Medical Care in Workers Comp and Social Security

Unless you qualify for medicare or medicaid or other state assistance a claimant seeking Social Security disability gets no medical care except any he can obtain on his own. Often in my town an impoverished person can try for Peak Vista which is a community facility manned by hard working dedicated people. Once you obtain SSDI (the typical Social Security disability) then medicare is possible (it kicks in after you've received 2 years of benefits but this could be soon if you were entitled to back amounts). What I do mean to point out is that you have no right to medicare until it kicks in but sometimes the agency will send you for an examination on your case. It is not treatment. In workers comp the process is different. Even in a contested case you may be able to obtain medical care though it is not always extensive until the claim is admitted or ordered to be covered. My problem is that in workers comp even in an admitted case there can be controversy over the extent of care. Insurers love to question causality by suggesting maybe the problem is not work related. Insurers love to second guess even the dedicated doctors by saying the surgery or expensive treatment requested may not be reasonable or necessary. I recall one time where my spouse using her health coverage had a knee operation many months before my workers comp client had his knee surgery. Delays seem to cause more expense and even medical complications. Of course in workers comp a covered treatment is paid 100% but nothing by the claimant. Also in workers comp long term care can be covered for life at zero expense to the claimant if it is appropriate. But for me I keep thinking that we should all have a national health plan and then all we would quibble about in workers comp is the extent of disability not wait while we dispute the treatment. Some physicians have a website calling for this at :

http://www.pnhp.org/

The Failure of Workers Compensation

Over at the website for the Center for Justice and Democracy they take on the current workers comp system. By and large they speak accurately in pointing out the flaws in the system. Here is a link to the summarized version of their criticism:
http://centerjd.org/MB_2007workerscomp.htm

Cost of Living Increases

Colorado workers comp benefits do not have a cost of living benefit. Someone left a comment and I thought it deserved a post by itself. There was a brief period when there was a cost of living benefit but that ended with claims which arose by 1994. In Social Security there are cost of living adjustments made yearly. Such is life and the only way to change it is to change the law.
It is regretable if not shameful that we limit benefits to those injured at work. It seems as if the old and disabled are pushed to the side by society despite being there and shouldering the load for us. Then we so limit benefits that we impoverish many of them. Taking care to honor and protect them is not part of our system. The recent VA problems at a VA Hospital indicate it even pertains to our soldiers. Sorry but that is simply wrong. The workers, the soldiers and the old did so much for us that they should be honored and made as comfortable as possible. When I handle a case I know I try to maximize benefits but I also know that it is often not enough. They deserve our respect and laws which provide significant benefits.

Other Types of Claims from work injuries

While we only handle work injuries and disability claims if you have a workers comp claim it does not mean that you are limited to just that claim. Sometimes from a work injury there may be other types of claims. One easy and common example is when someone is severely hurt at work and obtains workers compensation benefits. That person may also have a claim for Social Security disability benefits (SSDI). If so the workers comp insurance company gets a credit of a portion of your SSDI benefits (this may also apply to some other types of Social Security benefits too so check with a lawyer). Still you may get both benefits if you are totally disabled even if one of the benefits is somewhat reduced. It is always better to get two checks then just one. Of course when and if you should apply for SSDI is a matter to discuss with your lawyer so don't just go for it without checking further. There are many situations where it is a big mistake to apply too soon for Social Security benefits. Now aside from SSDI or even other Social Security programs can there be other claims? Yes. For example if you are delivering for your job and hurt in an auto accident you may also have a personal injury claim. Again do not handle this on your own because it does affect other benefits. Or, let's say the equipment which injured you is defective....again this can lead to another claim on top of the work injury or disability claim. In that this is quite complex you will need a lawyer. Don't do it yourself. An injured worker may even be able to file for unemployment benefits especially if workers comp benefits are delayed or disputed. Also if you are totally destitute there may be other social programs to assist you. Colorado has aid to the needy disabled. If you are fired it may lead to a wrongful termination claim or claim for discrimination. So don't think you can only have one claim when you are hurt at work. Other claims or benefits are possible though each type of claim or benefit may also affect your workers comp benefits. Your attorney may have to concentrate on what his area of expertise is but he can make suggestions in the other areas so discuss this with him. In my practice we maximize the workers comp benefits and then also pursue Social Security disability benefits for those severely disabled. If other claims are discussed or known to us we suggest other attorneys who can help in those areas.

