No COLA increase for Social Security Recipients, including those on Disability

SSD_Denial1For the first time in five years, Social Security recipients, including those on Social Security Disability (SSD) or Social Security Supplemental (SSI) benefits, will not receive an increase cost of living adjustment.  Benefits cost of living increases are determined by the rate of inflation.  This year, the fact recipients will not receive a raise, is a direct result of lower gasoline prices.

The inflation measure used by the Social Security Administration was down 0.6% for the 12 months that ended in September — largely due to a nearly 30% drop in gas prices. The COLA is set every October based on the September inflation report.

Lats year recipients realized a 1.7% increase.

If you, a relative, friend, or neighbor have applied for Social Security Disability benefits and have received a denial letter form Social Security, contact Mooney & Associates right away.  It is absolutely critical to contact us as soon as you receive a denial letter.  Denials are time sensitive and if you miss the 60 day window to appeal the denial, you will have to begin the application process all over again.  There are also other legal ramifications to missing the appeal deadline.  It doesn’t cost you anything for a consultation and we can meet with you in any of our twelve convenient locations through Central Pennsylvania.  Call 1-877-632-4656 to set up your FREE Consultation regarding Social Security Disability benefits.

PA Court: Issuance of a Medical-Only NCP in Workers Compensation differs from Acceptance and Subsequent Suspension of Benefits

The Pennsylvania Commonwealth Court recently distinguished between a Medical-Only Notice of Compensation Payable and an acceptance of a work injury and a subsequent Suspension of benefits, in Sloane v. W.C.A.B (Children’s Hospital of Philadelphia)  No 1399, C.D. 2014(Pa. Cmwlth. 2015).

CommCt

The relevant time lines are this:  An injured worker has three years after the date of the injury to file a Claim Petition to seek workers’ compensation benefits for the injury.  If a Notice of Compensation Payable (NCP) is issued and wage loss benefits are later suspended, the injured worker has 500 weeks, or three years from the date of last payment, whichever is later, to file for a reinstatement of disability benefits.   Do the same rules apply to a Medical-Only NCP that apply to a regular NCP with subsequent suspension?  That is the issue addressed in this case.

Claimant argued that the issuance of a Medical-Only NCP would have the same has the same effect as if a WC Judge issued an Order granting a claim petition with an immediate suspension of disability benefits in cases where medical treatment is required but there is no immediate wage loss.  Therefore, the Claimant argued the appropriate Bureau form would be a Reinstatement Petition, which would make the Petition timely if filed within 500-week period in which an injured workers is eligible for partial disability benefits.

The Workers Compensation Appeal Board rejected the argument, distinguishing between the granting of disability benefits and the issuance of a medical-only acceptance.  The Board’s rationale on a Medical-Only NCP is that the defendant only accepted the injury on a medical basis, not on a earning loss basis.  Essentially, by issuing a Medical-Only, the Employer never accepts wage loss as a result of the work injury.  Since no disability benefits were ever accepted, there are no disability benefits to be reinstated.

The Commonwealth Court agreed.  The Court stated,

Despite the apparent ambiguity relating to the proper form of the Petition, we need not resolve this issue because Claimant’s request for disability benefits for the 2006 injury would be untimely under the limitations periods of Section 413(a) or Section 315. Under Section 413(a), a reinstatement petition must be filed “within three years after the date of the most recent payment of compensation made prior to the filing of such petition.” 77 P.S. § 772. The payment of medical benefits by an employer does not constitute “compensation” for the purposes of Section 413(a) that would act to toll the liability period . . . Since no disability compensation had been paid for the 2006 injury, Claimant was required to establish an entitlement within 3 years of the date of the injury. The Petition filed on December 31, 2011 was therefore untimely under Section 413(a) . . .  Employer made its intent expressly clear that it would pay Claimant’s medical expenses but accepted no liability for wage-loss benefits. Thus, the Petition would also be untimely under Section 315.

The moral of this story.  If a Medical-Only NCP is issued in your case, you have a three year statute of limitation to file a Claim Petition alleging loss of wages as a result of the work injury.  After three years, your claim for wage loss benefits will be barred.  The even stronger moral of this story is, if you have been injured at work, contact a workers compensation Attorney right away.  Use the Mooney & Associates three step procedure when injured at work:  1) tell you employer about your injury right away; 2) seek medical attention immediately; and 3) contact Mooney & Associates at 1-877-632-4656 or email me at mab@mooney4law.com.  Workers Compensation is too complex and your rights in workers compensation are too important to go it alone against an insurance carrier.

