of applications for disability benefits, started pressuring the 140 doctors the agency uses to help evaluate some of the claims.  In an effort to encourage the quick processing of claims doctors were paid a flat rate of $80/case in stead of the previous $90/hour to review the cases.  Many times these cases have hundreds of pages of records to be reviewed and can turn on a few sentences.  


Also, doctors were assigned to evaluate conditions that were not in their areas of expertise.  One of the more interesting quotes came from Neil Novin, former chief of surgery at Baltimore's Harbor Hospital, who worked for Social Security part time for about 10 years. He said "People who shouldn't be getting [disability] are getting it, and people who should be getting it aren't getting it".   


In my experience this has always been the case, but now, with agency doctors being pressured to evaluate these cases quicker, we’ll likely see less competent and thorough evaluations.  This in turn will lead to longer delays, more cases waiting for a hearing and more money spent to evaluate more cases by administrative personnel within the SSA.  


Although I’ve never thought the agency doctors do a good job evaluating these cases, the situation will get worse now that 1/3 of the 140 doctors have either quit or been fired over this shift in philosophy.  In this setting it’s every more important to seek the help of a treating physician in offering a supportive report.  


See the complete article:  

Doctor Revolt Shakes Disability Program  (wsj.com)

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Social Security 2012: The Good News and The Bad News

The good news is the announcement by Social Security that the rate of payment will increase 3.6% The bad news that Part B Medicare premiums will offset the payment.

Monthly Social Security and Supplemental Security Income (SSI) benefits for more than 60 million Americans will increase 3.6 percent in 2012.

The 3.6 percent cost-of-living adjustment (COLA) will begin with benefits that nearly 55 million Social Security beneficiaries receive in January 2012. Increased payments to more than 8 million SSI beneficiaries will begin on December 30, 2011.

The Social Security Administration also noted that for some beneficiaries, the increase in Social Security benefits next year “may be partially or completely offset by increases in Medicare premiums.”

For an in depth analysis read the NY Times article.

Click here for PBS News Hour coverage.

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Workers Compensation Taxable Rules US Tax Court

Image via WikipediaThe US Tax Court has ruled that workers' compensation payments are not excluded from US income tax under Section 104(a)(1) if they are paid as a Social Security Setoff Section 86(d)(3).

The majority of the states permit Social Security to take the setoff. A minority of states allow a reverse setoff where the insurance carrier takes the setoff, and the workers' compensation benefits are reduced.

“Nevertheless, … we are duty-bound to apply the law as written by Congress to the facts as they occurred and not as they might have occurred. Because [the taxpayer's] Social Security benefits were reduced by the amount of workers’ compensation benefits received, that offset amount is treated as a Social Security benefit and is, therefore, taxable,” the court said.

Source: Dolan Media Newswires

For over 3 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered work related accidents and injuries.

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Court Rules Social Security Offset Not Barred by Time

A NJ Court of Appeals has ruled that the reverse-offset permitted under Federal law was allowed to be asserted by an insurance carrier years after an original workers' compensation judgment was entered. Even though the employee pleaded that the insurance company had sat on its rights for years, and done nothing to assert the offset, the Court maintained that the insurance company was entitled to reclaim the benefits it had overpaid.

Since the information provided by parties to define the numerical offset was lacking, and the decision below lacked "specific reasons and analysis," the matter was remanded for further proceedings.

NJ is one of the states that elected to have the insurance company / employer take the offset under the options available in 1980. Most states allow Social Security to take the offset.

Gonzalez v Bristol-Meyers Squibb, 2011WL611722, Docket No. A-2187-09T3 (NJ App Div 2011)

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Court Grants Motion to Reconsider Statute of Limitations in CMS Case

In order to avoid any "maifest injustice," the Court that had previously dismissed the Government's case against insurance companies and lawyers for failure to reimburse the Centers for Medicare and Medicaid Services (CMS), has granted a motion to reconsider under the plaintiff's accrual theory.

