Tag Archives: Benefits

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Contact a Workers’ Compensation Lawyer, Even if Your Medical Bills Are Being Paid: Here’s Why

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

Nebraska is a state that has a “prompt payment rule” for medical expenses in workers’ compensation cases. This means that so long as your employer has sufficient knowledge that your medical care is necessary because of the injury, your bills should be paid. This is a huge plus because even a minor workers’ compensation injury can cause an employee to rack up thousands of dollars in medical bills.   

In Nebraska, delay of medical payment is treated as a denial of a claim. That is why a delay in paying for medical bills from a work injury gives the employee the right to pick their own doctor for a work injury.

The issue of doctor choice brings up a couple of the hidden dangers of the prompt payment rule.  Many times, employers will promptly pay medical expenses for doctors who will oftentimes release employees before they are done healing and return employees back to work before they are ready. Employees need to be able to know their doctor-choice rights before they agree to an employer/insurer-oriented clinic or doctor – especially if that doctor is not their family doctor.  link know their doctor choice rights to  title Physician choice crucial to work comp claimants )

Secondly, employees can get lulled into contentment when an employer pays their medical bills. Medical benefits are one aspect of workers’ compensation benefits; the other is loss of income benefits. An employer/insurer may use their leverage with a doctor to minimize loss of income benefits. Also, when employees get into litigation, they are oftentimes confused by the fact that an employer will pay for medical benefits, but not loss of income benefits, or will deny that the injury is even work related. This is related to the prompt payment rule. Just because an employer pays medical bills, that doesn’t necessarily mean that they or a workers’ compensation judge will believe those medical bills are related to the work accident.

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Disability, USA? A Different Point of View About Social Security Disability Benefits

Today’s post comes from guest author Barbara Tilker, from Pasternack Tilker Ziegler Walsh Stanton & Romano.

You may have seen a recent report on 60 Minutes regarding the Social Security Administration’s disability program.  If, after watching that report, you became concerned that either a) Social Security would soon run out of money, or b) Social Security was paying disability benefits to either outright frauds or those who just aren’t disabled, I wouldn’t blame you.  That’s not because those things are true, but because this “report” was extremely biased and inaccurate.  The truth is that Social Security is well-funded and will be able to pay benefits well into the future, if not indefinitely.

It’s true that applications for Social Security disability benefits increase when the unemployment rate goes up.  What’s not true, however, is that otherwise healthy people are drawing a disability check during bad economic times.  The Center for Retirement Research at Boston College recently published a report that concluded that applications for benefits did rise when the unemployment rate went up, but that most of these “extra” claims were denied.  Those who were approved tended to be older individuals working physically demanding jobs whose bodies were just worn out after years of hard labor.  

Applications for disability benefits have increased recently, and a large part of that increase can be attributed to the fact that Americans are simply getting older.  One of the consequences of getting older is that your body doesn’t work as well as it used to, and you become much more likely to get a chronic disease such as diabetes.  It’s no surprise that disability applications will increase as more and more Americans enter the most disability-prone category of their lives.

People might worry that this increase in applications means that Social Security will soon run out of money to pay benefits.  60 Minutes didn’t do anything to allay those fears, stating several times that the trust fund is going broke in the next few years.  The disability trust fund currently only receives a fraction of the amount collected in payroll taxes, with the vast majority going to the retirement trust fund.  There is a simple fix for this problem – the government can either give more of each dollar to the disability fund, or transfer some money from the retirement fund to the disability fund.  In fact, this has been done several times, but with the money going from the disability fund to the retirement fund.  Social Security is well-funded and in no danger of going broke – don’t let anyone tell you otherwise.

60 Minutes also made it appear that disability benefits are there for anyone who applies, with no need to present any medical documentation to back up their claims.  Those who have been through the process know that this is just false.  The standard of disability for Social Security’s program is extremely high.  Only those who are truly disabled – and who have the documentation to back it up – are awarded benefits. 

There are some people who try to game the system and get benefits that they are not eligible for.  Due to Social Security’s strict standards, most of these people are denied benefits in the first place.  For those that do resort to fraud, Social Security has an investigative unit dedicated to finding these individuals.  Once caught, they face stiff penalties, including restitution and jail time. 

Despite what 60 Minutes would have you believe, Social Security’s disability program is well-funded, and only pays benefits to those who can prove they deserve them.  Don’t be fooled by sensationalistic programs designed to mislead rather than inform.

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Your Social Security Benefits After The Defense Of Marriage Act (DOMA) Decision

Today’s post comes from guest author Barbara Tilker, from Pasternack Tilker Ziegler Walsh Stanton & Romano.