What does it cost you to have a consultation with me regarding your workers compensation claim?  NOTHING.  We have full-time offices in Chambersburg, Carlisle, Shippensburg, Hanover, Gettysburg, Harrisburg, and York.  We have other meeting offices throughout South Central Pennsylvania.  We will meet you at the office closest to you.

PA Commonwealth Court changes Impairment Rating Evaluations in Workers Compensation

CommCtThe Pennsylvania Commonwealth Court invalidated Section 306 (a.2)1 of the Workers Compensation Act, as amended, finding the language to be an unlawful delegation of power to a private entity.  Let’s first take a look at the language of Section 306 (a/.2)1.

(a.2)
(1) When an employe has received total disability compensation pursuant to clause (a) for a period of one hundred four weeks, unless otherwise agreed to, the employe shall be required to submit to a medical examination which shall be requested by the insurer within sixty days upon the expiration of the one hundred four weeks to determine the degree of impairment due to the compensable injury, if any. The degree of impairment shall be determined based upon an evaluation by a physician who is licensed in this Commonwealth, who is certified by an American Board of Medical Specialties approved board or its osteopathic equivalent and who is active in clinical practice for at least twenty hours per week, chosen by agreement of the parties, or as designated by the department, pursuant to the most recent edition of the American Medical Association “Guides to the Evaluation of Permanent Impairment.”

The language in dispute is bold and italicized in the above statutory section.

By way of background, once a Claimant has reached at least 104 weeks of total disability, an Impairment Rating Evaluation can take place by request from the Employer/Insurance Carrier.  Should the IRE physician find the ‘whole body impairment’ to be less than 50%, which in most cases it will be under 50%, then disability benefits may be automatically converted or by way of Petition to Modify Benefits, from total disability benefits to partial disability benefits.  It is important to note that this does not affect the actual rate of compensation, but caps the number of weeks benefits are payable to 500 weeks, which is about 9.6 years.

The legal question in this case, Protz v. WCAB (Derry Area School District),  No. 1024 C.D. 2014 (Pa. Cmwlth 2015).  revolved around the edition of the American Medical Association Guidelines used by the IRE physicians.   As you can see above, the Legislature placed language in the Act that stated the “most recent‘ edition should be utilized for the IRE.  Claimant’s attorney in this case argued that at the time the Legislature passed the Act, the 4th Edition of the Guidelines was the latest version, and that any new Edition thereafter was an unlawful delegation to ta private entity, namely, the American Medical Association.

The Commonwealth Court agreed. The Court said;

In this case, the General Assembly adopted as its own the methodology enumerated by the AMA at the time it enacted Section 306(a.2)—
that is, the methodology contained in the Fourth Edition of the Guides. The General Assembly has not reviewed and re-adopted the methodology contained in subsequent editions. Moreover, unlike in Pennsylvania Builders Association, where the General Assembly provided for review of the new codes by the Department of Labor and Industry, in this case, any form of review of subsequent editions of the AMA Guides is wholly absent, leaving unchecked discretion completely in the hands of a private entity.  (Id. at 17)

The Court is essentially stating that the Legislature provided absolutely no administrative means to have each new edition’s standards reviewed by the PA Department of Labor & Industry, or for that matter, any state government agency.  Furthermore, the Court specifically explained why a ‘carte blanche’ or ‘unchecked discretion” to a private entity is not permissible.

Even then if we had found that there are adequate standards allowing for a delegation to a governmental agency, Section 306(a.2)(1) would still be unconstitutional because the delegation here was to a private party. Unlike governmental agencies which are supposed to act disinterestedly and only for the public good, that presumption cannot be made with regard to private entities. There is no accountability to the public, either directly through the rulemaking process providing for public input and comment or indirectly through the appointment and confirmation power and the power of the purse.15  More simply, the keystone behind the prohibition against unlawful delegation is that the General Assembly, not private bodies, enacts laws which the government agencies implement in accordance with the standard given to them in the enactment.16 (Id. at 18)

IRE evaluation must now go back to the 4th AMA Guidelines until such time the Court further addresses the issue ot the Legislature amends the Act to provide for oversight.