Council Seldom Grants An Exception
The most recent issue of the newsletter of the National Organization of Social Security Claimants Representatives (NOSSCR), which is not available online, has an article prepared by Social Security’s Office of Appellate Operations Staff on the exception process at the Appeals Council. Generally, a claimant may not file a new claim for disability benefits while an old claim is pending at the Appeals Council. However, there is an exception process where there is evidence of a new critical or disabling condition. Here’s a table from the article showing just how infrequently the agency finds grounds for an exception:
Does it seem outrageous to you that any claimant could file a new claim while an old one is pending at the Appeals Council? What do you think about the fact that the Appeals Council sits on most cases for well over a year and often over a year and a half yet denies review something like 80% of the time? It almost seems like the delay is intentional, just to make taking a case to the United States District Court less appealing. Whether it’s intentional or not, that’s the effect. I don’t think that’s appropriate.
Exclusions, barriers, bans and hurdles describe many injured workers’ experiences with workers’ compensation. A system that was supposed to assist them and provide streamlined procedures to recoup medical costs and lost wages has become a nightmare for individuals who’ve been injured on-the-job. A new policy brief by the National Economic & Social Rights Initiative (NESRI) describes seven destructive trends in workers’ compensation laws which reflect the attitude of many in state legislatures who “see workers’ comp as an unnecessary cost for business rather than a critical health care and social insurance program.” NESRI’s list them as the following:
More workers’ health conditions are excluded from coverage (e.g., some state laws explicitly disallow claims for hearing loss, repetitive motion injuries and back disease.)
Increased procedural barriers to workers claims (i.e., originally designed to be a “no fault” system, most workers have to retain lawyers and their own medical experts to support their claims.)
Reduced income support for disabled workers (e.g., a fixed number of weeks of pay for disabled workers, regardless of the individual’s condition or advice from a physician.)
More employer control over workers’ medical treatment (e.g., workers are forced to use physicians selected by the employer or insurer who have a vested interest in saving money.)
End to universal mandates that employers carry workers’ compensation insurance (e.g., in 2013, Oklahoma joined Texas in allowing employers to “opt out” of carrying work comp insurance.)
Bans on workers suing insurers for dishonest and misleading practices by insurers.
Reduced access to attorneys (e.g., cutting the fees that an attorney can charge for handling a worker’s case.)
None of this is new to public health researchers and organizations who’ve studied workers’ experiences with the workers’ compensation system (e.g., here, here, here, here, here, here.) As Les Boden, PhD wrote in a 2012 article in the American Journal of Industrial Medicine:
“The sorry and declining state of workers’ compensation in the U.S. is largely the consequence of the political power of employers and insurers, bolstered by their ability to frame the political debate. Employer costs per $100 of covered wages declined from $2.18 in 1989 to $1.33 in 2009, reflecting both legal restrictions on workers’ compensation and declining reported injury rates. Yet even today the debate in the states is about excessive employer costs and employers’ threats to move to states (or countries) with lower workers’ compensation costs. The simplest way to reduce costs is to reduce the amount of benefits paid to workers, through raising barriers to approval of claims or reducing the benefits in claims that are approved.”
The impact of the destructive trends described in NESRI’s brief are made real through the voices of injured workers. Robert Hudson, 61, was working for the school district in Addison, New York when he was exposed to muriatic acid while cleaning a swimming pool. He’d never cleaned a pool before and wasn’t trained on how to do it safely. “I was a company man and I wanted to get the job done,” explained Hudson.
Injuries to his respiratory system were severe. Hudson wanted to continue working, but could no longer climb ladders or the other physical work required by the job. His doctor says he is permanently disabled. He used his paid sick leave and personal leave for three months while waiting for the workers compensation system to make a decision about his case. It was seven months later when he received his first payment from work comp for lost wages. His weekly payment was $202.36 compared to the $400 he used to earn. In a report prepared by the New York Committee for Occupational Safety and Health (NYCOSH), Hudson describes his frustration with the workers’ comp system:
“They keep sending me to independent medical examiners to prove my condition is not what my doctors are saying it is. I am being badgered. The procedures are flawed. My life as it was is ended now. I can never work again. I am tired of being screwed by all these people. They don’t have to live with the constant worry, and coughing their brains out all night long…”
In 2009, the American Public Health Association (APHA) adopted a policy statement calling for reforms to the workers’ compensation system. Not the pro-business “reforms” that create hurdles for injured workers, but improvements to create a safety net for workers and their families. Among others, APHA proposes a national system with
uniform coverage of health care and adequate loss-of-earnings benefits for all occupational injuries and illnesses;
health care for injured workers provided by providers independent of employer involvement and insurance industry control;
health care providers removed from the responsibility of determining eligibility for benefits;
an emphasis on prevention of injury and illness, and rehabilitation of those unable to return to work, and
mandatory root cause investigation requirements for all occupational injuries and illnesses.
The US workers’ compensation system—dating back to Wisconsin’s law in 1911—stems from a bargain between workers and employers. Workers who are injured or made ill from hazards at work would receive medical care and payment of lost wages while they recover. In exchange, employers could not be sued by workers for the harm the employer caused. The destructive trends profiled by NESRI, however, illustrate that decades of “reforms” make the bargain no longer a good deal for injured workers.