Nearly two months after the Supreme Court struck down Section 3 of the Defense of Marriage Act (DOMA), the Social Security Administration has announced that it will start to pay benefits to some individuals in same-sex marriages. In order to be eligible for benefits, these individuals must meet the same criteria as individuals in opposite-sex marriages, in addition to several other requirements.

Only applications for spousal benefits are being approved right now. Spousal benefits are payable to a spouse who either 1) did not work enough to be entitled to Social Security benefits or 2) worked enough to be entitled to Social Security benefits but would be entitled to a larger benefit on their spouse’s earnings record.  This is generally the case when one spouse earned significantly more than the other spouse over the course of their working lives. The individual on whose earnings record the claim is made (the number holder, in SSA’s terms) must also be entitled to old-age or disability benefits from Social Security. In order to receive spousal benefits, you must be at least age 62 and have been married to the number holder for at least one year.

The individual applying for benefits (the claimant, in SSA’s terms) must show that he or she was married to the number holder in a state that permits same-sex marriage and that the number holder is living in a state that recognizes same-sex marriage either 1) when the application for benefits is filed or 2) while the application is pending a final determination. It does not matter what state the claimant lives in. What matters for SSA’s purposes is the state the number holder lives in. This only matters when spouses live in different states.

Below is a chart from SSA that shows which states recognize same-sex marriages performed in other states, and when those states permitted same-sex marriages.  If a state is not listed, it does not recognize same-sex marriages performed in other states or permit same-sex marriages to be performed.

Before filing a claim for benefits or moving to a different state, you should consult with an experienced attorney or with the Social Security Administration to determine your eligibility for benefits.  As SSA continues to pay benefits to more individuals in connection with the Supreme Court’s decision, we will provide updated information regarding who may be eligible for these benefits.

State

Date Same-Sex Marriages from Any Other State Was Recognized

Date Same-Sex Marriages Were Permitted in the State

California June 17, 2008 – November 4, 2008

June 26, 2013 – present

June 17, 2008 – November 4, 2008

June 26, 2013 – present

Connecticut November 12, 2008 November 12, 2008
Delaware July 1, 2013 July 1, 2013
Iowa April 30, 2009 April 20, 2009
Maine December 29, 2012 December 29, 2012
Maryland February 23, 2010 January 1, 2013
Massachusetts May 17, 2004 May 17, 2004
Minnesota August 1, 2013 August 1, 2013
New Hampshire January 1, 2010 January 1, 2010
New York February 1, 2008 July 24, 2011
Rhode Island May 14, 2012 August 1, 2013
Vermont September 1, 2009 September 1, 2009
Washington December 6, 2012 December 6, 2012
Washington, DC July 7, 2009 March 9, 2010

 

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Slow Recovery Affects Workers’ Compensation Benefits and Costs

Today’s post comes from guest author Kit Case from Causey Law Firm.

A Press Release by the National Academy of Social Insurance

 

WASHINGTON, DC – Workers’ compensation benefits declined to $57.5 billion in 2010 according to a report released today by the National Academy of Social Insurance (NASI). The drop in workers’ compensation benefits was largely due to a 2.1 percent drop in medical benefits for injured workers. Employers’ costs for workers’ compensation also fell by 2.7 percent in 2010. As a share of covered wages, employers’ costs in 2010 were the lowest in the last three decades.

 

“As a share of covered wages, employers’ costs in 2010 were the lowest in the last three decades.”

 

“Employers’ costs as a percent of payroll declined in 43 jurisdictions,” said John F. Burton, Jr., chair of the study panel that oversees the report. “This decline is probably due to the slow pace of the recovery, with many jurisdictions still experiencing relatively high unemployment rates.”

 

Workers’ Compensation Benefits, Coverage, and Costs, 2010
Total

2010

Change   Since 2009 (%)

Covered workers (in thousands)

124,454

-0.3%

Covered wages (in billions)

$5,820

2.6%

Benefits paid (in billions)

$57.5

-0.7%

Medical benefits

$28.1

-2.1%

Cash benefits

$29.5

0.7%

Employer costs (in billions)

$71.3

-2.7%

Per $100 of Covered Wages

2010

Change   Since 2009 ($)

Benefits paid

$0.99

-$0.03

Medical benefits

$0.48

-$0.03

Cash benefits

$0.51

-$0.01

Employers’ costs

$1.23

-$0.06

Source: National Academy of Social Insurance, 2012.

 

The new report, Workers’ Compensation: Benefits, Coverage and Costs, 2010, is the fifteenth in the series that provides the only comprehensive data on workers’ compensation benefits for the nation, the states, the District of Columbia, and federal programs. 