"As its fourth ground for reconsideration, Plaintiff argues that the court erred in concluding that the Government inadequately raised a theory of continuing accrual against all defendants concerning the annual $2.5 million payments from 2004 through 2014 contemplated in the Abernathy Settlement Agreement. Admittedly, Plaintiff did not address this theory in its responsive briefing to the Defendants’ motions to dismiss. At the September 13, 2010 hearing, the court granted verbal leave for Plaintiff to submit a motion to amend its complaint to more clearly articulate a claim on this issue. For whatever reason, Plaintiff has failed to do so, but argues in its motion to reconsider that it properly pled a theory of continuing accrual in its First Amended Complaint and raised it at the hearing. Though this theory should have been raised and argued in Plaintiff’s brief in response to the multiple motions to dismiss filed by Defendants, the court will allow Defendants an opportunity to respond in full to this issue to avoid any possible clear error. Therefore, the court GRANTS Plaintiff’s motion to reconsider as to the issue raised in part D regarding a continuing accrual theory and ORDERS that Defendants have until Tuesday, November 16, 2010 to respond as to whether the allegations pled in Plaintiff’s First Amended Complaint are sufficient to state a claim for a theory of continuing accrual; and if so, whether the court committed clear error in dismissing Count VI of Plaintiff’s First Amended Complaint.

"Finally, the court RESERVES RULING as to the tolling issue raised in part E of Plaintiff’s motion to reconsider. To avoid any possible clear error and/or manifest injustice, the court will allow Defendants until Tuesday, November 16, 2010 to respond as to: 1) whether the court should reconsider the issue of tolling; and 2) if the court does, whether it committed clear error in application of the appropriate burden of raising or pleading tolling in this context and in granting the motion to dismiss before discovery had yet occurred.

USA v James J. Strickler, et al CV 09=BE-2423-E

For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

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NJ Rejects Broad Medicare Release Language in Judgments

The NJ Division of Workers Compensation has indicated that broad release "language should not be included as part of a settlement order, attached to a settlement order or placed or part of the settlement record."

Specifically the following sample language was rejected, The claimant, , agrees to indemnify defendant, hold harmless the respondent from any action by Medicare seeking payment of past, current or future medical expenses for the claimant. Claimant shall further hold the respondent harmless from any and all adverse consequences in the event the settlement results in the loss of right to Social Security and/ Medicare benefits to the extent claimant would have been entitled to those benefits in the absence of the settlement agreement."

A memo was issued on October 28, 2010, by the Director and Chief Judge, The Honorable Peter J. Calderone.
...
For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

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No Social Security COLA for 2011

Like so many state workers' compensation programs, Social Security and Supplemental Security Income (SSI) benefits for more than 58 million Americans will not automatically increase in 2011, the Social Security Administration announced.


The Social Security Act provides for an automatic increase in Social Security and SSI benefits if there is an increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of the last year a cost-of-living adjustment (COLA) was determined to the third quarter of the current year.  As determined by the Bureau of Labor Statistics, there is no increase in the CPI-W from the third quarter of 2008, the last year a COLA was determined, to the third quarter of 2010, therefore, under existing law, there can be no COLA in 2011.

Other changes that would normally take effect based on changes in the national average wage index also will not take effect in January 2011.  Since there is no COLA, the statute also prohibits a change in the maximum amount of earnings subject to the Social Security tax as well as the retirement earnings test exempt amounts.  These amounts will remain unchanged in 2011.  The released agency fact sheet provides more information on 2011 Social Security and SSI changes.

Information about Medicare changes for 2011, when available, will be found at www.Medicare.gov.  The Department of Health and Human Services has not yet announced if there will be any Medicare premium changes for 2011.  Should there be an increase in the Medicare Part B premium, the law contains a “hold harmless” provision that protects more than 70 percent of Social Security beneficiaries from paying a higher Part B premium, in order to avoid reducing their net Social Security benefit.  Those not protected include higher income beneficiaries subject to an income-adjusted Part B premium and beneficiaries newly entitled to Part B in 2011.  In addition, almost 20 percent of beneficiaries have their Medicare Part B premiums paid by state medical assistance programs and thus will see no change in their Social Security benefit.  The state will be required to pay any Medicare Part B premium increase.