Initial Denials in Social Security cases

Colorado has one of the highest denial rates for those first applying for SSD or SSI benefits. In Colorado almost 70% are denied. Where is the best state to apply for benefits? DC also known as the District of Columbia is the lowest but Hawaii is the best place to live and apply as it grants more then half who initially apply. Tennessee denies 77% so it gets the worst place award. California? It denies 56.6% of those who first apply. Of course after any denial a claimant should consider appealing the denial. It is important to realize that the burden is always on the claimant to show he or she is unable to work and satisfy the requirements to obtain benefits. When you go down to apply on your own there are many forms to fill out but key factors are all your doctors and all the places you've worked in the past 15 years or so. Records are sought by the agency but be aware that it really is your burden to make sure all the important records are submitted to the agency. Sometimes doctors forget to submit records or there are recent records for recent treatment. Make sure all this is given to the agency and if you are not sure go get the records yourself and submit them. Expecting others to care about you and take care of you and be diligent to protect your rights is true if you've retained a lawyer but don't expect the agency to do so.

Delays in Workers Comp cases

Previously I've mentioned about the delays to obtain a hearing in Social Security cases. But that situation is simply a matter of waiting for a hearing date and sprucing up the case for the hearing. In workers compensation the delays are varied depending on the case. Cases seldom proceed in a straight line or so it seems to me. One delay is when the claim is contested. This alone can take a hearing. Another delay can be with medical treatment. Sometimes the treatment is not thorough and yet unless there is a change of doctors (which also can lead to delay) the claimant has to go to a separate examination (called a DIME and mentioned previously). This also can take more then two months to arrange and even more time to wait for the results and still more time to await the insurers response. Sometimes further medical treatment is deemed needed and this is delayed until sometime after the DIME evaluation. Surgery adds still more months to the process and that is assuming it all goes smoothly. If the insurer disputes the need for surgery or other treatment it can take another hearing. Many cases often seem to take two years or more to wrap up if you are intent on protecting the rights of the claimant. I can say that most delays are based on medical issues or treatment. With medical care there is no certain timeline for recovery. Asking your lawyer when all this will be finished is often met with vague answers but the reason is simple: the legal matters cannot be finished until all appropriate medical treatment and conclusions are provided. If you wish to get it all over with sooner then you also must waive all further rights and benefits for a cash settlement. Such a settlement is seldom wise and often impossible to fairly analyze. While cases can be settled it is rare to try to do so until all the steps have been taken both medically and legally. Again this means delay. Imagine deciding you have to settle your case and move on with your life. You do so for quick cash and give up all your rights. Then you seek to return to work but find out you can no longer do your trade. You also find out that your back injury acts up on you but no one will pay for further treatment. By then you figure you made a mistake but its too late. By settling too soon there is no do over...its just done. So workers comp delays are terrible because your life is on hold but better to protect yourself before you are cut loose without anything further. In fact in some cases you are never finished. Your injury or complications from it can mean there is a need for lifetime medical care. From the time I take a case to the end of it usually takes from one to two years. There are exceptions where it is just a few months on the short side to well over two years on the long side.

Maximum permanent partial disability rate

Unless you are permanently and totally disabled the most you will be paid for having a permanent injury is based on specific state calculations and the medical rating (degree of impairment by either the authorized doctor, a Division IME doctor or by order). Your wage is often a factor in the calculations as is your age. But what I'd like to point out in this note is that the payment is biweekly until the amount is exhausted. A claimant can get an advance or even a lump sum but otherwise the amount is paid out every two weeks at a set rate. The highest rate for these biweekly checks changes each year but at present it is $413.95 a week. It can be less as it must be computed for each person. What this can mean is that you've been receiving temporary benefits of two-thirds your average wage which can drop down to the rate set for permanent benefits. The theory is that when permanency is determined you can return to work or find new work and receive the biweekly permanency checks anyway unlike temporary money where earnings are deducted. You or your attorney can get an advance if properly done so you might look into it. All this pertains to whole person impairments only. Scheduled extremity amounts are paid out differently. Here is the link for the maximum calculation:
http://www.coworkforce.com/DWC/FormsDeskAids/DESKAIDS/PDFDeskaids/Desk_Aid_4_Max_Rates.pdf