 

“This report represents the first time the Academy has released employers’ costs by state.”

This report represents the first time the Academy has released employers’ costs by state. For a table showing employers’ costs for all fifty states and the District of Columbia, refer to Table 12 (page 34).

Most states reported a decrease in the number of workers covered but an increase in covered wages between 2009 and 2010. During the same period, the total amount of benefits paid to injured workers declined in 26 jurisdictions and increased in 25. As a share of payroll, benefits paid to injured workers fell by three cents to $0.99 per $100 of payroll in the nation.

The share of medical benefits for workers’ compensation has increased substantially over the last 40 years. During the 1970s medical benefits nationally accounted for 30 percent of total benefits, whereas in 2010 the share of benefits paid for medical care was almost 50 percent. Experts attribute this trend to the rising cost of health care.

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“I’m In It for the Money!”

Today’s post comes from guest author Roger Moore from Rehm, Bennett & Moore.

Surprisingly, many employers and insurance companies actually believe workers hurt themselves on purpose or at the very least put themselves in positions where they think an injury is likely. We hear this a lot as a basis for not settling claims for existing employees. Employers are worried that it will encourage other employees to get injured as well. What does that say about the particular employer who believes this? Either they are downplaying lots of injuries or they truly believe employees are willfully getting hurt.

The reality is that most of our clients come to us because their injury-related medical bills are not being paid or they’re not being paid for time off from work due to their injury.

In this age of limited, and in some cases very limited, workers’ compensation benefits, you would have to be an imbecile to actually believe people are willingly causing permanent injuries to themselves to cash in on the “windfall” that is workers’ compensation. Who would honestly trade even thousands of dollars for a lifetime of uncompensated pain and suffering? The reality is that most of our clients come to us because their injury-related medical bills are not being paid or they’re not being paid for time off from work due to their injury. The vast majority of them don’t even ask how much they could get for their injuries in their initial meeting with us, as I’m sure is the case with most workers’ compensation law firms.

This is one of a long line of personal-injury myths perpetrated by the insurance industry to make filing a workers’ compensation claim a stigma. It’s similar to the one about “if you file a claim our premiums will go up and they’ll have to shut down the plant.” Shouldn’t the question really be: are we requiring too much physically of our employees, and if so, what can we do to make things safer? Instead, Continue reading

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If You’re Going Out To Eat Check Out “Behind The Kitchen Door”

Today’s post comes from guest author from Jon Gelman, LLC – Attorney at Law.

For many celebrating the holiday season is inggo out to eat for an enjoyable experience. Unknown to many restaurant patrons are the problems of restaurant workers and include:  low wages, occupational stress and lack of medical benefits that requires restaurant workers to go to work sick.

Behind The Kitchen Door exposes the working conditions in the restaurant industry.

“How do restaurant workers live on some of the lowest wages in America? And how do poor working conditions—discriminatory labor practices, exploitation, and unsanitary kitchens—affect the meals that arrive at our restaurant tables? Saru Jayaraman, who launched a national restaurant workers organization after 9/11, sets out to answer these questions by following the lives of ten restaurant workers in cities across the country – New York City, Washington DC, Philadelphia, Houston, Los Angeles, Houston, Miami, Detroit, and New Orleans. Blending personal and investigative journalism, Jayaraman shows us that the quality of the food that arrives at our restaurant tables is not just a product of raw ingredients: it’s the product of the hands that chop, grill, sauté, and serve it, and the bodies to whom those hands belong.

“Behind the Kitchen Door “ is a groundbreaking exploration of the political, economic, and moral implications of eating out. What’s at stake when we choose a restaurant is not only our own health or “foodie” experience, but the health and well-being of the second-largest private sector workforce—the lives of 10 million people, many immigrants, many people of color, who bring passion, tenacity, and important insight into the American dining experience.

Download the 2012 National Diners Guide – See how your favorite restaurant ranks

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Is Your Workers’ Compensation Check Late?

Today’s post comes from guest author Brody Ockander from Rehm, Bennett & Moore.

My work comp check was late or hasn’t come yet. Now what?

If you are entitled to workers’ compensation checks, and the insurance company has not paid them on time, you might be entitled to a penalty from the insurance company in addition to the amount that you are owed.

The penalties for late payments vary from state to state, but most states have laws to help workers when this problem arises.

In Nebraska, the work comp insurance company has 30 days to pay benefits from the day that it has notice of the disability, or 30 days from the day that the Court entered an Order, Award, or Judgment. If the insurance company does not pay the benefits within those 30 days, you may be entitled to Continue reading