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Thursday, September 19, 2013

What is the Date Last Insured, and Why Does it Matter?

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

A person who has been out of the labor market for quite some time before he applies for Social Security Disability (SSD) may find that his application for benefits is rejected because he cannot prove he became disabled before his date last insured.  

In order to qualify for benefits in the first place, a person must pay Social Security taxes long enough to have insured status. When the individual stops working and therefore stops paying into the system, eventually he will hit his date last insured and lose his insured status. It is a little like a private insurance policy: when you stop paying the premiums, you no longer are covered by the policy.  For a person who has work steadily in his lifetime, the date last insured is arrived at and insured status lapses about five years after stopping work.
 The Social Security Administration has another program for the medically disabled called Supplemental Security Income (SSI) where there is no date last insured rule, but there are other program requirements and limitations. In a future article, we will explore the differences between the Social Security Disability (SSD) and Supplemental Security Income (SSI) programs.   
     As an example of how the date last insured issue can prevent a person from getting Social Security Disability (SSD) benefits, consider the case of a 35 year-old woman who has worked steadily since her late teens. She and her husband have twins when she is in her mid-30s. There are a lot of late night feedings and diapers to change! She stays home to take care of the twins while her husband continues to work to support the family. When the twins turn five, she begins to think about returning to work, perhaps when they go into first grade a year or so later. Five years has passed, and she reaches her date last insured. She loses her insured status and has not yet returned to work. When the twins turn six, she gears up her job search, but has not yet re-entered the labor market. Then medical catastrophe strikes: she has a very disabling stroke – unusual in a person this young, but not unheard of. She clearly cannot work. She applies for Social Security Disability and is turned down because she did not become disabled before her date last insured. Unlike the Social Security Retirement program, where it is possible to collect Social Security Retirement (SSR) benefits on the earnings record of one’s spouse, the Social Security Disability program only allows for benefits to be paid on the basis of one’s own earnings record.

     Consider another scenario with this family of four. When the twins are three, mom is diagnosed with Multiple Sclerosis. This condition can progress slowly or more quickly. In her case, she suffers a fairly quick progression of symptoms. By the time the twins are six and going into first grade, she is ready to return to work, except that she is suffering a variety of MS symptoms, including the profound fatigue that is experienced by many with this disease. Her combination of symptoms prevents her from working, so she applies for Social Security Disability. She passed her date last insured when the twins turned five. Will she get benefits? That depends. She certainly can apply for benefits after her date last insured, but she must be able to show that her symptoms had become sufficiently severe to prevent her from working before her date last insured. We have handled many cases where the individual is out past his or her date last insured. The key is to obtain all of the medical records that help to document the seriousness of the medical condition before that date last insured. Sometimes these can be buttressed with statements from family members or close friends who were in a position to observe at close range how seriously the person’s medical condition was affecting her functioning prior to the date last insured. In the case above, a statement from the husband likely would be helpful.

     The Social Security Administration has another program for the medically disabled called Supplemental Security Income (SSI) where there is no date last insured rule, but there are other program requirements and limitations. In a future article, we will explore the differences between the Social Security Disability (SSD) and Supplemental Security Income (SSI) programs. 

Photo credit: Đˆerry / Foter.com / CC BY

Medical Costs Still Treading Upward

The cost of medical treatment in workers' compensation claims, despite a resumed trend in lower claims, is continuing to increase.

View complete report: NCCI Workers Compensation Claim Frequency—2013 Update 

Oklahoma Work Comp Opt-Out System Under Legal Attack

The recently enacted, and high innovated cost-savings opt-out program in Oklahoma workers' compensation has come under direct legal attack as being unconstitutional.

On Tuesday, Sen. Harry Coates (R-Seminole) joined Rep. Emily Virgin (D-Norman) and the Professional Firefighters of Oklahoma in filing a challenge against the constitutionality of Senate Bill 1062, the workers’ compensation reform bill passed by the legislature and signed by Gov. Fallin during the 2013 legislative session.

“As a longtime businessman, I recognize that it’s necessary to have workers’ compensation rates as low as possible. In fact, I believe we need a workers’ compensation administrative system, just not the unconstitutional and unworkable system created by Senate Bill 1062.

It’s wrong that a fire fighter or any other injured worker should have to pay back benefits after returning to work. This is just one of many problems with this new law.

Instead, I’d support a bill that would give Oklahoma an administrative system like that in Missouri, which is working very well only a few years after being approved by that legislature. Back in 2005 when Missouri went to an administrative system, The Oklahoman advised the Oklahoma legislature to adopt the Missouri workers’ compensation system. That was good advice!

In 2012, the often-quoted Oregon Study showed that while Oklahoma had the sixth highest workers’ compensation rates in the nation, Missouri had one of the lowest rankings at number 36. Oklahoma was 47 percent ABOVE the national median and Missouri was 14 percent BELOW the study median.
Oklahoma needs to pass the Missouri law with no amendments and no changes. Missouri and Oklahoma have similar constitutional provisions regarding injuries, and the Missouri law has already survived constitutional tests. There is no doubt that their administrative system could work in Oklahoma and reduce rates for businesses, small and large.

I appreciate Rep. Emily Virgin and the Professional Firefighters of Oklahoma for joining me in this effort.”

BP claims investigation finds attorney took $40K kickback in exchange for expediting nearly $8M claim

Today's post was shared by Legal Newsline and comes from legalnewsline.com



The results of a two-month long investigation into allegations of fraud within the 2010 oil spill settlement program have revealed an alleged kickback scheme enacted by a claims attorney.