For additional information about the 2011 COLA, go to www.socialsecurity.gov/cola.

For additional information about changes in the national average wage index, go to www.socialsecurity.gov/OACT/COLA/AWI.html.
.....For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers who have sought Social Security Disability Insurance (SSDI) Benefits.

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3d Circuit Denies SSDI Claim Where Work Comp Claims Alleged to be a Stressor

The US 3rd Circuit Court of Appeals denied a claim for Social Security Disability Benefits where the claimant alleged that his workers' compensation claim was as stressor and the anxiety caused him to become totally and permanently disabled.

Wright v. Commissioner of Social Security, 2010 WL 2676382 (3rd Cir.(Pa.))

To read more about social security disability click here.

Click here for more information on office of Jon L. Gelman t. 973.696.7900 can assist you in a Social Security disability application/appeal.

CMS to Rely on New Life Tables for Workers Compensation Set Aside Agreements

The Centers for Disease Control (CDC) has recently published its 2006 United States Life Tables. Effective July 19, 2010, the Centers for Medicare & Medicaid Services (CMS) will begin referencing the CDC's Table 1: Life table for the total population: United States, 2006, for WCMSA life expectancy calculations. This means that for any newly submitted WCMSA proposal received by CMS' Coordination of Benefits Contractor (COBC), or where any WCMSA case is reopened on or after July 19, 2010, CMS will apply the CDC's 2006 Table 1 for life expectancy calculations.


In 2006, the overall expectation of life at birth was 77.7 years, representing an increase of 0.3 years from life expectancy in 2005. From 2005 to 2006, life expectancy at birth increased for all groups considered. It increased for males (from 74.9 to 75.1) and females (from 79.9 to 80.2), the white (from 77.9 to 78.2) and black populations (from 72.8 to 73.2), black males (from 69.3 to 69.7) and females (from 76.1 to 76.5), and white males (from 75.4 to 75.7) and females (from 80.4 to 80.6).


Click here to read more about Medicare Secondary Payer Act and workers' compensation.


Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon  Gelman or call 1-973-696-7900.

Delays Continue to Soar for Social Security Disability Determinations

The number of pending Social Security disability claims continues to increase. Congressman Rob Filner  of California has introduced legislation to federalize the State Disability Determination Services (DDS).

Filner, at a recent joint hearing of the Ways and Means Committee  testified the backlog of Social Security Disability claims is continuing to mount. In California alone, 40,000 cases were involved in the backlog and 1,000 new cases were being added each month. State imposed furloughs have complicated the process even further.


To read more about social security disability click here.

Click here for more information on how our office can assist you in a Social Security disability application/appeal.

Social Security at a Critical Crossroads

The last safety net for injured workers, Social Security, is now facing severe economic challenges ahead. At a recent hearing before the US House Ways and Means Committee testimony was presented that the system is now at a critical crossroad because of a surge in disability applications complicated by an increasing administrative backlog.

Beth Bates, testified on behalf of the Consortium for Citizens with Disabilities, “...The wave of new claims is having a very significant impact at the state Disability Determination Services (DDSs) that will eventually affect the hearing level.  At the DDS levels (initial and reconsideration), the number of new applications, applications waiting for a decision, and processing times are all on the rise.  In fiscal year (FY) 2009, SSA received 385,000 new claims, an increase of nearly 15% since the end of FY 2008.  Even more worrisome is the growing backlog of pending initial claims at the DDSs, i.e., those waiting for a decision, up nearly 40% since the end of FY 2008.”

Click here for the complete transcript

Click here for the Subcommittee on Social Security Chairman Tanner Announces a Hearing on Clearing the Disability Claims Backlogs: The Social Security Administration’s Progress and New Challenges Arising From the Recession

Click here to read more about Social Security and workers’ compensation

Social Security's Inconsistencies

The News Journal of Delaware has reported broad statistical inconsistencies in the Social security claims determination process. In an 11 part series entitled, "Shut Out of Social Security," the paper analyzed statistical data from all states, hearing office and administrative law judges revealing variances in percentages of workloads and denial rates for disability benefits.

To read more about Social Security and productivity reports click here.