Sometimes I get a new client calling to inquire about social security disability benefits because the have been diagnosed with diabetes, or MS, or fibromyalgia, or any medical diagnosis of a medical condition. I think some clarification is needed about what the Social Security Administration (SSA) and/or the Administrative Law Judge (ALJ) consider in awarding or denying an applicant social security disability benefits. It is important to know that it is not the diagnosis itself that is disabling. It is…
One of the first things asked when setting up an appointment to see me regarding a work injury is - - - what information do I need to bring to the free consultation? I can answer that right here. Most of the information that I need, you should know. You experienced the work injury. The more information you provide, the better. Here is what I need to know at the initial consultation. What was the date of the work injury?…
Federal Workers Compensation is an entirely different system than your traditional state workers compensation. Federal Workers Compensation is for employees of the Federal Government and claims are handled by the Office of Workers Compensation Programs (OWCP) within the US Department of Labor and Industry. So, what happens in you are an injured Federal Government employee, you get injured at work, and OWCP subsequently denies your claim? Does a Federal Government employee have any appeal rights? The answer is --- YES,…
It really is a shame that Social Security Disability has such a stigma attached to it. And there is. There is that thought out there that people on Social Security Disability are getting nothing but 'hand outs' or 'entitlements' or 'welfare'. It's our political world of uninformed opinions that grips our society today. Fact is, that workers have paid for these benefits through their payroll taxes over their entire career. Just like you to pay into unemployment or car…
One of the more important, and often overlooked, aspects of a workers compensation claim in Pennsylvania is the description of injury. More times than not, if you get hurt at work and your employer accepts your work injury, the description of your injury provided is nothing more than a ‘strain/sprain’ or ‘contusion’, whether it be to your neck, back, shoulder, etc. . . Often times, it is simply not accurate.
So why is that the description provided on the PA Department of Labor & Industry forms that you get? Could be a few reasons. First, many insurance carries only accept sprain/strains and contusions. Second, your actual injury may have just happened and the actual medical diagnosis is unclear. Third, it may actually be accurate.
More than likely, the first two reasons are applicable. Many insurance carriers do not accept anything outside those generalized descriptions. There is a reason for that. By accepting only generalized descriptions of injury like a strain/sprain, it provides the insurance carrier leeway in denying future medical treatment. For example, if you have an accepted left shoulder strain, but you recently had a left shoulder MRI that indicated a rotator cuff tear, the insurance carrier may deny surgery. They will deny surgery based on the fact that they only ever accepted a left shoulder strain/sprain, not a rotator cuff tear. Another frequent example is a head injury. Often times, the accepted injury for a head injury is a ‘head contusion’. That provides leeway for the insurance carrier to deny treatment for concussion and post concussion syndrome. They often do as well. (more…)
You may have heard about Medicare Set Aside agreements when it comes to Workers Compensation lump sum settlements. They are complex and confusing too many. Let me try and help explain a little about this complex area of law.
First, when is a Medicare Set Aside agreement required as part of a structured workers compensation settlement? Generally, with a worker’s compensation settlement, federal law prohibits Medicare from paying for injury-related medical expenses or medications that an employer is responsible to pay. In essence, other insurance coverage exists for those medical expenses. To achieve that purpose, Federal government regulations require that a portion of settlement funds be “set-aside” in an account to pay for future medical expenses related to the work injury. So what specifically triggers this process? Here are the general criteria when a settlement should be submitted for CMS review.
CMS will only review new WCMSA proposals that meet the following criteria:
The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or
The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00
So, what is the important words in here — “is” and reasonable (more…)
The Ownership of a regional Central Pennsylvania law firm, Mooney & Associates, has expanded. Founding Attorney John J. Mooney III has added Attorney Jason Imler of Hanover, Attorney George Swartz II of Hanover, and Attorney Mark Buterbaugh, of Shippensburg, as equal owners of the regional firm. The law firm announced the expansion via a press release, as picked up here by the Central Pennsylvania Business Journal. For purposes of this Blog, I am proud to be part of the new ownership group…
Mooney & Associates recently won a case for an injured Pennsylvania worker that included bilateral avascular necrosis. The claimant had both left and right hips replaced and the insurance carrier was forced to pay for both hip replacements. Generally, avascular necrosis of the hip (AVN) is a degenerative condition that is not completely understood by the medical community. Essentially, avascular hip necrosis is a dying bone condition within the hip that in most cases will lead to a hip replacement. It is not a condition that…
Mooney & Associates wishes our employees, our clients, and those we do business with, a very Happy Easter. We take pride in our representation of those in vulnerable situations due to injuries from work accidents, motor vehicle accidents, slip and falls, dog bites, and our clients who are disabled and need Social Security Disability. We value our clients and hope they can enjoy the Easter holiday.
Is there any interplay between a lump sum workers compensation settlement and social security disability benefits? Yes, there is. And your workers compensation attorney better be aware of it.
Social Security is still entitled to an offset. It is statutory, meaning, it is a legal requirement. So what is the best process to deal with a potential offset when settling a workers compensation case? Your attorney should ensure that any future offsets are either minimal or eliminated. It should be done by spreading your settlement over your lifetime expectancy. This is done through special social security offset language in Paragraph 13 of the Compromise and Release Agreement, otherwise known as the “Sciarotta Allocation.” The allocation is based on the case Sciarotta v. Bowen. (more…)