The simple answer is yes, you can. Assuming you are seriously injured at work you can receive both. However, there is an offset and your SSD will be lowered by the 80% rule. In essence, your SSD monthly payments will be reduced if your comp and SSD payments together exceed 80% of your regular monthly pay.
In this case, you are trading dollars and in many cases a workers compensation settlement in Michgan is a valid option.
Many choose to take the lump sum settlement from Michigan Workers Compensation to get away from the insurance carrier, the adjuster and the insurance carriers investigators. The worker’s Compensation settlement in Michigan, is tax-free is the only place that will pay a lump sum settlement. Social Security disability will only pay monthly payments and usually your monthly payments from Social Security will be maximized if you settle your Michigan Worker’s Compensation case.
Social Security Disability: The Initial Application Stage
The initial stage of the Social Security Disability process involves the initial filing of your Social Security Disability application and the Social Security Administration’s review of your initial claim. In this stage of the process you will be filling out your application and providing the SSA with the documentation necessary to process your claim for Social Security Disability benefits. The Social Security office will then send your file to be reviewed for approval or denial based on the information provided in your application.
Applying for Social Security Disability Benefits
You can file your application for Social Security Disability online, over the phone or at your local Social Security office. You will be required to answer questions pertaining to your disability and your work history and will likely have to fill out a detailed Activities of Daily Living Questionnaire. It is important to prepare as much as possible before you apply to have the best chance of getting approved. Your medical records will need to be provided to the Social Security examiner and you may be asked to undergo a consultative exam. There must be evidence that your disability will last twelve months or longer in order to qualify for disability benefits.
When applying for disability benefits, you will be required to provide the Social Security office with certain personal information. It is helpful to have this information ready when completing your application for Social Security Disability benefits. Some of the personal information and documentation needed to complete your application include your social security number, your birth or baptismal certificate, the contact information for your doctors and the dates of your visits, the names and dosages of the medications you are taking, a complete history of your medical records, a copy of your most recent W-2 and a detailed work history.
Evaluating Your Claim for Social Security Disability Benefits
Once you have submitted your application, the Social Security office will check to see whether or not you have worked enough to qualify for Social Security Disability benefits and whether your current employment status disqualifies you from receiving disability benefits. If you meet the necessary criteria, the Social Security office will send your application to the Disability Determination Services department for a full review. It is this department that will be making the actual decision as to whether or not your disability claim is approved.
The Disability Determination Services office will review the information and medical records you have provided with your application for disability benefits. If the examiner reviewing your case does not have enough medical documentation to prove your disability, he or she may require you to attend a consultative exam. In some cases, more than one consultative exam may be requested.
After the Disability Determination Services have received all of the information needed to process your claim the employees with gather to evaluate the information within your file and will make a decision based on that information. They will approve or deny your claim based on the medical evidence provided, whether or not your specific disability is included in the Social Security Listing of Impairments, if you are able to perform the work you were doing prior to your disability and whether or not you are capable of performing any type of work at all.
Once the SSA approves or denies your claim they will send you a letter notifying you of the decision. If you are approved for benefits, your letter will state the amount of your monthly benefits and when those benefits will begin. If your application was not approved, the letter will explain why you were denied Social Security Disability benefits and what you need to do if you want to appeal the decision.
The Disability Determination Services only approves approximately 37 percent of the initial Social Security Disability applications received by the SSA. The remaining 63 percent of applicants are denied benefits. Many of those denied applicants go on to appeal the decision made by the Disability Determination Services. Hired a qualified disability lawyer will improve chances of being approved at the initial stage.
The Application Processing Time-Frame
It normally takes between three to six months for a Social Security Disability applicant to receive a decision on their initial application. The exception to this rule is those applicants who qualify for Social Security’s Compassionate Allowance program. The Compassionate Allowance program helps people with severe disabilities get approved for Social Security Disability benefits more quickly. If you have one of the disabilities listed under the Compassionate Allowance program, your initial application may be processed in as little as twenty days.
Crucial Information regarding your social security credits.
Each week you work, money is taken out of your check to fund the social security disability fund. If you work for approximately 6 continuous years you will earn 40 social security credits. Once you earn 40 social security work credits, you are eligible to be approved for social security Disabilty payments if and only if, you can prove to the federal government that you are disabled. WHAT PEOPLE DONT KNOW ABOUT THEIR SSD CREDITS. If you stop working completely, your SSD credits expire in 5 years. If this happens you are no longer able to obtain SSD benefits even if you are disabled. I am finding more and more people in their 50s and early 60s that don’t know that their credits expire. Many people stop working, thinking they will get better and go back to work. They call my office after their credits have expired. This is a huge problem. Please keep in mind that even though you have worked for 20 to 40 years, your SSD credits expire in 5 years. You must file and prove Disabilty before your credits expire.
Should I get a Social Security disability attorney for my initial application and first appeal?
While you can file the initial application and the initial appeal on your own, I would highly recommend that you obtain experienced attorney help, from an attorney that specializes in Social Security cases. I say this because the initial application asks you many questions that can be used against you at a later time. How you answer the questions on the initial application can have a major impact on if you’re case is denied initially and/or denied if you how youon appeal. Again I would suggest that you hire counsel to advise you for the entire process of applying for Social Security disability