Lionel Sutton, a former senior attorney within the Court Supervised Settlement Program, or CSSP, is accused of taking a $40,000 referral fee from the Andry Lerner Law Firm and attempted to more quickly resolve a claim worth $7,908,460.

The New Orleans firm, which bills itself as “BP Oil Spill Lawyers” on the firm website, is accused of using Sutton’s position within the claims center to make the acceptance of the claim in question faster and easier.
Freeh
Freeh
The investigation was headed by ex-FBI Director Louis B. Freeh who was asked to be a special investigator on the case by U.S. District Judge Carl Barbier in early July after claims administrator Patrick Juneau revealed that an internal investigation into the CSSP showed potential conflicts of interest.

The $7.9 million claim in question was originally a case handled by Christine Reitano, Sutton’s wife, who shortly after receiving the case became an employee of the claims administration office. Subsequent to her appointment Sutton is alleged to have referred the case to the Andry Lerner Law Firm for a referral fee to be paid to Crown LLC, a water reclamation company he owned and in which Andry Lerner partner Glen Lerner had invested $1 million.

Freeh stated in the report that...
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CDC: Antibiotic-resistant bugs sicken 2 million a year

Concern for the spread of infections has lead to a heightened sense of concern in the workplace. New electronic hand washing faucets, and the sprouting up of hand cleansing stations. Workers compensation continue to pay the price for the spread of infections. Today's post was shared by CIDRAP and comes from www.cidrap.umn.edu


The US Centers for Disease Control and Prevention (CDC) said today that antibiotic-resistant pathogens sicken 2 million Americans a year and listed the three most urgent threats as Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), and Neisseria gonorrhoeae.

The agency's first all-encompassing report on antibiotic disease threats spans 114 pages and ranks the pathogens in part to spur a multipronged effort to prioritize and battle the problems. Antibiotic-resistant microorganisms play a role in 23,000 deaths each year, the CDC said.
At a media briefing today, CDC Director Tom Frieden, MD, MPH, said the landmark report provides a snapshot of the antibiotic-resistant organisms that have the biggest impact on human health. He said the numbers are very conservative estimates that don't take into account infections that occur outside hospitals, such as nursing homes and dialysis centers.

The numbers are worrisome, because so few antibiotics to battle the new pathogens are in the development pipeline, he said. "If we don't take action early, the medicine cabinet will be empty for patients with life-threatening infections."

The CDC ranked the antibiotic-resistant organisms based on seven criteria: health impact, economic impact, how common the infection is, 10-year projection of how common it will become, ease of spread, antibiotic availability, and prevention barriers. It also grouped the organisms into three groups, based on threat level.

Topping the list is C...
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Wednesday, September 18, 2013

Many States Look to Raise Minimum Wage

The trend to raise minimum wages will ultimately raise workers' compensation rates and premiums. It is a necessary item to maintain a productive and healthy workforce,Today's post was shared by Steven Greenhouse and comes from www.pewstates.org

California’s recent decision to raise its minimum wage to $10 an hour by 2016—a higher minimum rate than any other state has now—may add momentum to the drive for higher hourly rates in at least eight other states in 2014.

New Jersey could become the fifth state this year to increase its state minimum wage if voters approve a measure on Nov. 5 that would boost the hourly rate by $1, to $8.25.

In states as varied as Alaska, Idaho, Massachusetts and South Dakota, advocates are pushing to put minimum wage hikes on state ballots in 2014. Meanwhile, elected officials are leading the charge in Hawaii, Illinois, Maryland, Minnesota, and the District of Columbia.

The action at the state level comes as organized labor and liberal groups have backed a wave of strikes by fast-food workers in cities across the country to put a spotlight on hourly wages.  Advocates are pressing for a national $15 hourly wage, more than twice the $7.25 federal minimum wage.

States cannot set a minimum wage that is lower than the federal standard, but they are free to establish a higher one. Washington state currently has the highest state minimum wage at $9.19; followed by Oregon ($8.95) and Vermont ($8.60). Connecticut, the District of Columbia and Illinois all have a state minimum of $8.25. In addition, some 120 cities have enacted “living wages” that set a minimum standard for businesses that receive city contracts. City minimums range from $9 to $16 an hour.
...
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For Workers Leaving Their Jobs, Health Exchanges Offer Insurance Choices Beyond COBRA

The Affordable Care Act will impact all areas of the delivery of medicine in the workplace.Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org


Workers who lose their jobs and their employer-based health insurance will have new coverage options when the Affordable Care Act's state marketplaces open in October. But consumer advocates are concerned many may not realize this and lock themselves into pricier coverage than they need.

Today, the only option for many laid-off workers is to continue their employer-provided coverage for up to 18 months under the federal law known as COBRA. Because they have to pay the entire premium plus a 2 percent administrative fee, however, the coverage can be a financial hardship for people who are scrambling to keep up with expenses after losing their jobs.

Many of these people will likely be better off buying a plan on the state health insurance marketplaces, also called exchanges. Plans sold there must cover a comprehensive set of 10 "essential health benefits," and consumers can choose among four plan types with different levels of cost-sharing. Premium tax credits will be available to people with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for an individual in 2013), often making exchange coverage significantly more affordable than COBRA.

"COBRA was a transitional type of coverage while you're between jobs, but now we have a subsidized form of coverage available, exchange plans with subsidies," says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.
It's...
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